Invited Speaker

Pharmacologic Strategies for Asthma Management
Pierluigi Paggiaro
Italy

Pharmacologic treatment for asthma has received large attention in the last years. The current international guidelines recommend a regular treatment with inhaled corticosteroids (ICS) or with ICS/LABA combination, with the addition of rescue short-acting beta2-agonists in the presence of acute symptoms. This strategy (the “traditional strategy”) has been demonstrated to be effective in the long-term management of asthma, in reducing airway inflammation and improving bronchial hyperresponsiveness, but sometimes it requires high dose ICS for a long period of time, with potential risk of side effects.

From the FACET study, it has been demonstrated that acute asthma exacerbations have a 3-5 days period during which asthma symptoms progressively increase up to the appearance of a clear exacerbation; this fact allows to have some “room” for an appropriate and quick increase in the use of additional drugs which may prevent the occurrence of the exacerbation. All studies using the SMART strategy (using formoterol/budesonide combination not only as regular treatment but also as required) have shown that the additional use of ICS/LABA combination when symptoms increase may lead to a reduction in the number and severity of the exacerbations (Humbert et al, Allergy 2008). This strategy has been tested in a group of mildest asthmatics, comparing the efficacy of rescue salbutamol/beclomethasone with regular beclomethasone treatment (Papi et al, NEJM 2007), showing a similar efficacy in front of a consistent reduction in the mean daily dose of ICS. Rescue treatment using combination has been tested in other recent studies, and it is the objective of a multicenter Italian study on moderate asthmatics.

The improvement in the pharmacologic strategies for asthma management may increase the compliance of the patients and reduce the burden of the drug therapy, with similar efficacy on the main outcomes of asthma.