Achieving asthma control in patients with moderate disease

FitzGerald, J. Mark; Shahidi, Neal

doi:10.1016/j.jaci.2009.12.978

Cited by 16 publications

(10 citation statements)

References 36 publications

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“…11,52 ICSs, which are the foundation treatment of choice for patients with asthma, 6,53,54 were originally developed to treat primarily the central airways. Anti-IgE therapy (omalizumab; Xolair) was developed on the basis of the proposed IgE-driven allergic inflammation in the conducting airways.…”

Section: Discussionmentioning

confidence: 99%

Mast cell–associated alveolar inflammation in patients with atopic uncontrolled asthma

Andersson

Bergqvist

Mori

et al. 2011

Journal of Allergy and Clinical Immunology

114

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Section: Discussionmentioning

confidence: 99%

Mast cell–associated alveolar inflammation in patients with atopic uncontrolled asthma

Andersson

Bergqvist

Mori

et al. 2011

Journal of Allergy and Clinical Immunology

114

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“…Now we must look at new targets to improve overall asthma control, for example, reducing exacerbations, especially in young children, addressing issues of health disparities, continuing to reduce school absence due to asthma, and early intervention to alter the course of the disease. Fitzgerald and Shahidi (92) provided a Current Perspectives review to address asthma control in patients with moderate disease. They are usually treated initially with low-dose inhale corticosteroids (ICSs) supplemented with a short-acting bronchodilator as a rescue medication.…”

Section: Opportunities To Improve Controlmentioning

confidence: 99%

Advances in pediatric asthma in 2010: Addressing the major issues

Szefler

2011

Journal of Allergy and Clinical Immunology

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Last year's Advances in Pediatric Asthma concluded with the following statement "If we can close these [remaining] gaps through better communication, improvements in the health care system and new insights into treatment, we will move closer to better methods to intervene early in the course of the disease and induce clinical remission as quickly as possible in most children". This year's summary will focus on recent advances in pediatric asthma that take steps moving forward as reported in Journal of Allergy and Clinical Immunology publications in 2010.Some of those recent reports show us how to improve asthma management through steps to better understand the natural history of asthma, individualize asthma care, reduce asthma exacerbations, manage inner city asthma, and some potential new ways to use available medications to improve asthma control. It is clear that we have made many significant gains in managing asthma in children but we have a ways to go to prevent asthma exacerbations, alter the natural history of the disease, and to reduce health disparities in asthma care.Perhaps new directions in personalized medicine and improved health care access and communication will help maintain steady progress in alleviating the burden of this disease in children, especially young children.

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“…In patients with persistent asthma who are undertreated and remain symptomatic while taking SABA alone, LTRA provide a prompt improvement in asthma control, although low-dose ICS are generally more effective than LTRA as first-line maintenance treatment (Busse et al, 2001). In North America, mono-therapy with LTRA is a common therapeutic option for patients with mild persistent asthma (FitzGerald and Shahidi, 2010; Lougheed et al, 2010). However, ICS are generally preferred (NAEPP National Asthma Education and Prevention Program: Expert Panel Report III, 2007) due to their greater efficacy as first-line agents in both adults and children with asthma (Szefler et al, 2005).…”

Section: Drugs For Patients With Mild Persistent Asthmamentioning

confidence: 99%

“…However, ICS are generally preferred (NAEPP National Asthma Education and Prevention Program: Expert Panel Report III, 2007) due to their greater efficacy as first-line agents in both adults and children with asthma (Szefler et al, 2005). Nonetheless, LTRA can be used as controllers in patients who cannot tolerate ICS or prefer a non-steroid drug (FitzGerald and Shahidi, 2010; Lougheed et al, 2010). …”

Section: Drugs For Patients With Mild Persistent Asthmamentioning

confidence: 99%

Pharmacotherapy of Patients with Mild Persistent Asthma: Strategies and Unresolved Issues

Montuschi¹

2011

Front. Pharmacol.

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In studies comparing regular versus on-demand treatment for patients with mild persistent asthma, on-demand treatment seems to have a similar efficacy on clinical and functional outcomes, but it does not suppress chronic airway inflammation or airway hyper-responsiveness (AHR) associated with asthma. Data on the efficacy of a continuous treatment with inhaled corticosteroids (ICS) in preventing the progression of asthma are conflicting. There is the possibility that patients without a regular treatment with ICS may develop a more severe asthma associated with airway structural changes (remodeling) and a progressive loss of lung function. However, the possible clinical and functional consequences of persistent, not controlled, airway inflammation in patients with asthma have to be established. Assessment of asthma control should include inflammatory outcomes, such as fraction of exhaled nitric oxide and sputum eosinophil counts. Until the relationships between symptoms, lung function tests, AHR, airway inflammation, exacerbations, and airway remodeling are clarified, regular treatment seems to be generally more appropriate than on-demand treatment to warrant a greater control of asthma. Select subgroups of patients with mild asthma who are well controlled by regular treatment might adopt the on-demand treatment plan as an intermediate step toward the suspension of controller medication. The increasing evidence for heterogeneity of asthma, the growing emphasis on asthma subphenotypes, including molecular phenotypes identified by omics technologies, and their possible implications for different asthma severity and progression and therapeutic response, are changing the paradigm of treating patients with asthma only based on classification of their disease severity to a pharmacological strategy more focused on the individual asthmatic patient. Pharmacological treatment of asthma is going toward a personalized approach.

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Achieving asthma control in patients with moderate disease

Cited by 16 publications

References 36 publications

Mast cell–associated alveolar inflammation in patients with atopic uncontrolled asthma

Mast cell–associated alveolar inflammation in patients with atopic uncontrolled asthma

Advances in pediatric asthma in 2010: Addressing the major issues

Pharmacotherapy of Patients with Mild Persistent Asthma: Strategies and Unresolved Issues

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