Asthma treatment new guidelines

In this video, Dr. Roger Seheult of MedCram discusses the new guidelines in the treatment of asthma and COPD. The new guidelines put forth for the treatment of asthma are quite different; however, COPD treatment did not receive any major changes.

What was in the old asthma guidelines?

In the old paradigm, all patients are put on a short acting beta agonist to help dilate the bronchus. Then in COPD, a long acting muscarinic (LAMA) agonist and then a long acting beta agonist (LABA) is added followed by an inhaled corticosteroid. This is the maintenance treatment for copd. However, for asthma it used to be that patients with intermittent asthma could be treated with a short acting beta agonist and then if it was persistent they would add as a maintenance an inhaled corticosteroid (ICS) followed by a long acting beta agonist followed by a long acting muscarinic agonist. 

What does the research show?

However, with recent research, the evidence has led to a change in the guidelines. In this article, a randomized control study, in mild asthma, they were randomized to one of three treatment groups, an albuterol group, a budesonide maintenance group and a budesonide-formoterol group. It found that having patients use something with an inhaled corticosteroid during an exacerbation is the way to go. In this study, it found that using a short acting beta agonist alone vs a combination of budesonide-formoterol there was an decrease in exacerbations requiring systemic steroids. 

What do the new guidelines recommend?

These findings led the experts to come up with a new recommendation for asthma guidelines. This is known as the 2022 Global Initiative for Asthma also known as GINA. They are now recommending  that the preferred treatment is now the low dose ICS and formoterol. If the symptoms are persistent then you would start to use it on a regular basis followed by the addition of a LAMA. The alternative is to take the SABA and whenever that is used to also take your ICS at the same time.

Risk factors that increase the risk of exacerbations even if you have few asthma symptoms include high SABA use, obesity, GERD, food allergies, smoking and major psychological or socio economic problems. 

What if you have both COPD and asthma?

What happens if you have both COPD and asthma? According to the GINA recommendations if you have features of both asthma and COPD, then you need to be treated as asthma in an acute exacerbation. Do not give a LAMA or LABA without an ICS. 



 Controlled Trial of Budesonide–Formoterol as Needed for Mild Asthma (NEJM) |… 

Combination fixed‐dose beta agonist and steroid inhaler as required for adults or children with mild asthma (Cochrane Library) |… 

Key recommendations for primary care from the 2022 Global Initiative for Asthma update (Nature) |…


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