Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
A 46-year-old woman with persistent asthma is evaluated in clinic for scheduled follow-up visit. Since her most recent visit 6 months ago, her disease has been stable on a regimen of high-dose inhaled corticosteroids plus a long-acting β-agonist and as-needed albuterol, which she uses approximately once every 1 to 2 weeks. The patient is pleased with the current therapy, and the as-needed albuterol is continued.
Which of the following would be the best approach to this patient's therapy?
A Continue inhaled corticosteroids and the long-acting β-agonist at current doses
B Discontinue inhaled corticosteroids and the long-acting β-agonist
C Continue the long-acting β-agonist and reduce the dose of inhaled corticosteroids
[
D Discontinue the long-acting β-agonist and reduce the dose of inhaled corticosteroids
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
Correct Answer = C)
Key Point
In a patient taking high-dose inhaled corticosteroids as part of therapy for persistent asthma whose disease is stable, reducing the dose of corticosteroids should be considered to prevent therapy-related side effects.
Inhaled corticosteroids are generally safe in asthma; however, their long-term use, especially at high doses, can be associated with such side effects as osteoporosis, glaucoma, cataract, easy bruising, and suppression of the hypothalamic-adrenal axis. For many asthma outcome measures, the dose-response curve for inhaled corticosteroids is relatively flat above a dose of 400 μg/d. Therefore, when patients taking high-dose inhaled corticosteroids are stable, lowering the dose should be considered. This patient should go from high to a moderate dose and continue the long-acting β-agonist. Asthma control is better with the combination of moderate-dose inhaled corticosteroids and a long-acting β-agonist than with high-dose inhaled corticosteroids without a β-agonist. Although the benefits of long-acting β-agonists in asthma are well established, concerns about increased asthma-related deaths in patients using these agents have prompted a re-evaluation of their use. The FDA has mandated including a œblack box warning in the package insert for these drugs to notify patients about this possible risk. The National Asthma Education and Prevention Program (NAEPP) Expert Panel is revising its asthma treatment guidelines and is expected to address the proper placement of long-acting β-agonists in the step-wise approach to treatment of asthma.
