Asthma

Asthma

Definition

  • Reversible obstructive airway disease characterized by smooth muscle hyperreactivity and airway inflammation.

  • Remember

    • Airway Inflammation with flow limitation

    • Airway Reversibility

    • Airway Reactivity

Common Phenotypes

  • Allergic (Atopic) Asthma

    • Biomarker: High IgE

    • History of eczema/allergic rhinitis, positive skin-prick tests 

    • Responsive to inhaled corticosteroids (ICS)

  • Non-Allergic Asthma:

    • Triggered by viral infections, exercise, or cold air.

    • Often neutrophil-driven

    • May require higher ICS doses or alternative controllers.

Treatment & Management 

  • For patients with allergies, ensure allergies are addressed to help with their asthma management. 

  • Step therapy

    • Traditional approach to asthma management that starts with a rescue inhaler (short beta agonist such as albuterol) and adds on a daily controller inhaler (inhaled corticosteroid such as fluticasone/flovent) in a stepwise approach. 

  • SMART (single-inhaler maintenance-and-reliever therapy) 

    also known as Maintenance-and-reliever therapy (with ICS-formoterol)  

    • Treatment regimen in which the patient uses an ICS-formoterol inhaler every day (maintenance dose), and also uses the same medication as needed for relief of asthma symptoms (reliever doses) 

    • MART is a preferred treatment option at Steps 3 and 4 for children 6–11 years, with a lower dose ICS-formoterol inhaler.

Medication Ages 4-11 years Ages 12+ years
Budesonide-Formoterol (Symbicort) 1-2 puffs 1-2x daily + 1 puff as needed (up to 8 total/day) 1-2 puffs 1-2x daily + 1 puff as needed (up to 12 total/day)
Mometasone-Formoterol (Dulera) 1-2 puffs 1-2x daily + 1 puff as needed (up to 8 total/day) 1-2 puffs 1-2x daily + 1 puff as needed (up to 12 total/day)

  • Biologics 

    • Biologics are a type of medication that target specific proteins involved in the immune system. Here is a list of biologics used to treat asthma:  

      • Benralizumab (Fasenra)

      • Dupilumab (Dupixent)

      • depemokimab-ulaa (Exdensur)

      • Mepolizumab (Nucala)

      • Omalizumab (Xolair)

      • Reslizumab (Cinqair)

      • Tezepelumab (Tezspire)

Asthma & Allergy Foundation of America - Biologics Chart

Clinical Pearls

Resources 

2020 Asthma & Allergy SIG - Asthma Toolkit 

SIG Member Publications