An extensive literature review undertaken by the Woolcock Institute of Medical Research has examined the pharmacological strategies for self-management of asthma exacerbations in adults, including those using inhaled corticosteroid/long-acting â2-agonist (ICS/LABA) therapy.
The review provides evidence-based recommendations on the best way to use oral corticosteroids (OCS) to treat severe exacerbations and questions whether studies support the common practice of doubling inhaled corticosteroids (ICS) doses as a form of treatment. It also looks at whether increasing ICS to high doses is an alternative to OCS, as well as the effects of increasing the dose of combination therapy during exacerbations.
Use of inhaled ICS/LABA for maintenance and relief, and the effectiveness of short- acting â2-agonist (SABAs) in the management of exacerbations have also been addressed.
Dr Helen Reddel of the Woolcock Institute and Dr David Barnes from Royal Prince Alfred Hospital, authors of the narrative review which is published in the latest issue of European Respiratory Journal, said the project was undertaken in a bid to help clinicians determine the specific therapeutic instructions which should be included in written asthma action plans.
Dr Reddel explains most of the advice in current international guidelines about how to manage exacerbations was published prior to the introduction of combination therapy.
"However recent years have seen an increase in the proportion of patients being prescribed combination inhaled corticosteroid/long-acting â2-agonist therapy in one inhaler device for the management of persistent asthma," she said.
"The review recognises the importance of written action plans as a beneficial part of an integrated program to substantially improve health outcomes for people with asthma. Our aim was to determine what recommendations should be included in these plans and to make sure they encompass patients taking combination therapy," she said.
A Medline search was used to review relevant papers covering the period 1990-2004. Key findings include:
Dr Reddel points outs there is a need for further studies to clarify remaining issues about self-management of asthma exacerbations, particularly with regard to side-effects of treatment and patient acceptability.
The research was undertaken with the assistance of GlaxoSmithKline. A full outline of the review's findings will be published in the July issue of ERJ.
For further information contact Lucy:
Woolcock Institute of Medical Research
+61 403 753 028
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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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