Overview
Moderate persistent asthma is characterized by persistent symptoms (e.g., daily symptoms, nighttime awakenings) and frequent exacerbations despite use of inhaled corticosteroids. Effective management aims to control symptoms, maintain normal activity levels, and minimize the risk of exacerbations 1.Diagnosis
Persistent symptoms requiring daily controller medication 1.
Evidence of airflow obstruction that is often reversible 1.
Frequent use of short-acting beta-agonists (SABA) for symptom relief 1.
Spirometry showing FEV1/FVC ratio < 0.70 and variable airflow obstruction 1.
Peak expiratory flow (PEF) variability > 20% over 2-4 weeks 1.Management
First-line treatment: Inhaled corticosteroids (ICS) as the cornerstone, e.g., fluticasone 250-500 mcg BID 1.
Add-on therapy: Long-acting beta-agonists (LABA) combined with ICS (e.g., fluticasone/salmeterol 500/50 mcg BID) for better control 1.
Leukotriene receptor antagonists: As an alternative or add-on for patients unable to tolerate ICS (e.g., montelukast 10 mg QD) 1.
Monitoring: Regular spirometry and PEF monitoring to assess control 1.
Action plans: Individualized asthma action plans to manage exacerbations 1.
Patient education: Regular health coaching and education to improve adherence and self-management 1.Special Populations
Pregnancy: Continue ICS; consider stepping down LABA if possible; monitor closely 1.
Elderly: Focus on minimizing side effects while maintaining control; regular reassessment essential 1.
Comorbidities: Tailor management considering coexisting conditions like COPD; integrated care plans recommended 1.Key Recommendations
Implement regular telephone health coaching to improve patient self-management and reduce hospital admissions (Evidence: Moderate) 1
Use a combination of ICS and LABA as first-line therapy for moderate persistent asthma to achieve better symptom control (Evidence: Strong) 1
Individualize asthma action plans and ensure regular monitoring of lung function to maintain control (Evidence: Moderate) 1References
1 Steventon A, Tunkel S, Blunt I, Bardsley M. Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls. BMJ (Clinical research ed.) 2013. link