Modern Asthma Treatment: Medications and Inhalers for Symptom Control

Bronchial asthma is a chronic airway disease characterized by airflow obstruction, inflammation, and airway hyperresponsiveness [1]. Although asthma shares some features with chronic obstructive pulmonary disease (COPD), such as obstruction and inflammation, their developmental mechanisms differ significantly, requiring distinct approaches to diagnosis, monitoring, and, crucially, pharmacological treatment [1].

Basic Principles of Asthma Pharmacotherapy

The treatment of bronchial asthma is based on recommendations from international guidelines, such as the Global Initiative for Asthma (GINA) [1]. The goal of therapy is to achieve and maintain symptom control, prevent exacerbations, and improve the patient's quality of life. Pharmacological treatment of asthma in adults and children is constantly evolving, and new evidence regularly updates existing approaches [2, 6].

An important aspect is the individualization of therapy. The choice of medications and their dosage depend on the severity of the disease, the frequency of symptoms, the presence of comorbid conditions, and the patient's response to treatment.

Inhaled Medications: The Foundation of Treatment

Inhaled medications are the cornerstone of asthma treatment because they deliver the drug directly to the airways while minimizing systemic side effects. These include:

• Inhaled Corticosteroids (ICS): These drugs reduce airway inflammation, which is a key pathological mechanism of asthma. They are used for long-term disease control and are the mainstay of maintenance therapy [3].
• Long-Acting Beta-Agonists (LABA): These drugs relax airway muscles, widening them and making breathing easier. They provide a long-lasting effect and are often used in combination with ICS. The use of LABAs as monotherapy in asthma patients carries potential risks, so they are typically prescribed alongside ICS [4, 5].
• Short-Acting Beta-Agonists (SABA): Used for the rapid relief of symptoms such as dyspnea and cough, as needed. In recent years, various inhaled agents for symptom relief have also been actively studied [2].

There are also combination inhalers containing both an ICS and a LABA in a single device, which simplifies the treatment regimen and improves patient adherence [3].

New Delivery Forms and Biological Therapy

In addition to traditional inhalers, other drug delivery methods are being developed. For example, the tulobuterol transdermal patch (HokunalinTM Tape) is the first bronchodilator available as a patch. This system ensures peak blood concentration of the drug in the morning hours, when respiratory function often deteriorates, and reduces the risk of systemic side effects. Ease of use and once-daily application contribute to good patient adherence [7].

In recent years, significant progress has been made in the development of biological drugs for the treatment of severe asthma. These drugs target specific molecular pathways involved in the development of asthma-related inflammation. The choice of biological therapy is often based on patient phenotyping and the identification of treatable traits [3]. Studies from 2024–2025 are actively investigating the efficacy of various biological agents, including benralizumab for the treatment of eosinophilic COPD and asthma exacerbations, as well as conducting comparative studies between different biologics [2, 6].

Asthma-COPD Overlap (ACO)

A distinct group of patients comprises those with Asthma-COPD Overlap (ACO). These patients often experience higher morbidity compared to those with asthma alone or COPD alone [4]. The optimal therapeutic approach to ACO remains incompletely understood, as such patients have frequently been excluded from most clinical trials on asthma and COPD. Current recommendations are based on expert opinion [3, 4].

Due to the underlying asthmatic component, initial therapy for patients with ACO typically includes the early use of inhaled corticosteroids combined with a long-acting bronchodilator [3, 4]. If maintenance inhalation therapy proves ineffective, advanced treatment methods based on phenotyping and the identification of treatable traits may be considered [3].

Features of Pediatric Asthma Treatment

Pediatric asthma is the most common chronic disease in childhood and imposes a significant burden on the healthcare system. Despite the availability of guidelines for pediatric asthma management, some controversial issues remain regarding the best treatment approach in primary care settings and the prevention of exacerbations. These issues include the use of written asthma action plans and the role of long-acting beta-agonists (LABAs) [5].

References

• 1. Pharmacological treatment in asthma and COPD. PubMed Link
• 2. Pulmonology: What You May Have Missed in 2024. PubMed Link
• 3. Pharmacologic Management Strategies of Asthma-Chronic Obstructive Pulmonary Disease Overlap. PubMed Link
• 4. Management of asthma COPD overlap. PubMed Link
• 5. Controversies in Pediatric Asthma. PubMed Link
• 6. Pulmonology: What You May Have Missed in 2025. PubMed Link
• 7. Transdermal tulobuterol patch, a long-acting β(2)-agonist. PubMed Link

The information provided in the article is for reference purposes only and cannot replace an in-person consultation with a qualified medical professional. Self-medication can be hazardous to your health.