바로가기메뉴

본문 바로가기 주메뉴 바로가기

Tuberculosis & Respiratory Diseases

Article Contents

Prev Next
e-Submission

Vol.82 No.3
Citation Share

Dilemma of Asthma Treatment in Mild Patients

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2019, v.82 no.3, pp.190-193


& (2019). Dilemma of Asthma Treatment in Mild Patients. Tuberculosis & Respiratory Diseases, 82(3), 190-193.
  • Downloaded
  • Viewed
PDF Download

Abstract

Inhaled corticosteroids (ICSs) have been widely used as a key medication for asthma control. However, ICSs have been known to cause respiratory infections, such as pneumonia and pulmonary tuberculosis. Consequently, a dilemma exists regarding recommendation of persistent lifetime use of ICSs to mild asthma patients. Short-acting β-agonists (SABAs) have also been widely used for symptom relief. However, SABAs have been reported to increase the risk of asthma-related death, though incidences have been very rare. Consequently, a dilemma exists regarding recommendation of a SABA alone without an ICS or a controller to asthma patients even with very mild disease. In the real world, asthma patients tend to intermittently use ICS and more likely to be dependent on SABA since many patients want immediate relief of their symptoms. Consequently, a dilemma exists regarding the underuse of ICSs but the overuse of SABAs. One strategy for solving the presented dilemma would be identification of patients with asthma who require persistent use of asthma controllers. Such patients, who may be referred to as “persistent controller users,” should continuously receive ICSs, even under controlled states of asthma. Another strategy would be a patient-adjusted, symptom-driven, intermittent-toregular treatment combining low-dose ICS/rapid-onset long-acting β-agonists instead of using a SABA alone or with lowdose ICS for the asthma patients with mild disease. Both of these two strategies could avoid the risky treatment of a SABA alone without an ICS and could reduce the dose of ICS with the maintenance of asthma control.

keywords
Asthma, Therapeutics

Reference

1.

1. Korean Institute for Health and Social Affairs. Prevalence of asthma like symptoms in Korean adult population. Korean J Med 2001; 60:196-205.

2.

2. Global Asthma Network. The global asthma report 2014 [Internet]. Global Asthma Network; 2014 [cited 2017 Dec 29]. Available from: http://www.globalasthmareport.org/burden/mortality.php.

3.

3. Barnes PJ. New drugs for asthma. Semin Respir Crit Care Med 2012; 33:685-94.

4.

4. Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med 2000; 343:332-6.

5.

5. Global Initiative for Asthma. Global strategy for the diagnosis and prevention [Internet]. Global Initiative for Asthma; 2017[cited 2017 Dec 29]. Available from: https://ginasthma.org/.

6.

6. Kim DK, Park YB, Oh YM, Jung KS, Yoo JH, Yoo KH, et al. Korean asthma guideline 2014: summary of major updates to the Korean asthma guideline 2014. Tuberc Respir Dis 2016; 79:111-20.

7.

7. Brode SK, Campitelli MA, Kwong JC, Lu H, Marchand-Austin A, Gershon AS, et al. The risk of mycobacterial infections associated with inhaled corticosteroid use. Eur Respir J 2017; 50:1700037.

8.

8. Lee CH, Kim K, Hyun MK, Jang EJ, Lee NR, Yim JJ. Use of inhaled corticosteroids and the risk of tuberculosis. Thorax 2013; 68:1105-13.

9.

9. Qian CJ, Coulombe J, Suissa S, Ernst P. Pneumonia risk in asthma patients using inhaled corticosteroids: a quasi-cohort study. Br J Clin Pharmacol 2017; 83:2077-86.

10.

10. Smeeth L, Boulis M, Hubbard R, Fletcher AE. A population based case-control study of cataract and inhaled corticosteroids. Br J Ophthalmol 2003; 87:1247-51.

11.

11. Hanania NA, Chapman KR, Sturtridge WC, Szalai JP, Kesten S. Dose-related decrease in bone density among asthmatic patients treated with inhaled corticosteroids. J Allergy Clin Immunol 1995; 96(5 Pt 1):571-9.

12.

12. Zhang L, Prietsch SO, Ducharme FM. Inhaled corticosteroids in children with persistent asthma: effects on growth. Cochrane Database Syst Rev 2014; (7):CD009471.

13.

13. van Noord JA, Smeets JJ, Maesen FP. A comparison of the onset of action of salbutamol and formoterol in reversing methacholine-induced bronchoconstriction. Respir Med 1998; 92:1346-51.

14.

14. Crane J, Pearce N, Flatt A, Burgess C, Jackson R, Kwong T, et al. Prescribed fenoterol and death from asthma in New Zealand, 1981-83: case-control study. Lancet 1989; 1:917-22.

15.

15. Suissa S, Ernst P, Boivin JF, Horwitz RI, Habbick B, Cockroft D, et al. A cohort analysis of excess mortality in asthma and the use of inhaled beta-agonists. Am J Respir Crit Care Med 1994; 149(3 Pt 1):604-10.

16.

16. Suissa S, Hemmelgarn B, Blais L, Ernst P. Bronchodilators and acute cardiac death. Am J Respir Crit Care Med 1996; 154(6 Pt 1):1598-602.

17.

17. O’Byrne PM, Jenkins C, Bateman ED. The paradoxes of asthma management: time for a new approach? Eur Respir J 2017; 50:1701103.

18.

18. Beasley R, Weatherall M, Shirtcliffe P, Hancox R, Reddel HK. Combination corticosteroid/beta-agonist inhaler as reliever therapy: a solution for intermittent and mild asthma? J Allergy Clin Immunol 2014; 133:39-41.

Tuberculosis & Respiratory Diseases

e-Submission OA Policy