Adjunctive therapy for asthma: Treatment options

The National Heart, Lung, and Blood Institute guidelines on the diagnosis and management of asthma recommend using inhaled corticosteroids (ICSs) at the lowest dose possible to maintain control of disease as the backbone of asthma therapy for persistent asthma at mild, moderate, and severe levels. In patients with persistent asthma, this can be accomplished with adjunctive, or add-on, therapy to low-dose ICS, Add-on therapeutic agents include long-acting beta(2)-agonists (LABAs), theophylline, and leukotriene modifiers. The addition of LABAs to existing ICS therapy improves all aspects of asthma control, including exacerbations. Both LABAs and ICSs have complementary modes of action in treating asthma by affecting both airway inflammation and smooth muscle dysfunction, Theophylline and leukotriene modifiers as add-on therapy to ICSs are considered to be clinically equivalent to higher-dose ICS therapy. Like LABAs, theophylline and leukotriene modifiers offer a steroid-sparing effect. All 3 add-on therapies offer a more rapid onset of action than corticosteroid therapy alone, thus potentially increasing compliance. Current evidence suggests that LABAs are the most effective add-on therapy and are even more effective than higher doses of ICSs alone.