Chest
Clinical CommentaryRescue Treatment in Asthma: More Than As-Needed Bronchodilation
Section snippets
Clinical Evidence and Rationale
Several studies have shown the efficacy of ICS in acute conditions, in mild to moderate exacerbations, where high-dose ICS resulted in comparable efficacy to systemic steroids.10, 11, 12, 13, 14
The use of intermittent treatment with inhaled corticosteroid, guided on a symptom-based written action plan in the absence of any regular treatment, has been recently tested in adults with mild asthma.15 Compared to twice-daily regular treatment with ICS, intermittent treatment is not associated with an
Pathophysiology and Underlying Molecular Mechanisms
Asthma symptoms are associated not only with bronchoconstriction but also with enhanced lower airway inflammation,3, 4, 5, 6, 7 and both β2-agonists and ICS rapidly exert their bronchodilator or antiinflammatory effects on the lower airways.
The fast bronchodilator effect of rapid-onset inhaled β2-agonists bronchodilators is mediated mainly by a relaxing effect on contracted lower airway smooth muscle. In addition to their direct bronchodilator effect, inhaled β2-agonists may also have important
Rapid Pharmacologic Interactions Between Inhaled Corticosteroids and β2-Agonists
Not only can ICS and β2-agonists act rapidly, but they can interact in a two-way fashion when simultaneously present at the pharmacologic cell target, with each drug enhancing the effect of the other. This interaction is likely to be relevant in the use of their combination as a rescue medication for symptom relief.
Conventional wisdom had been that corticosteroids and β2-agonists act through separate and distinct pathways. Corticosteroids diffuse into the target cells (in the lower airways,
Future Research
Taken together, this evidence clarifies the potentiating effect of corticosteroids and β2-agonists interactions that occurs rapidly and could explain the clinical efficacy of the use of this combination as rescue treatment. Given the clinical advantages and the established molecular mechanisms, with virtually absent side effects, we suggest that this approach should now be regarded as optimal PRN strategy at any degree of asthma severity: it needs no technical explanation, it is easy to learn
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Cited by (0)
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).
- 1
Dr. Papi received research funding from and has been on scientific advisory boards for AstraZeneca, Chiesi, GlaxoSmithKline, and UCB;
- 2
Dr. Caramori has received lecture fees from GSK and Chiesi Farmaceutici;
- 3
Dr. Adcock received research funding from and has been on scientific advisory boards for GlaxoSmithKline, Chiesi, and AstraZeneca;
- 4
Dr. Barnes received research funding from and has been on scientific advisory boards for AstraZeneca, Chiesi, Cipla, GlaxoSmithKline, and UCB.