Asthma in adults: Principles of treatment

Abstract

The goals of treatment are prevention of fatalities, hospitalizations, and emergency department visits, along with achieving good long-term control of asthma, with reduction of symptoms, maintenance of normal activity level, prevention of exacerbations and accelerated loss of pulmonary function (forced expiratory volume in the first second of expiration [FEV1]), and avoidance of harm from therapies. Treatment is often initiated based on the severity of symptoms, physical examination findings, and, for some patients, the FEV1 or peak expiratory flow rates. Comorbidities such as gastroesophageal reflux disease and laryngopharyngeal reflux, rhinitis or rhinosinusitis, sleep apnea, recurrent infections, smoking, and substance abuse should be addressed. Two treatment modalities are indicated only for individuals with allergic asthma: allergen-specific immunotherapy (commonly known as allergy shots), and biologic therapies that target type-2 (T2) inflammation. Allergen immunotherapy is effective in decreasing symptoms and medication use in select patients with mild-to-moderate allergic asthma. In addition, patients who receive allergen immunotherapy for allergic rhinitis may have a decreased risk of developing asthma. Omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab are monoclonal antibodies that target T2 inflammation and are indicated for either moderate-to-severe or severe asthma. These have been well studied to improve asthma symptoms and have specific characteristics unique to each individual medication. A focus on adherence can be considered in choosing therapy because it is not clear which biologic to choose in T2 high asthma at this time.

Oral Candidiasis as a Local Adverse Effect of Inhaled Corticosteroids: What the Dental Practitioner Should Know

“…Incorrect inhalation technique is an important factor that causes inadequate delivery of the drug to the lungs, and oropharyngeal complications may limit the effectiveness of ICs due to the large amount of aerosol accumulated in the mouth (Kwah and Peters, 2019). For the old chlorofluorocarbon (CFC)-driven pMDI devices which have the active drug included as a micronized suspension, the lack of shaking the device prior to use or between consecutive doses might cause the suspension to disperse inconveniently in the propellant and result in up to 50% reduction in the delivery of β2-agonists and corticosteroids.…”

Principles of asthma treatment and appropriate use of new drugs

“…ICS는 지속성 천식의 치료 약제 중 가장 효과적인 항염 증약제로, 일차 치료를 담당한다 [2]. ICS는 기도 염증을 감 소시키고, 천식의 증상, 폐기능, 삶의 질을 개선시킨다 [5].…”

Curcumol inhibits PDGF-BB-induced proliferation and migration of airway smooth muscle cells by suppressing ERK/CREB pathway

“…14 Current asthma treatments focus on reducing the symptoms through ameliorating inflammation, and the drugs used primarily contain beta-adrenoceptor-2 (β2) agonists, leukotriene antagonists, and corticosteroids. 15 However, these drugs produce various side effects such as osteoporosis, cardiovascular effects, headaches, and vomiting. 16 Traditional herbal medicines have been widely applied for the treatment, cure, and prevention of many diseases.…”