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Improvement in combination therapy for severe asthma

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Asthma is a leading cause of hospitalization, worldwide. Of these, 5 to 10 percent cases are resistant to treatment, and are classified as “severe” or “difficult to treat”. In such people, asthma is potentially life-threatening. Read on to know how experts like Pulmonologist in Lahore treat severe asthma, and what are the latest improvements in combination therapy.

What is the treatment consideration in asthma?

The treatment considerations in asthma include management and control of symptoms, quick relief for acute attacks and avoiding triggers to reduce the frequency of attacks. Asthma is rarely managed with monotherapy, which is why most treatment guidelines include a combination of drugs.

Triple therapy for asthma includes inhaled corticosteroids (ICS), along with long acting beta 2 agonists (LABA) and muscarinic antagonists (LAMA). Therapy with a combination of ICS and LABA in a single inhaler significantly improves symptoms, compared to single drugs. Combination therapy also improves the adherence to treatment as the patient has to take only a single drug.

What are the treatment options?

Asthma is a chronic inflammatory disease, characterized by bronchoconstriction, hypersecretion of mucus and airway hyperresponsiveness. Therefore, the therapy is directed to decrease inflammation, dilate the bronchi, and decrease the mucus production. The drugs for these, therefore include:


Traditionally, inhaled medication like tiotropium is for chronic obstructive pulmonary disease (COPD), however, in 2015, the FDA approved tiotropium, for the treatment of asthma. When added to the regimen with inhaled corticosteroids and beta blockers, tiotropium offers good control and adherence to treatment.


Bronchial thermoplasty

The surgical treatment for severe asthma includes bronchial thermoplasty, which is reserved for very severe disease. In this technique, radiofrequency is used to destroy some of the smooth muscle lining to prevent bronchoconstriction. It is delivered in three sessions, all of which are three weeks apart to reduce the symptoms.

Monoclonal antibodies

The first monoclonal antibody, approved by the FDA was omalizumab, which is a monoclonal antibody (mAb) binding IgE. Immunoglobulin E (IgE) is increased in the blood in moderate to severe allergic asthma, and drugs like omalizumab are indicated for children and adults with persistent allergic asthma.

Before adding a biological agent like omalizumab, making the correct diagnosis is mandated. These drugs are only approved for asthma, and not other conditions with bronchoconstriction that mimic asthma-like COPD, hypersensitivity pneumonitis, bronchiectasis, and intermittent laryngeal obstruction.

Leukotriene modifiers

Another group works by blocking the action of leukotrienes. Leukotrienes is responsible for the narrowing of airways, and therefore, blocking them helps to attenuate the symptoms. There are three drugs approved for asthma treatment, including montelukast, zileuton, and zafirlukast. These medications must be taken to prevent asthma attacks, particularly in children.

Intravenous or oral steroids

Systemic corticosteroids are recommended for people with incomplete responses to beta-agonists. Oral and intravenous corticosteroids offer the same efficacy with regard to treatment. They speed up the resolution of obstruction and also prevent late-phase exacerbation.

Other drugs

Other drugs for treatment include cromolyn sodium, oral corticosteroids, inhaled short-acting beta-agonists, and inhaled short-acting anticholinergics.

Dietary modification

Prospective cohort studies show an association between obesity and asthma. Higher body mass index has a higher association with asthma, and in fact, is more difficult to control in obese patients. Loss of even 5 to 10 percent of weight is helpful in improving the quality of life and asthma control. 

What is the future of asthma treatment?

Researchers are working on newer drugs for the relief of acute symptoms as well as the prevention of the disease. Experimental drugs like fevipiprant are in development, in people with allergic asthma that healthcare professionals like Pulmonologist in Islamabad can prescribe to asthmatics. 

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