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ALLERGIES
Asthma Management
By Jeffrey S. Hallett, MD
Asthma now affects more than 300 million people worldwide and controller medications, but also on newer concept therapeutics such
its prevalence is rising, particularly in underserved populations. as ultra-LABAs, dissociated steroid agonists, cytokine modulators,
mast cell inhibitors, monoclonal antibodies, and improved forms of
In the past, asthma was viewed as a disease of bronchoconstriction allergen immunotherapy.
and was treated predominantly with bronchodilators. More recently
it has been viewed as an inflammatory disease with a focus on anti- Bronchodilators are important for preventing and relieving bron-
inflammatory treatments. Inhaled corticosteroids (ICSs) have revo- choconstriction and the major advance has been the introduction
lutionized the management of asthma, leading to better control of of the LABAs salmeterol, formoterol, and vilanterol, which last for
symptoms, a reduction in hospitalization, and reduced mortality. over 12 hours. These drugs have complementary actions to corti-
costeroids and fixed combination inhalers with a corticosteroid are
Current management of asthma is highly effective. Most patients now the most effective available therapy for asthma. There are now
are well controlled if they take regular ICSs with or without long- several even longer acting β2-agonists ("ultra-LABAs") coming to
acting β2-agonists (LABAs) in combination inhalers. Yet despite the market, including indacaterol, carmoterol, and olodaterol, which
availability of effective therapies, many patients with asthma appear have a duration of action greater than 24 hours and are suitable for
to be poorly controlled largely due to poor compliance. Most sur- once-daily dosing.
prising is the fact that over 80 percent of patients with difficult-to-
treat asthma have poor compliance with regular inhaled A once-daily muscarinic antagonist, tiotropium bromide, is less
combination therapy. Even in patients with corticosteroid-depen- effective as a bronchodilator in asthma than β2-agonists and is used
dent asthma, only half take oral corticosteroids regularly. As a result, predominantly in chronic obstructive pulmonary disease (COPD)
there is increasing emphasis on not only newer and more effective but appears to be a useful add-on therapy in some patients with se-
20 San Antonio Medicine • March 2017
