Via practica 6/2021

Update in asthma pharmacotherapy

Asthma is one of the most common chronic, non-communicable diseases in children and adults and it is characterised by variable respiratory symptoms and variable airflow limitation. Asthma is a consequence of and aconsequence of complex gene–environment interactions, with heterogeneity in clinical presentation and the type and intensity of airway inflammation and remodelling. The goal of asthma treatment is to achieve good asthma control in order to minimise symptom burden and risk of adverse disease outcomes. Antiinflammatory and bronchodilator treatments are the mainstay of asthma therapy and are used in a stepwise approach. Pharmacological treatment is based on a cycle of assessment and re-evaluation of symptom control, risk factors, comorbidities, side-effects, and patient satisfaction by means of shared decisions. The GINA 2019 report highlights significant updates in mild asthma management and these recommendations represent a clear deviation from decades of clinical practice mandating the use of symptom-driven SABA treatment alone in those with mild asthma. New biological therapies for treatment of severe asthma, together with developments in biomarkers, represent a promising approach for phenotype-specific interventions and more personalised treatment. The objective of this short review is to highlight current approach and recommendations since the GINA 2019 document represents significant shifts in asthma management at Steps 1 and 2 of the 5 treatment steps.

Keywords: Asthma bronchiale, phenotypes, personalized approach, GINA Global Initiative for Asthma, asthma pharmacological treatment