The Journal of Allergy and Clinical Immunology, Feb, 2010, Vol.125(2), p.307(5)
To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jaci.2009.12.978 Byline: J. Mark FitzGerald, Neal Shahidi Abbreviations: ICS, Inhaled corticosteroid; LABA, Long-acting [beta]-adrenergic agonist; LTRA, Leukotriene receptor antagonist; RR, Relative risk Abstract: Patients with moderate asthma are symptomatic on an ongoing basis. They are usually treated initially with low-dose inhaled corticosteroids (ICSs) supplemented with a short-acting bronchodilator as a rescue medication. Most steroid-naive patients will achieve good control with this strategy. For patients in whom adherence, inhaler technique, environmental control, and comorbidities have been addressed but who still have uncontrolled symptoms, the addition of a long-acting [beta]-adrenergic agonist should be considered. Some patients might require a higher dose of ICS. Leukotriene receptor antagonists might be considered as alternate initial therapy or as an add-on to maintenance therapy with an ICS. All patients should receive a structured education program emphasizing the need for ongoing maintenance treatment, even when control is achieved. Patients should also be provided with a written action plan that clearly explains which additional anti-inflammatory therapy should be taken if asthma symptoms worsen. The most effective strategy in this situation has been shown to be the quadrupling of the maintenance dose of ICS. Author Affiliation: University of British Columbia Respiratory Division and the Centre for Lung Health (www.centreforlunghealth.ca), University of British Columbia, Vancouver, British Columbia, Canada Article History: Received 8 September 2009; Revised 7 December 2009; Accepted 8 December 2009 Article Note: (footnote) J.M.F. is a Michael Smith Foundation for Health Research Distinguished Scholar and a Canadian Institute for Health Research and BC Lung Scientist and is funded in part by the National Sanitarium Association., Disclosure of potential conflict of interest: J. M. FitzGerald is on advisory boards for GlaxoSmithKline, Astra Zeneca, Novartis, Pfizer, Boehringer-Ingelheim, Nycomed, Merck-Dome Sharpe, and Topigen; is on the speakers' bureau for GlaxoSmithKline, Astra Zeneca, Boehringer-Ingelheim, Pfizer, and Merck-Dome Sharpe; has received research support (paid directly to the University of British Columbia) from the Canadian Institute of Health Research, the Michael Smith Foundation for Health Research, the Centre for Disease Control Atlanta, AllerGen NCE, the BC Lung Association, the National Sanitarium Association, Astra Zeneca, GlaxoSmithKline, Boehringer-Ingelheim, Merck-Dome Sharp, Wyeth, Schering-Plough, Genentech, and Topigen; and is a member of the Global Initiative for Asthma (GINA) Executive and chair of the GINA Science Committee and a Member of Canadian Thoracic Society Asthma Committee. N. Shahidi had declared that he has no conflict of interest.
Asthma -- Care And Treatment ; Glucocorticoids
Cengage Learning, Inc.