Asthma Management: Current Guidelines and Treatment Strategies for Asthma Control

Abstract

Asthma is a chronic inflammatory disorder of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. The pathophysiology involves various cells and cellular components, including mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells. This inflammation leads to widespread but variable airflow obstruction and increased bronchial sensitivity to a range of stimuli. Asthma affects over 330 million people worldwide, with prevalence rates varying widely between countries. Epidemiological studies have shown increasing prevalence in developing nations adopting Westernized lifestyles and among children with allergic sensitization and multimorbidity. The diagnosis of asthma is based on a probabilistic assessment of symptoms and fluctuating expiratory airflow limitation, as no definitive diagnostic standard exists. Differential diagnoses and comorbidities, such as rhinitis, rhinosinusitis, obesity, obstructive sleep apnea, and gastroesophageal reflux disease, should be evaluated and managed appropriately. The management of asthma involves a stepwise approach, with inhaled corticosteroids (ICS) being the cornerstone of maintenance therapy. Long-acting β2-agonists (LABAs) are recommended in combination with ICS for patients with inadequately controlled asthma. Other treatment options include leukotriene modifiers, long-acting muscarinic antagonists (LAMAs), and targeted biological therapies for severe, uncontrolled asthma. Short-acting β2-agonists (SABAs) are no longer considered the best sole therapy for intermittent asthma, and formoterol in combination with ICS is now recommended for as-needed use. Non-pharmacological interventions, such as avoiding triggers, maintaining a healthy lifestyle, and considering bronchial thermoplasty in select cases, may also play a role in asthma management.