Asthma supportive therapy
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Asthma Supportive Therapy: Current Insights and Emerging Options
SMART and As-Needed Therapies in Asthma Management
Single Maintenance and Reliever Therapy (SMART) and as-needed inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combinations have shown significant efficacy in managing asthma across various severities. In mild-to-moderate asthma, low-dose SMART and as-needed low-dose ICS/LABA combinations are highly effective in reducing exacerbations. For moderate-to-severe asthma, low- to medium-dose SMART and high-dose ICS/LABA with as-needed short-acting β2-agonist are equally effective, though SMART is often preferred due to its ranking in treatment efficacy. These therapies are well-tolerated and improve lung function and disease control, making them suitable options for asthma management.
Emerging Therapeutic Options for Symptomatic Asthma
Despite adherence to guideline-based treatments, many asthma patients remain symptomatic. Emerging therapies in clinical trials include anti-interleukin agents (e.g., benralizumab, reslizumab, dupilumab), a chemoattractant receptor-homologous molecule antagonist (OC000459), phosphodiesterase-4 inhibitors (e.g., roflumilast), and long-acting muscarinic antagonists (LAMAs) like tiotropium bromide. Among these, tiotropium has shown the most promise as an add-on therapy to ICS, improving lung function across various asthma severities. Ongoing studies will further clarify the roles of these emerging therapies in asthma management.
Manual Therapy for Asthma: Current Evidence
Manual therapies, including chiropractic manipulation, massage therapy, and chest physiotherapy, have been explored for asthma treatment. However, the evidence supporting their efficacy is limited and inconsistent. Some trials have shown no significant differences between manual therapies and control treatments, while others have reported improvements in lung function with massage therapy, though these findings require further validation . Overall, there is insufficient evidence to recommend manual therapies as a standard treatment for asthma .
Natural Products in Asthma Treatment
Natural products, particularly plant-based compounds, have been investigated as alternative or complementary treatments for asthma. These products are valued for their potential to reduce side effects and costs associated with conventional asthma medications. Studies have highlighted the effectiveness of various natural products in alleviating asthma symptoms and improving lung function. However, more research is needed to fully understand their mechanisms and establish standardized treatment protocols.
Pulmonary Rehabilitation in Asthma Management
Pulmonary rehabilitation, a non-pharmacological intervention, has shown beneficial effects in asthma patients. It improves exercise capacity, asthma control, and quality of life while reducing symptoms like wheezing, anxiety, and bronchial inflammation. Despite these benefits, further research is required to develop specific rehabilitation programs tailored to individual patient needs.
Triple Therapy for Asthma
Triple therapy, combining ICS, LABA, and LAMA, is being explored for asthma patients who remain symptomatic despite standard treatments. This approach is particularly considered for patients with a history of smoking or frequent exacerbations. While the pharmacological rationale supports its use, ongoing trials are needed to determine the optimal timing and cost-effectiveness of triple therapy in asthma management.
Conclusion
Asthma management continues to evolve with the development of new therapies and treatment strategies. SMART and as-needed ICS/LABA combinations remain effective options for reducing exacerbations. Emerging therapies and natural products offer promising alternatives, while pulmonary rehabilitation provides additional benefits. However, the role of manual therapies and the optimal use of triple therapy require further investigation. Ongoing research will be crucial in refining these approaches to improve outcomes for asthma patients.
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