Treatment of moderate persistent asthma in adolescents and adults
- Stephen Peters, MD, PhD, FACP, FCCP, FAAAAI, FCPP
Stephen Peters, MD, PhD, FACP, FCCP, FAAAAI, FCPP
- Professor of Medicine and Pediatrics
- Wake Forest University Health Sciences
- Jennifer W McCallister, MD, FACP, FCCP
Jennifer W McCallister, MD, FACP, FCCP
- Associate Professor of Clinical Internal Medicine
- The Ohio State University Wexner Medical Center
- Rodolfo Pascual, MD
Rodolfo Pascual, MD
- Associate Professor of Internal Medicine
- Wake Forest University Health Sciences
The principal goals of treatment of moderate persistent asthma are to minimize symptoms, normalize pulmonary function, prevent exacerbations, and improve health-related quality of life. A theoretical goal is to prevent the putative long-term consequences of airway inflammation, particularly airway remodeling and chronic persistent airway obstruction. (See "Pathogenesis of asthma".)
The standard pharmacologic approaches to moderate persistent asthma in adolescents (children over the age of 12 years) and adults will be reviewed here. This information is consistent with the “National Asthma Education and Prevention Program (NAEPP): Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma – Full Report 2007" . Similar guidelines have been published by the Global Initiative for Asthma (GINA) .
An overview of asthma management, including trigger control and the use of controller medications for asthma in children younger than 12 years of age, is presented separately. (See "An overview of asthma management" and "Trigger control to enhance asthma management" and "Asthma in children younger than 12 years: Treatment of persistent asthma with controller medications".)
●Daily symptoms of asthma
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- GENERAL PRINCIPLES
- Patient education
- Immunotherapy for allergic asthma
- SHORT-ACTING BETA AGONISTS
- INITIATING CONTROLLER THERAPY
- Preferred options
- - Medium-dose inhaled GCs
- - Low-dose inhaled GCs plus a LABA
- A course of oral GCs in addition
- Alternate options
- - Leukotriene-modifying agents
- - Theophylline
- ADJUSTING THERAPY
- Assessing control
- Increasing therapy
- - Medium-dose inhaled GCs plus a LABA
- - Medium-dose inhaled GCs plus tiotropium
- - Medium-dose inhaled GCs plus a leukotriene-modifying agent
- - Combining multiple therapies
- Decreasing therapy
- ACUTE EXACERBATIONS
- LONG-TERM MONITORING
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS