Journal Article

Asthma

Kim, Harold, O’Keefe, Andrew, Connors, Lori, Ling, Ling

2025

Overview

Asthma is one of the most common respiratory disorders in Canada, however, many Canadians with asthma remain poorly controlled. In most patients, control can be achieved through appropriate therapy, including: inhaled corticosteroids (ICS), combination ICS/long-acting beta2-agonists (LABA), “triple therapy” with ICS/LABA/long-acting muscarinic receptor antagonist (LAMA), and biologic therapies. The medical management of severe asthma, in particular, has changed dramatically with the incorporation of biologics in asthma treatment plans. Allergen-specific immunotherapy represents a potentially disease-modifying therapy for many patients with asthma; it must only be prescribed by physicians with appropriate training in allergy. Other essential components of asthma management include: regular monitoring of asthma control and risk of exacerbations; patient education and written asthma action plans; assessing barriers to treatment and adherence to therapy; adequate management of comorbidities (e.g., allergic rhinitis) and reviewing inhaler device technique. This article provides a review of current literature and guidelines for the appropriate diagnosis and management of asthma in adults and children. A clinical diagnosis of asthma should be suspected in patients with intermittent symptoms of wheezing, coughing, chest tightness and breathlessness.Objective measurements of lung function, preferably using spirometry, are needed to confirm the diagnosis. The best time to perform this testing is when the patient is symptomatic. Spirometry can generally be performed in children 6 years of age and older.In children < 6 years of age who are unable to perform spirometry, a trial of therapy (8-12 weeks in duration) and monitoring of symptoms can act as a surrogate method to diagnose asthma.All asthma patients should be prescribed a rapid-acting bronchodilator to be used as needed for relief of acute symptoms.ICS therapy (either alone or in combination with a LABA) is the standard of care for most patients with asthma.LTRAs can also be used as add-on therapy if asthma is uncontrolled despite the use of low-to-moderate ICS or ICS/LABA doses.The LAMA, tiotropium, by mist inhaler can be added in patients 18 years of age or older with an exacerbation history despite ICS/LABA treatment. Two “triple therapy” combination ICS/LABA/LAMA inhalers are approved for use in Canadian adults.Biologic therapy targeting IgE, IL-4/IL-13, IL-5 or TSLP may be useful in select cases of difficult to control or severe asthma.Allergen-specific immunotherapy is a potentially disease-modifying therapy that can be considered in most cases of allergic asthma.Regular monitoring of asthma control and exacerbation risk, adherence to therapy and inhaler technique are important components of asthma management.

• Publisher: BioMed Central
• Subject: Review