How would you treat a severe asthma patient?
Meet Your Adult Patient
Asthma is a variable condition that requires a versatile treatment regimen – what treatment would you recommend for the following patient?
- This is a fictional patient.Thomas, Age 40Roofer
This is a fictional patient.Thomas, Age 40Roofer
Thomas has lived with asthma since childhood but was recently diagnosed with severe asthma. He is currently treated with a ICS/LABA as maintenance and a reliever therapy, but decides to visit his GP as his asthma symptoms are still interfering with his quality of life.
| Current presentation | Hasn’t been sleeping well due to persistent coughing at night. Likes to stay active, but running triggers his asthma, so he has stopped recently |
|---|---|
| Current treatment | Combination inhaled corticosteroid/long acting B2 agonist (800 mcg budesonide equivalent/day) used as maintenance and reliever therapy (MART). |
| Inhaler technique | Good |
| Severe exacerbation in the last 12 months | 2 requiring oral corticosteroids. |
SPIRIVA® Respimat® (tiotropium) is indicated as add-on maintenance bronchodilator treatment in patients aged 6 years and older with severe asthma who experienced one or more severe asthma exacerbations in the preceding year. In adult patients with severe asthma, tiotropium should be used in addition to inhaled corticosteroids (≥ 800μg budesonide/day or equivalent) and at least one controller.1
BTS/SIGN 2019: Summary of asthma management in adults.
Thomas is currently prescribed medium-dose ICS plus LABA, which is Step 3 (additional controller therapies).1
However, his asthma control remains suboptimal, so he should move up to Step 4 (specialist therapies), where two or more controller therapies may be required, as well as an as-needed reliever inhaler.1
Note: BTS/SIGN state that adults whose asthma is not adequately controlled on recommended initial or additional controller therapies should be referred for specialist care, where tiotropium is an add-on treatment option.1
- Adapted from BTS/SIGN. 2019.1
- Please refer to the guidelines for further information on specialist therapies which may be recommended as treatment options.
- Abbreviations
- BTS/SIGN, British Thoracic Society/Scottish Intercollegiate Guidelines Network; ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene receptor antagonist; MART, maintenance and reliever therapy; SABA, short-acting β2-agonist.
- Reference: 1. BTS/SIGN. British guideline on the management of asthma, 2019. Available at: www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/ (accessed April 2023).
Footnotes / abbreviations
- The details of this case is fictional and created for educational purposes only.
- BTS/SIGN, British Thoracic Society/Scottish Intercollegiate Guidelines Network; GINA, Global Initiative for Asthma; ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; NICE, National Institute for Heath and Care Excellence.; MART, maintenance and reliever therapy.
References
- SPIRIVA® Respimat® (tiotropium) Summary of Product Characteristics.
- SPIRIVA® HandiHaler® (tiotropium) Summary of Product Characteristics.
- Tiogiva® (tiotropium) Summary of Product Characteristics.
- Braltus® Zonda® (tiotropium) Summary of Product Characteristics.
- ▼ Incruse® Ellpita® (umeclidinium) Summary of Product Characteristics.
- Seebri® Breezhaler® (glycopyrronium) Summary of Product Characteristics.
- ▼ Eklira® Genuair® (aclidinium) Summary of Product Characteristics.
- Acopair® (tiotropium) Summary of Product Characteristics.
PC-GB-107317 V1
April 2023