|
|
| Key Learning Points |
|
- Both asthma and COPD are chronic inflammatory lung pathologies, whose therapy is determined on the basis of the severity step of the disease.
- The classification of severity levels of the diseases is established by
evaluating patients’ lung functions and symptoms.
- Treatments are designed on the basis of a stepwise approach therapy
which directly correlates to severity: whenever the severity of the disease
would increase, patient therapy should be correspondingly raised (step-up
phase), in the pursuit of achieving disease control.
- While in the management of asthma, once obtained optimal disease
control, maintenance therapy should be titrated down to minimal
effective doses to decrease the incidence of side effects (step-down phase),
in COPD no step-down approach is possible, due to the relentless
progression of the disease.
- The most important classes of controller medications in asthma and COPD
management are ICSs (Inhaled Corticosteroids) and LABAs (long-acting β2-agonists). However, these drugs are taken by asthmatic and COPD patients
following a diametrically opposite progressive order. In particular:
- In asthma, ICSs can relent the inflammatory process underlying the
disease: they represent therefore the first line therapy, and LABAs, which
should never be used as monotherapy, are added to an ICS treatment
only in moderate/severe stages of the disease, when asthma control
cannot be achieved anymore with ICS alone;
- In COPD, since for the time being no disease modifying therapy are
available, bronchodilators including LABAs represent the cornerstone of
therapy, by producing bronchodilation and alleviating symptoms. ICSs
do not affect the inflammatory component of COPD, but, in late stages
of the disease, when added to a bronchodilator therapy, contribute to
symptoms and exacerbations control, patients health status and lung
functions improvements.
|
 |
 |
| |
|
