Inhaled Management of Asthma

Over one-third of patients with asthma are uncontrolled on inhaled corticosteroid (ICS)/long‑acting β₂‑agonist (LABA) therapy,^1,2 placing them at risk of exacerbations and hospitalisation and negatively impacting their quality of life.^3–5

Asthma is a heterogeneous disease, often driven by chronic airway inflammation (Figure 1) and characterised by airway smooth muscle (ASM) contraction which is responsible for bronchoconstriction. This causes symptoms such as wheezing and breathlessness.^1,2 The worsening of these symptoms results in asthma exacerbations.³

Inhaled treatment is the preferred route of delivery for asthma medication as inhalers deliver drugs rapidly and directly to the airways.¹ Controller inhalers contain anti‑inflammatory medication such as inhaled corticosteroid (ICS) and are used on an as-needed or daily basis, depending on the severity of asthma, whereas reliever inhalers aim to relieve symptoms quickly.¹

Inhaled therapies underpin the GINA strategy stepwise approach to asthma management (Figure 1).¹ 

The updated 2019 GINA strategy advises that all adults and adolescents with asthma should receive inhaled corticosteroid (ICS)‑containing controller therapy to reduce their risk of exacerbations and control symptoms.¹ Patients should be encouraged to adhere to their controller medication even when symptoms are infrequent, to reduce or eliminate the need for reliever therapy.

(Image is of a model, used for illustrative purposes only.)

Research continues apace to provide insights into the role of inhaled combination therapies in asthma.

Table 1 summarises available information on the study designs and key results for recent clinical trials investigating the use of new LABA/LAMA/ICS combination therapies for the treatment of asthma.