Asthma

Abstract

Asthma is one of the most common respiratory disorders in Canada, however, many Canadians with asthma remain poorly controlled. In most patients, control can be achieved through appropriate therapy, including: inhaled corticosteroids (ICS), combination ICS/long-acting beta₂-agonists (LABA), "triple therapy" with ICS/LABA/long-acting muscarinic receptor antagonist (LAMA), and biologic therapies. The medical management of severe asthma, in particular, has changed dramatically with the incorporation of biologics in asthma treatment plans. Allergen-specific immunotherapy represents a potentially disease-modifying therapy for many patients with asthma; it must only be prescribed by physicians with appropriate training in allergy. Other essential components of asthma management include: regular monitoring of asthma control and risk of exacerbations; patient education and written asthma action plans; assessing barriers to treatment and adherence to therapy; adequate management of comorbidities (e.g., allergic rhinitis) and reviewing inhaler device technique. This article provides a review of current literature and guidelines for the appropriate diagnosis and management of asthma in adults and children.

Fig. 1

A simplified, stepwise algorithm for the treatment of asthma in children ≤ 5 years of age [9]. *If prescribing LTRA, advise about potential neuropsychiatric adverse effects. ICS: inhaled corticosteroid, LTRA leukotriene receptor antagonist, SABA short-acting beta₂ agonist

Fig. 2

A simplified, stepwise algorithm for the treatment of asthma in children 6–11 years of age [9]. *In Canada, ICS-formoterol is not approved for children under 12 years of age although it is sometimes prescribed off-label for children 6–11 years of age ^†If prescribing LTRA, advise about potential neuropsychiatric adverse effects. ICS inhaled corticosteroid, IgE immunoglobulin E, IL interleukin, LABA long-acting beta₂ agonist, LTRA leukotriene receptor antagonist, OCS oral corticosteroid, SABA short-acting beta₂ agonist

Fig. 3

A simplified, stepwise algorithm for the treatment of asthma in adolescents and adults (≥ 12 years of age) [9]. *Indicated for patients ≥ 18 years of age. ICS inhaled corticosteroid, LTRA leukotriene receptor antagonist, LABA long-acting beta₂-agonist, IgE immunoglobulin E, IL interleukin, LAMA long-acting muscarinic receptor antagonist, SABA short-acting beta2 agonist, TSLP thymic stromal lymphopoietin, OCS oral corticosteroids