As-needed ICS-LABA in Mild Asthma: What Does the Evidence Say?

AbstractFor the last three decades, the guidelines for asthma management have supported a stepwise therapeutic approach, based on the administration of controller medications (especially inhaled corticosteroids) complemented by on-demand use of rescue medication. Classically, the rescue medication recommended comprised short-acting β agonists (SABA). Some years ago, the use of Symbicort Maintenance and Reliever Therapy (SMART) demonstrated the benefits of a combination of budesonide-formoterol, an inhaled corticosteroid, and a long-acting β agonist (ICS-LABA) as rescue medication in moderate and severe asthma. The results we re enthusiastically received, and this therapeutic option was adopted in the guidelines for moderate to severe asthma patients. Recently, four trials (two randomised placebo control trials under the auspices of the SYGMA project and two real-life studies, Novel START, and the PRACTICAL trial) have e xplored the potential benefits of substituting SABA with budesonide-formoterol as rescue medication in mild asthma patients. The SYGMA 1 and 2 studies showed that the combination with formoterol-budesonide as rescue medication provides better asthma control than short-acting β-agonists alone in GIN A step 2 patients, although the superiority was slight. Compared to budesonide maintenance therapy, the fixed combination of ICS-LABA on demand provides poorer asthma control. Regarding exacerbations, the fixed dose ICS-LABA combination on demand show...
Source: Drugs - Category: Drugs & Pharmacology Source Type: research

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AbstractAsthma is a heterogeneous disease, with the immune processes behind the chronic inflammation underlying this disorder differing between the various identified asthma endotypes. In addition to heterogeneity in underlying disease pathophysiology, asthmatics fall across a broad spectrum of disease severity and can vary greatly in their response to convention asthma therapies. A small percentage of patients with severe persistent asthma will remain uncontrolled despite treatment with high-dose inhaled corticosteroids and a long-acting beta-agonist. Less than two decades ago, there were few options for these treatment-r...
Source: Clinical Reviews in Allergy and Immunology - Category: Allergy & Immunology Source Type: research
ConclusionsThe findings of this study from the SABINA program show that SABA overuse (at least three canisters per year) is common across Europe, despite the different healthcare and reimbursement policies of each country.
Source: Advances in Therapy - Category: Drugs & Pharmacology Source Type: research
Publication date: Available online 23 January 2020Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Cindy L.J. Weinstein, Nicholas Ryan, Xiaoli Zhang, Tulin Shekar, Davis Gates, Stephen J. Lane, Ioana Agache, Robert A. Nathan, SPIRO InvestigatorsAbstractBackgroundDue to historical safety concerns with use of long-acting beta agonists in asthma, step-down from inhaled corticosteroid/long-acting beta agonist (ICS/LABA) combination therapy to ICS monotherapy is recommended once asthma control is achieved.ObjectiveTo evaluate the benefit/risk question about whether asthma patients who achieve diseas...
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
Abstractp38 MAPK inhibition may have additive and synergistic anti-inflammatory effects when used with corticosteroids. We investigated crosstalk between p38 MAPK inhibitors and corticosteroids in bronchial epithelial cells to investigate synergistic effects on cytokine production and the molecular mechanisms involved. Effects of the p38 MAPK inhibitor BIRB-796 and dexamethasone alone and in combination on LPS, polyI:C or TNF α -induced IL-6, CXCL8 and RANTES were assessed in 16HBEs (human epithelial cell line) and on TNFα-induced IL-6 and CXCL8 in primary human epithelial cells from asthma patients and healthy...
Source: Journal of Molecular Medicine - Category: Molecular Biology Source Type: research
We examined whether the use of antiasthmatic drugs was associated with the development of type 1 diabetes in childhood in a nationwide, register-based case-cohort study. We identified all children who were born 1.1.1995-31.12.2008 in Finland and diagnosed with type 1 diabetes by 2010 (n = 3,342). A 10% random sample from each birth year cohort was selected as a reference cohort (n = 80,909). Information on all dispensed antiasthmatic drugs (the Anatomical Therapeutic Chemical classification system code R03) during 1995-2009 were obtained, and the associations between the use of antiasthmatic drugs and the development of ty...
Source: Am J Epidemiol - Category: Epidemiology Authors: Tags: Am J Epidemiol Source Type: research
Authors: Albertson TE, Chenoweth JA, Pearson SJ, Murin S Abstract Introduction: Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) is a disease phenotype that shares T helper lymphocyte cell Th1/neutrophilic/non-Type-2 Inflammation pathways thought to be key in COPD and Th2/eosinophilic/Type-2 inflammatory pathways of asthma. The pharmacology of treating ACOS is challenging in severe circumstances.Areas covered: This review evaluates the stepwise treatment of ACOS using pharmacological treatments used in both COPD and asthma. The most common medications involve the same inhalers used to treat COPD...
Source: Expert Opinion on Pharmacotherapy - Category: Drugs & Pharmacology Tags: Expert Opin Pharmacother Source Type: research
Publication date: Available online 21 January 2020Source: The Lancet Respiratory MedicineAuthor(s): Ian P Sinha, Susanna R Dodd, Christopher Grime, Daniel B Hawcutt, Ricardo M Fernandes, Matthew R Roberts, Justus M Simba, Paula R Williamson
Source: The Lancet Respiratory Medicine - Category: Respiratory Medicine Source Type: research
Publication date: Available online 21 January 2020Source: Pulmonary Pharmacology &TherapeuticsAuthor(s): Sposato Bruno, Camiciottoli Gianna, Bacci Elena, Scalese Marco, Carpagnano Giovanna Elisiana, Pelaia Corrado, Santus Pierachille, Maniscalco Mauro, Masieri Simonetta, Angelo Corsico, Nicola Scichilone, Baglioni Stefano, Murgia Nicola, Folletti Ilenia, Bardi Giulio, Grosso Amelia, Cameli Paolo, Latorre Manuela, Antonino Musarra, Bargagli ElenaAbstractBackgroundMepolizumab (MEP) has been recently introduced to treat severe eosinophilic asthma. Trials have demonstrated a significant effectiveness in this phenotype. We ...
Source: Pulmonary Pharmacology and Therapeutics - Category: Respiratory Medicine Source Type: research
Abstract AIM: The aim of our study was to assess any association between ICS use and tracheobronchomalacia (TBM). METHODS: We conducted a retrospective analysis on asthma and COPD patients with and without TBM. Patients were diagnosed with TBM on the basis of CT scan, flexible bronchoscopy or both. Patients were deemed to be on ICS if they were on treatment for at least 3 months. Simple logistic regression models were used to assess the association between TBM status and each proposed factor. A multivariable logistic regression model was used to assess the association between TBM and steroid dose. RESULT...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
CONCLUSION: This guideline offers recommendations on the role of non-invasive measurements of airway inflammation and treatment for cough due to asthma or NAEB based on the available literature, identifies gaps in knowledge and areas for future research. PMID: 31972181 [PubMed - as supplied by publisher]
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
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