References

Al-Showair RAM, Pearson SB, Chrystyn H The Potential of a 2Tone Trainer To Help Patients Use Their Metered-Dose Inhalers. Chest. 2007; 131:1776-1782 https://doi.org/10.1378/chest.06-2765

Allen DB, Bielory L, Derendorf H Past lessons and future issues. Journal of Allergy and Clinical Immunology. 2003; 112:(3)S1-S40 https://doi.org/10.1016/S0091-6749(03)01859-1

Anderson DE, Kew KM, Boyter AC Long-acting muscarinic antagonists (LAMA) added to inhaled corticosteroids (ICS) versus the same dose of ICS alone for adults with asthma. Cochrane Database of Systematic Reviews. 2015; https://doi.org/10.1002/14651858.CD011397.pub2

Balanag VM, Yunus F, Yang PC Efficacy and safety of budesonide/formoterol compared with salbutamol in the treatment of acute asthma. Pulmonary Pharmacology and Therapeutics. 2006; 19:139-147 https://doi.org/10.1016/j.pupt.2005.04.009

Bateman ED, Boushey HA, Bousquet J Can Guideline-defined Asthma Control Be Achieved?. American Journal of Respiratory and Critical Care Medicine. 2004; 170:(8)836-844 https://doi.org/10.1164/rccm.200401-033oc

Bateman E, Reddel H, O'Byrne P As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma. New England Journal of Medicine. 2018; 378:(20)1877-1887 https://doi.org/10.1056/nejmoa1715275

Beasley R, Holliday M, Reddel HK Controlled Trial of Budesonide–Formoterol as Needed for Mild Asthma. New England Journal of Medicine. 2019; 380:(21)2020-2030 https://doi.org/10.1056/nejmoa1901963

Bennett J, Tattersfield A Time course and relative dose potency of systemic effects from salmeterol and salbutamol in healthy subjects. Thorax. 1997; 52:458-464 https://doi.org/10.1136/thx.52.5.458

Newer And Common Inhaled Therapy Licensed for Asthma or COPD. 2020. https://www.primarycaretraining.co.uk/wp-content/uploads/2020/02/Drugs-and-Devices-Feb-2020.pdf (accessed 20 March 2020)

Bourke SJ, Burns GP Respiratory Medicine Lecture Notes.Oxford: Wiley-Blackwell; 2011

British Thoracic Society/Scottish Intercollegiate Guideline Network. British guideline on the management of asthma. 2019. https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/ (accessed 29 March 2020)

Cates CJ, Lasserson TJ Combination formoterol and inhaled steroid versus beta(2)-agonist as relief medication for chronic asthma in adults and children. Cochrane Database of Systematic Reviews. 2009; https://doi.org/10.1002/14651858.cd007313.pub2

Cates CJ, Karner C Combination formoterol and budesonide as maintenance and reliever therapy versus current best practice (including inhaled steroid maintenance), for chronic asthma in adults and children. Cochrane Database of Systematic Reviews. 2013; https://doi.org/10.1002/14651858.cd007313.pub3

Chauhan BF, Ducharme FM Addition to inhaled corticosteroids of long-acting beta2-agonists versus anti-leukotrienes for chronic asthma. Cochrane Database of Systematic Reviews. 2014; (1) https://doi.org/10.1002/14651858.CD003137.pub5

Dalby R, Spallek M, Voshaar T A review of the development of Respimat Soft Mist Inhaler. Int J Pharm. 2004; 283:(1–2)1-9 https://doi.org/10.1016/j.ijpharm.2004.06.018

Dwan K, Milan SJ, Bax L Cochrane Database of Systematic Reviews. Vilanterol and fluticasone furoate for asthma. Cochrane Systematic Review. 2016; https://doi.org/10.1002/14651858.CD010758.pub2

Edwards SJ, Von Maltzahn R, Naya IP Budesonide/formoterol for maintenance and reliever therapy of asthma: A meta-analysis of randomised controlled trials. Int J Clin Practice. 2010; 64:(5)619-627 https://doi.org/10.1111/j.1742-1241.2009.02320.x

Evans DJW, Kew KM, Anderson DE, Boyter AC Long-acting muscarinic antagonists (LAMA) added to inhaled corticosteroids (ICS) versus higher dose ICS for adults with asthma. Cochrane Database of Systematic Reviews. 2015; (7) https://doi.org/10.1002/14651858.CD011437.pub2

Giraud V, Roche N Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. European Respiratory Journal. 2002; 19:(2)246-251 https://doi.org/10.1183/09031936.02.00218402

Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2020. http://ginasthma.org (accessed 4 February 2020)

Haidl P, Heindl S, Siemon K Inhalation device requirements for patients' inhalation maneuvers. Respiratory Medicine. 2016; 118:65-75 https://doi.org/10.1016/j.rmed.2016.07.013

Kankaanranta H, Lahdensuo A, Moilanen E Add-on therapy options in asthma not adequately controlled by inhaled corticosteroids: a comprehensive review. Respiratory Research. 2004; 5 https://doi.org/10.1186/1465-9921-5-17

