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Review
. 2020 Jun 19;117(25):434-444.
doi: 10.3238/arztebl.2020.0434.

The Treatment of Mild and Moderate Asthma in Adults

Marek Lommatzsch  1 , Roland Buhl, Stephanie Korn
Affiliations
Review

The Treatment of Mild and Moderate Asthma in Adults

Marek Lommatzsch et al. Dtsch Arztebl Int. .

Abstract

Background: Asthma is a chronic inflammatory airway disease that usually causes variable airway obstruction. It affects 5-10% of the German population.

Methods: This review is based on relevant publications retrieved by a selective search, as well as on national and international guidelines on the treatment of mild and moderate asthma in adults.

Results: The goal of treatment is to attain optimal asthma control with a minimal risk of exacerbations and mortality, loss of pulmonary function, and drug side effects. This can be achieved with a combination of pharmacotherapy and non-drug treatment including patient education, exercise, smoking cessation, and rehabilitation. Pharmacohterapy is based on inhaled corticosteroids (ICS) and bronchodilators. It is recommended that mild asthma should be treated only when needed, either with a fixed combination of ICS and formoterol or with short-acting bronchodilators. For moderate asthma, maintenance treatment is recommended, with an inhaled fixed combinations of ICS and long-acting beta-mimetics, possibly supplemented with longacting anticholinergic agents. Allergen immunotherapy, i.e., desensitization treatment, should be considered if the allergic component of asthma is well documented and the patient is not suffering from uncontrolled asthma. Asthma control should be monitored at regular intervals, and the treatment should be adapted accordingly.

Conclusion: The treatment of asthma in adults should be individually tailored, with anti-inflammatory treatment as its main component.

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Figures

Figure 1
Figure 1
Level of asthma control according to the German National Disease Management Guideline 2020 (7) To measure the level of asthma control, the National Disease Management Guideline 2020 (7), following the Global Initiative for Asthma (GINA), recommends asking the patient four questions. Lung function should also be tested to check for airway obstruction, and the patient should be asked about any exacerbations that have occurred (these additional criteria help assessment of the risk that asthma control will deteriorate in the future). Modified from (7).
Figure 2
Figure 2
Stepped approach to pharmacological therapy according to the German National Disease Management Guideline (Nationale Versorgungsleitlinie) 2020 (7) Following GINA, the German National Disease Management Guideline recommends a five-step approach to treatment. Depending on the level of asthma control, medications are stepped up or down until good asthma control is achieved with as few medications as possible at the lowest possible dosage. Modified from (7). *1 Fixed-dose combination (low-dose ICS + formoterol) on an as-needed basis is not approved for steps 1 and 2 (as of February 2020) *2 ICS+formoterol as needed if this combination is also used for maintenance therapy GINA, Global Initiative for Asthma; ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene receptor antagonist; OCS, oral glucocorticosteroid; SABA, short-acting inhaled β2-agonist
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References

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