While there is no cure for asthma, various FDA-approved therapies are available, and expert-recommended guidelines from the National Asthma Education and Prevention Program (NAEPP) and the Global Initiative for Asthma (GINA) provide healthcare providers with evidence-based recommendations for the treatment, management, and prevention of asthma. In May 2023, the updated GINA report was released and is considered a comprehensive and practical resource for clinicians to utilize in managing asthma for pediatric and adult patients.

Examples of pharmacologic management for asthma may include using maintenance/controller medications, such as inhaled corticosteroids, long-acting bronchodilators (beta-agonists and anticholinergics), theophylline, and leukotriene modifiers. For uncontrolled severe asthma despite optimized maximum therapy, GINA 2023 recommends the use of add-on anti-immunoglobulin E antibodies (omalizumab), anti-interleukin (IL5) antibodies, and anti–IL4/IL13 antibodies in selected patients depending on asthma phenotype. Relief medications include short-acting bronchodilators, systemic corticosteroids, and ipratropium.

Asthma treatment is contingent upon the frequency and severity of symptoms and typically involves monitoring the patient’s signs and symptoms, identifying possible triggers, educating patients/caregivers about avoiding potential triggers to reduce or avert flare-ups/exacerbations when feasible, and devising an individualized treatment plan comprised of the use of pharmacologic and nonpharmacologic therapies.

Clinicians should also be aware of the significance of shared decision-making and patient education and encourage patients to take an active role in asthma management via recommended self-management measures.

According to GINA recommendations, the primary goals for treating asthma should be patient-centered and should include optimizing the control of asthma symptoms, reducing or preventing the incidence of asthma flare-ups/exacerbations, and preventing and decreasing the incidence of medication-related adverse effects. It is important to note that treatment plans should be routinely assessed, reviewed, and adjusted when warranted based on patient response to prescribed therapy.

When devising a treatment plan, shared decision-making should be implemented, taking into consideration the degree of symptom control, identifying risk factors or triggers that may increase the incidence of flare-ups/exacerbations, phenotypic characteristics, and patient preferences. Counseling techniques should be tailored to the patient/caregiver’s understanding, using written and verbal instructions, as well as the safety and efficacy of available medications and the cost to the payer or the patient.

The GINA report also indicates that effective asthma management warrants a team effort between the patient/caregiver and the healthcare provider. Patient-centered care for asthma management should involve routine assessment, adjustment, and review of goals and treatments, and patients should be aware that therapy changes are sometimes warranted until optimization of response is achieved.

According to the 2023 GINA report, treatment generally includes long-term use of a low-dose inhaled corticosteroid (ICS) treatment to maintain control of asthma symptoms and reliever medication as needed for symptom relief. Clinicians must also consider that the inhaler device selection should be tailored to patient needs, and treatment plans should also include a written asthma action plan that consists of recognizing when symptom control is deteriorating, the name of the medication to administer, and when and how to obtain medical care. The action plan should be written (i.e., printed, pictorial, electronic) rather than only verbal. A template of an asthma action plan can be found on the Asthma and Allergy Foundation of America website.

Asthma management involves a continual cycle that entails routine assessment, adjustment to therapy if warranted, and an ongoing review of the patient’s response to treatment.

Asthma treatment aims to relieve and control symptoms, reduce the risk of severe exacerbations, and minimize adverse treatment effects, such as oral corticosteroids and the overuse of short-acting beta2-agonists (SABA).

For safety, GINA recommends that all adults, adolescents, and children aged between 6 and 11 years with asthma should receive ICS-containing medication and should NOT be treated with SABA alone since data indicate that SABA-only therapies are associated with augmented risk of exacerbations, lower lung function, and asthma-related mortality. Additionally, regular use of SABA alone increases allergic response and airway inflammation and decreases the bronchodilator response to SABA when it is needed.

An ICS-containing therapy should be initiated as soon as possible after an asthma diagnosis is confirmed.

The 2023 GINA strategy splits treatment for adults and adolescents into two tracks for simplicity. The primary difference between the tracks is the type of reliever therapy employed for symptom relief. Treatment may be stepped up or stepped down within a track using the same reliever at each step, or it may be switched between tracks according to the patient’s individual needs.

In January 2023, the FDA approved Airsupra (albuterol/budesonide) as the first and only rescue medication approved in the United States indicated for as-needed treatment or prevention of bronchoconstriction and to diminish the risk of exacerbations in patients with asthma aged 18 years and older. Airsupra is a first-in-class, pressurized metered-dose inhaler, fixed-dose combination rescue medication containing albuterol, a short-acting beta2-agonist, and budesonide—an anti-inflammatory ICS designed to treat both symptoms and inflammation.

The approval of Airsupra was based on efficacy results in adult patients from two phase III trials: MANDALA and DENALI. The findings from these studies demonstrated that combination therapy significantly reduced the risk of severe asthma exacerbations versus albuterol alone in patients with moderate-to-severe asthma and improved lung function compared with its individual components and placebo in patients with mild-to-moderate asthma.

On April 11, 2024, the FDA announced the approval of Fasenra (benralizumab) for add-on maintenance treatment for patients with severe asthma aged 6 to 11 years with an eosinophilic phenotype. This agent was initially approved in 2017 as an add-on maintenance for treating severe eosinophilic asthma (SEA) in patients aged 12 and older. It is currently approved as an add-on maintenance therapy for patients aged 6 years and older with SEA in the U.S. Approval for the expanded indication was supported by evidence from TATE—an open-label, multinational, nonrandomized, parallel assignment phase III trial—and adequate, well-controlled trials in adult and adolescent populations. In the TATE study, benralizumab met the primary endpoints, demonstrating pharmacokinetics and pharmacodynamics in children aged 6 to 11 years old with SEA were consistent with those observed in previous clinical trials.

Educating patients/caregivers about asthma and their roles in actively controlling asthma symptoms and routine medical care are powerful tools that aid in effectively managing and preventing asthma symptoms, optimizing adherence to therapy and clinical outcomes, and improving the patient’s health-related quality of life.

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