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Chapter 12: Asthma: Principles of treatment

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Abstract:

The goals of treatment are prevention of fatalities, hospitalizations, and emergency department visits, along with achieving good long-term control of asthma, with reduction of symptoms, maintenance of normal activity level, prevention of exacerbations, and accelerated loss of pulmonary function (forced expiratory volume in 1 second [FEV1]) as well as avoiding harm from therapies. Treatment often is initiated based on severity of symptoms, physical examination findings, and, for some patients, the FEV1 or peak expiratory flow rates. Comorbidities such as gastroesophageal reflux disease and laryngopharyngeal reflux, rhinitis or rhinosinusitis, sleep apnea, recurrent infections, smoking, and substance abuse should be addressed. Two treatment modalities are indicated only for individuals with allergic asthma: allergen-specific immunotherapy, commonly known as allergy shots, and omalizumab. Allergen immunotherapy is effective in decreasing symptoms and medication use in selected patients with mild-to-moderate allergic asthma. In addition, patients receiving allergen immunotherapy for allergic rhinitis may have a decreased risk of developing asthma. Omalizumab, a recombinant humanized monoclonal anti-IgE antibody indicated for persistent moderate-to-severe allergic asthma, has been shown to improve asthma-related quality of life, decrease clinically significant exacerbation rates, number of courses of oral corticosteroids, and reduce the severity of exacerbations. It is administered every 2‐4 weeks subcutaneously, and improvement should be ascertained after 4‐6 months.

Keywords: Allergen specific; asthma; control; goals of treatment; immunotherapy; omalizumab; prevention of exacerbations

Document Type: Research Article

DOI: http://dx.doi.org/10.2500/aap.2012.33.3545

Publication date: May 1, 2012

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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