Keeley D, Partridge MR Emergency MDI and spacer packs for asthma and COPD. The Lancet Respiratory Medicine. 2019; 7:(5)380-382 https://doi.org/10.1016/S2213-2600(19)30046-3

Kew K, Karner C, Mindus S Combination formoterol and budesonide as maintenance and reliever therapy versus combination inhaler maintenance for chronic asthma in adults and children. Cochrane Database of Systematic Reviews. 2013; https://doi.org/10.1002/14651858.CD009019.pub2Kew

Kew KM, Dahri K Long-acting muscarinic antagonists (LAMA) added to combination long-acting beta2-agonists and inhaled corticosteroids (LABA/ICS) versus LABA/ICS for adults with asthma. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.. https://doi.org/10.1002/14651858.CD011721.pub2

Kudo M, Ishigatsubo Y, Aoki I Pathology of Asthma. Frontiers in Microbiology. 2013; 4 https://doi.org/10.3389/fmicb.2013.00263

Lötvall J, Bateman ED, Bleecker ER 24-h duration of the novel LABA vilanterol trifenatate in asthma patients treated with inhaled corticosteroids. European Respiratory Journal. 2012; 40:570-579 https://doi.org/10.1183/09031936.00121411

Medicines.org.uk. Xolair 150 mg solution for injection in pre-filled syringe, summary of product characteristics. 2019a. https://www.medicines.org.uk/emc/product/4725/smpc#PHARMACOLOGICAL_PROPS (accessed 23 March 2020)

Medicines.org.uk. Nucala 100 mg solution for injection in pre-filled pen, Summary of product characteristics. 2019b. https://www.medicines.org.uk/emc/product/10563/smpc#PHARMACOLOGICAL_PROPS (accessed 23 March 2020)

Medicines.org.uk. Relvar Ellipta 184 micrograms/22 micrograms inhalation powder, pre-dispensed, Summary of product characteristics. 2019c. https://www.medicines.org.uk/emc/product/5225/smpc#INDICATIONS (accessed 24 March 2020)

Medicines.org.uk. Respimat 2.5 microgram, inhalation solution. Summary of product characteristics. 2019d. https://www.medicines.org.uk/emc/product/407/smpc (accessed 10 May 2020)

Medicines.org.uk. Montelukast 10 mg Film Coated Tablets. Summary of product characteristics. 2016. https://www.medicines.org.uk/emc/product/7312/smpc (accessed 2 May 2020)

Medicines.org.uk. Atrovent Inhaler CFC-Free, Summary of product characteristics. 2018. https://www.medicines.org.uk/emc/product/61/smpc (accessed 10 May 2020)

Nathan RA, Sorkness CA, Kosinski M Development of the asthma control test: a survey for assessing asthma control. The Journal of allergy and clinical immunology. 2004; 113:(1)59-65 https://doi.org/10.1016/j.jaci.2003.09.008

National Institute for Health and Care Excellence. Omalizumab for treating severe persistent allergic asthma. 2013. https://www.nice.org.uk/guidance/ta278/chapter/1-Guidance (accessed 23 March 2020)

National Institute for Health and Care Excellence. Asthma: diagnosis, monitoring and chronic asthma management. 2017. http://www.nice.org.uk/guidance/ng80 (accessed 29 March 2020)

National Institute for Health and Care Excellence. Clinical Knowledge Summary Scenario: Newly-diagnosed asthma. 2020a. https://cks.nice.org.uk/asthma#!scenario (accessed 24 March 2020)

National Institute for Health and Care Excellence. Clinical Knowledge Summary. 2020b. https://cks.nice.org.uk/corticosteroids-inhaled#!scenarioRecommendation:5 (accessed 3 May 2020)

NHS London Procurement Partnership. Rightbreathe. 2020. https://www.rightbreathe.com (accessed 10 May 2020)

O'Byrne PM, FitzGerald JM, Bateman ED Inhaled Combined Budesonide-Formoterol as Needed in Mild Asthma. New England Journal of Medicine. 2018; 378:(20)1865-1876 https://doi.org/10.1056/nejmoa1715274

OpenPrescribing.net. EBM DataLab. University of Oxford. 2020. https://openprescribing.net (accessed 31 May 2020)

Palmqvist M, Persson G, Lazer L Inhaled dry-powder formoterol and salmeterol in asthmatic patients: onset of action, duration of effect and potency. European Respiratory Journal. 1997; 10:2484-2489 https://doi.org/10.1183/09031936.97.10112489

Pinnock H, Burton C, Campbell S Clinical implications of the Royal College of Physicians three questions in routine asthma care: a real-life validation study. Primary Care Respiratory Journal. 2012; 21:(3)288-294 https://doi.org/10.4104/pcrj.2012.00052

Rabe KF, Atienza T, Magyar P Effect of budesonide in combination with formoterol for reliever therapy in asthma exacerbations: a randomized controlled, double-blind study. Lancet. 2006; 368:744-753 https://doi.org/10.1016/s0140-6736(06)69284-2

