EARLY PRESCRIPTION OF INHALATION CORTICOSTEROID IN BRONCHIAL ASTHMA

Abstract

The article is devoted to the concept of early treatment of patients with intermittent and slight course of bronchial asthma with the use of fixed combinations of inhaled corticosteroids and long-acting beta2-agonists. It describes the basic pathophysiological and molecular mechanisms of this therapy, and the synergy of its components and the local anti-inflammatory effects. Considerable attention is paid to the justification of different strategies for the prescription of steroid-containing combinations as initial therapy: regular prescription of fixed doses, use of a single inhaler for maintenance and symptomatic therapy, including ICS for patients with intermittent and mild BA, abandonment of regular therapy and use of combinations only for therapy on demand. It is emphasized that the basis for the application of such a strategy is low adherence to regular ICS therapy in patients with rare symptoms and undesirability of complete withdrawal of low dose ICS in patients with the light course of the disease because of the high risk of exacerbations. Current evidence suggests that the concept of early prescription of combinations on demand allows combining symptomatic and anti-inflammatory therapy as part of the start of treatment of patients with mild bronchial asthma.