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Pharmacological strategies for self-management of asthma exacerbations Reddel HK; Barnes DJEur Respir J 2006[Jul]; 28 (1): 182-99Written action plans are effective within asthma self-management, but there are few guidelines about the specific medication adjustments which can be recommended for self-treatment of exacerbations. This review examines pharmacological strategies for self-management of asthma exacerbations in adults, including those for inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) users. Oral corticosteroids are well-established in clinical practice and clinical trials for the treatment of severe exacerbations, including during combination therapy. Evidence supports 7-10 days treatment, with no need to taper except to reduce side-effects. Doubling the dose of ICS is not effective. Several studies have shown benefit from high-dose ICS (2,400-4,000 microg beclomethasone equivalent) for 1-2 weeks. This may be achieved by adding a high-dose ICS inhaler to maintenance ICS or ICS/LABA therapy. There is inconclusive evidence about acutely increasing the dose of maintenance budesonide/formoterol for exacerbations, and no studies of this approach with fluticasone/salmeterol. For patients taking maintenance budesonide/formoterol, use of the same medication as-needed reduces exacerbations. Short-acting beta2-agonists are still effective in producing bronchodilation during combination therapy; however, a higher dose may be required. There is a need for further studies to clarify remaining issues about self-management of asthma exacerbations, particularly with regard to side-effects of treatment and patient acceptability.|*Self Care[MESH]|Administration, Inhalation[MESH]|Administration, Oral[MESH]|Adrenal Cortex Hormones/*administration & dosage[MESH]|Adrenergic beta-Agonists/*administration & dosage[MESH]|Anti-Asthmatic Agents/*administration & dosage[MESH]|Asthma/*drug therapy[MESH]|Bronchodilator Agents/administration & dosage[MESH]|Combined Modality Therapy[MESH]|Humans[MESH] |
