Asthma therapy
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Advances in Asthma Therapy: A Comprehensive Overview
Manual Therapy for Asthma: Limited Evidence
Manual therapies, including chiropractic manipulation, massage therapy, and chest physiotherapy, have been explored as potential treatments for asthma. However, current evidence does not support their efficacy. A systematic review of randomized controlled trials (RCTs) found no significant differences in outcomes between chiropractic manipulation and sham treatments. Similarly, trials on massage therapy and chest physiotherapy did not show consistent improvements in lung function. The need for larger, well-designed RCTs to evaluate these therapies remains critical.
SMART and As-Needed Therapies: Effective Options
Single Maintenance and Reliever Therapy (SMART) and as-needed inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combinations have emerged as effective treatments for asthma. A network meta-analysis involving over 32,000 patients demonstrated that low-dose SMART and as-needed low-dose ICS/LABA significantly reduced the risk of exacerbations in mild-to-moderate asthma. For moderate-to-severe asthma, low- to medium-dose SMART was equally effective as high-dose ICS/LABA with as-needed short-acting β2-agonist (SABA) in reducing severe exacerbations. These therapies were well-tolerated and improved lung function and disease control, making them suitable options for asthma management.
Emerging Therapeutic Options: Targeted Treatments
Several new therapeutic agents are under development for symptomatic asthma, including anti-interleukin agents (e.g., benralizumab, reslizumab, dupilumab), a chemoattractant receptor-homologous molecule antagonist (OC000459), a phosphodiesterase-4 inhibitor (roflumilast), and long-acting muscarinic antagonists (e.g., tiotropium bromide). Among these, tiotropium has shown the most promise as an add-on therapy to ICS, demonstrating efficacy across various severities of asthma. These emerging treatments aim to address the unmet needs in asthma management, particularly for patients who remain symptomatic despite standard therapies.
Combination Therapies: Budesonide/Formoterol
The combination of budesonide (an ICS) and formoterol (a LABA) in a single inhaler for both maintenance and reliever therapy has been shown to reduce the risk of severe asthma exacerbations. Studies indicate that this combination therapy is more effective than high-dose ICS alone or ICS/LABA with SABA as a reliever. It simplifies asthma management by reducing the need for multiple inhalers and lowering the maintenance dose of ICS . This approach has been validated in both adults and children, although it is not yet licensed for children under 18 in some regions.
Modern Drug Treatment: Established and New Approaches
The cornerstone of asthma treatment remains the use of ICS and β2-agonists. However, the addition of second-line treatments such as leukotriene antagonists and theophylline can be beneficial for patients with inadequate control on ICS alone. The stepwise approach to asthma management aims to tailor therapy based on disease severity, with the goal of reducing symptoms, preventing exacerbations, and maintaining normal lung function . Despite the effectiveness of these treatments, adherence to guidelines remains a challenge, highlighting the need for patient education and support.
Conclusion
Asthma therapy has evolved significantly, with new and emerging treatments offering hope for better disease control. While manual therapies lack sufficient evidence, SMART and as-needed ICS/LABA combinations have proven effective in reducing exacerbations. Emerging targeted therapies and combination treatments like budesonide/formoterol provide additional options for patients with symptomatic asthma. Continued research and adherence to treatment guidelines are essential for optimizing asthma management and improving patient outcomes.
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