Rabe KF, Jörres R, Nowak D, Behr N Comparison of the effects of salmeterol and formoterol on airway tone and responsiveness over 24 hours in bronchial asthma. Am Rev Respir Dis. 1993; 147:1436-1441 https://doi.org/10.1164/ajrccm/147.6_pt_1.1436

Rowe BH, Spooner C, Ducharme F Corticosteroids for preventing relapse following acute exacerbations of asthma. Cochrane Database of Systematic Reviews. 2007; https://doi.org/10.1002/14651858.CD000195.pub2

Royal College of Physicians. Why Asthma Still Kills. The National Review of Asthma Deaths. 2014. https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills (accessed 11 February 2020)

Sanchis J, Corrigan C, Levy ML, Viejo JL Inhaler devices - From Theory to Practice. Respiratory Medicine. 2013; 107:(4)495-505 https://doi.org/10.1378/chest.06-2765

Sanders MJ Guiding Inspiratory Flow: Development of the In-Check DIAL G16, a Tool for Improving Inhaler Technique. Pulmonary Medicine. 2017; 2017:1-7 https://doi.org/10.1155/2017/1495867

Sarau HM, Ames RS, Chambers J Identification, molecular cloning, expression, and characterization of a cysteinyl leukotriene receptor. Molecular Pharmacology. 1999; 56:657-663 https://doi.org/10.1124/mol.56.3.657

Scullion J Medicines adherence in respiratory disease. Journal of Prescribing Practice. 2020; 2:(1) https://doi.org/10.12968/jprp.2020.2.1.24

Seberova E, Anderson A Oxis®(formoterol given by Turbuhaler®) showed as rapid an onset of action as salbutamol given by a pMDI. Respiratory Medicine. 2000; 94:(6)607-611 https://doi.org/10.1053/rmed.2000.0788

Selroos O, Borgstrom L, Ingelf J Use of dry powder inhalers in acute exacerbations of asthma and COPD. Therapeutic Advances in Respiratory Disease. 2009; 3:(2)81-91 https://doi.org/10.1177/1753465809103737

Simonsen T, Aarbakke J, Kay I Illustrated Pharmacology For Nurses.London: Hodder Arnold; 2006

Syed YY Fluticasone Furoate/Vilanterol: a Review of Its Use in Patients with Asthma. Drugs. 2015; 75:407-418 https://doi.org/10.1007/s40265-015-0354-5

Van Der Palen J Peak inspiratory flow through Diskus and Turbuhaler, measured by means of a peak inspiratory flow meter. Respiratory Medicine. 2003; 97:285-289 https://doi.org/10.1053/rmed.2003.1289

Inhaled therapy for asthma

02 July 2020
Volume 31 · Issue 7

Abstract

Andrew Booth explains why this is the preferred − and more successful − method when managing asthma

Inhaled therapy is key to the successful treatment of asthma. National guidelines provide us with the aim of asthma management, which is to maintain control of the disease. The correct combination of drug and device can be individually tailored to the patient. Drugs consist of bronchodilators and anti-inflammatories. Devices consist of aerosol inhalers, also known as pressurised metered dose inhalers, and dry powder inhalers. Both the drug and the device need to be prescribed if the treatment is to be clinically effective. A combination of inhaled steroid with long-acting B2 agonist is one of the most clinically effective ways of delivering asthma treatment. This can be prescribed either as a fixed daily dose with a concomitant short-acting B2 agonist as a reliever, or as maintenance and reliever therapy, which has been shown to improve asthma control and reduce exacerbations.

Asthma is a disease of the airways, characterised by airflow obstruction that varies over time, with symptoms including an unproductive cough, chest tightness, breathlessness, and wheeze that is detected by chest auscultation. Symptoms are brought on by triggers such as cold weather, respiratory virus, exercise, allergens, and stress (British Thoracic Society (BTS) / Scottish Intercollegiate Guideline Network (SIGN), 2019).

When exposed to a trigger, the smooth muscle that surrounds the airway contracts (bronchoconstriction) and the inside mucosal lining becomes inflamed (Kudo et al, 2013). Treatment involves bronchodilator and anti-inflammatory drugs, which are mostly delivered straight to the lungs via an inhaler device (National Institute for Health and Care Excellence (NICE), 2017; BTS/SIGN, 2019; Global Initiative for Asthma (GINA), 2020).

When compared to oral medication, inhaled therapy works faster, requires lower doses, and has fewer side effects (Allen et al, 2003). Effective inhaled therapy requires knowledge and ability to use an inhaler device, and the patient should be shown how to use this and have their technique checked by a healthcare professional who is competent to do so. Treatment relies on evidence-based inhaled therapy, with both drug and device being prescribed. Diagnosis and management is largely undertaken in primary care, with complex cases supported by secondary care and ‘difficult asthma’ services (NICE, 2017; BTS/SIGN, 2019; GINA, 2020).

Register now to continue reading

Thank you for visiting Practice Nursing and reading some of our peer-reviewed resources for general practice nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • New content and clinical newsletter updates each month