n CME : Your SA Journal of CPD - Asthma : second-line therapies : main article




  • Asthma is an inflammatory condition of the airway.
  • The inflammation is responsible for the manifestations of asthma, namely the symptoms, the airflow limitation and the airway hyperresponsiveness.
  • The majority of asthmatics are treated with a controller medication of which the inhaled corticosteroids (ICS) are the mainstay of therapy.
  • In patients not controlled on ICS alone, it is recommended that an additional controller medication is added, rather than simply increasing the ICS dose, and the long-acting beta-agonists are the preferred option.
  • Leukotriene receptor antagonists (LTRAs) are suitable options that are given orally
  • LTRAs appear to be particularly useful for the treatment of asthma in children, for asthmatic patients with allergic rhinitis, for the treatment of exercise-induced asthma and for aspirin-induced asthma.
  • Sustained release theophylline is an alternative additional controller therapy, which although very cheap, is associated with low efficacy and a high frequency of side-effects.
  • Chromones have limited value in the long-term management of asthma.
  • Anti-immunoglobulin E therapy is the most recently introduced therapy which is recommended for use as a second-line agent in patients with moderate to severe allergic asthma not controlled on standard recommended therapy.
  • For reliever therapy, the primary bronchodilators are the short-acting beta-agonists (SABA), although anticholinergic agents may be suitable for older adults, for those intolerant of SABA, and for patients with nocturnal or intrinsic asthma.


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