Published in IJCP
December 2018
American Family Physician
Medications for Chronic Asthma
December 11, 2018 | Nathan P. Falk, Scott W. Hughes, Blake C. Rodgers
Chronic asthma is a major health concern for children and adults worldwide. The goal of treatment is to prevent symptoms
by reducing airway inflammation and hyperreactivity. Step-up therapy for symptom control involves initiation with low-dose
treatment and increasing intensity at subsequent visits if control is not achieved. Step-down therapy starts with a high-dose
regimen, reducing intensity as control is achieved. Multiple randomized controlled trials have shown that inhaled corticosteroids
are the most effective monotherapy. Other agents may be added to inhaled corticosteroids if optimal symptom control is not
initially attained. Long-acting beta2 agonists are the most effective addition, but they are not recommended as monotherapy
because of questions regarding their safety. Leukotriene receptor antagonists can be used in addition to inhaled corticosteroids,
but they are not as effective as adding a long-acting beta2 agonist. Patients with mild persistent asthma who prefer not to
use inhaled corticosteroids may use leukotriene receptor antagonists as monotherapy, but they are less effective. Because of
their high cost and a risk of anaphylaxis, monoclonal antibodies should be reserved for patients with severe symptoms not
controlled by other agents. Immunotherapy should be considered in persons with asthma triggered by confirmed allergies if
they are experiencing adverse effects with medication or have other comorbid allergic conditions. Many patients with asthma
use complementary and alternative agents, most of which lack data regarding their safety or effectiveness.
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