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Asthma exacerbations · 4: Prevention
  1. J M FitzGerald1,
  2. P G Gibson2
  1. 1Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, Canada
  2. 2Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, Australia
  1. Correspondence to:
    Professor J M FitzGerald
    Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver General Hospital, Vancouver, BC, V5Z 1L8, Canada; markf @interchange.ubc.ca

Abstract

Asthma exacerbations are common. They account for a significant morbidity and contribute a disproportionate amount to the cost of asthma management. The optimal strategies for the prevention of asthma exacerbations include the early introduction of anti-inflammatory treatment—most commonly, low dose inhaled corticosteroids. This should be coupled with a structured education programme which has a written action plan as an integral component. Where patients continue to be poorly controlled, the addition of a long acting β agonist should be considered. The latter should not be used as monotherapy and should always be used with inhaled corticosteroids. Atopic patients with a history of repeated exacerbations, especially if they are steroid dependent and with a raised IgE, may be considered as potential candidates for omalizumab. In the early stages of an asthma exacerbation, doubling the dose of inhaled corticosteroids has been shown to be ineffective. The ideal strategy for the management of worsening asthma in patients on combination treatment, especially salmeterol and fluticasone, is uncertain. There is an emerging body of evidence for strategies on how to prevent progression to an exacerbation in patients taking a combination of budesonide and formoterol.

  • FEV1, forced expiratory volume in 1 second
  • ICS, inhaled corticosteroid
  • LABA, long acting β agonist
  • LTRA, leukotriene receptor antagonist
  • OCS, oral corticosteroid
  • PEF, peak expiratory flow
  • asthma
  • exacerbation
  • prevention
  • education
  • management

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Footnotes

  • Funding for these trials was received and administered by the host institution in the form of research grant funding. JMF is a recipient of a CIHR BC Lung Investigator Award and a Michael Smith Distinguished Scholar Award. PGG is an NHMRC Practitioner Fellow.

  • Competing interests: JMF has received research funding and consultant fees as a member of advisory boards and speaking panels for the following companies: AstraZeneca, GlaxoSmithKline, Novartis, Altana, Schering, Hofmann Le Roche. PGG has participated in clinical trials of asthma therapies funded by GlaxoSmithKline, AstraZeneca, Pharmaxis, Novartis, and NHMRC Australia.