Bronchial asthma is a chronic inflammatory disease of the airways that causes episodes of shortness of breath, coughing, wheezing and chest tightness. It is estimated to affect more than 260 million people worldwide, with a significant impact on patients’ quality of life and healthcare systems.
Asthma management is based on a stepwise approach that aims to maintain symptom control and prevent exacerbations. This is achieved through a combination of pharmacological and non-pharmacological strategies.
Stages of asthma treatment
The Global Initiative for Asthma (GINA) establishes a five-tiered treatment according to the frequency and severity of symptoms:
Step 1: ICS at low doses as needed, combined with a fast-acting LABA.
Step 2: ICS at low doses on a daily basis.
Step 3: Low-dose ICS + LABA.
Step 4: Medium-high dose ICS + LABA.
Step 5: Biological therapies in severe asthma.
When to go up or down a step?
Step up: If symptoms are frequent, there are nocturnal awakenings or rescue bronchodilators are required more than twice a week.
Step down: If the patient has been well controlled for at least three months, the ICS dose can be reduced gradually to minimise adverse effects.
Pharmacological treatment
Medicines used in the treatment of asthma are divided into two main groups:
🔹 Quick-relief drugs: such as short-acting bronchodilators used for immediate relief of symptoms, but do not control the underlying inflammation.
🔹 Long-term control drugs: used for daily disease management and prevention of symptoms and exacerbations. These include inhaled corticosteroids (ICS), long-acting bronchodilators, leukotriene receptor antagonists and biological therapies.
Benefits of immunotherapy in asthma
Sublingual immunotherapy is a treatment option for patients with allergic asthma, especially those sensitised to mites, pollens or animal epithelia. Its main benefit is to modify the patient’s immune response, reducing sensitivity to allergens and reducing the need for long-term medication. In addition, it has been shown to prevent the progression of asthma in children with allergic rhinitis.
Bronchial asthma is a chronic disease that requires structured management based on stepwise treatment and accurate diagnosis. A combination of appropriate medication, immunotherapy when indicated and patient education can improve quality of life and reduce the risk of exacerbations.
Bibliography:
- Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention, 2023. Available from: https://ginasthma.org
- Barnes PJ. Asthma therapy: the role of anti-inflammatory treatments. Eur Respir J. 2002;19(6):955-960. doi: 10.1183/09031936.02.00201802.
- National Heart, Lung, and Blood Institute (NHLBI). Guidelines for the Diagnosis and Management of Asthma. 2020. Available from: https://www.nhlbi.nih.gov/health-topics/asthma
- Bousquet J, Clark TJH, Hurd SS, et al. GINA guidelines on asthma and its management. Allergy. 2008;63(Suppl 86):8-10. doi: 10.1111/j.1398-9995.2008.01809.x.
- Kaur R, Sood A. Biologic therapies in asthma: Focus on monoclonal antibodies. Am J Respir Crit Care Med. 2020;201(5):559-574. doi: 10.1164/rccm.201907-1393CI.
- Haahtela T, Laatikainen T, Alenius H, et al. The role of allergen immunotherapy in asthma management. Ther Adv Respir Dis. 2020;14:1753466620910889. doi: 10.1177/1753466620910889.
