Behandeling van astma: aanwijzingen voor een verandering in aanpak

- In both children and adults with persistent asthma, treatment with an inhaled corticosteroid (ICS) is recommended. Moreover, inhaled bronchodilating agents have a clear role to play.

- The minimum effective dose of an ICS in the individual patient can be determined either by starting with a low dosage of ICS and increasing the dosage gradually on the basis of the symptoms (the ‘step-up’ approach), or by starting with a high dosage and, if the results are good, decreasing it to the point where adequate control is maintained (the ‘step-down’ approach).

- In a study of the step-up approach with the ICS fluticasone, with or without salmeterol as a long-acting β₂-agonist (LABA) in adult patients with asthma, the approach with salmeterol produced the best results, namely, good asthma control in 71 of the patients and total control in 41.

- In a study involving both children and adults with asthma, good results were obtained from treatment with a relatively low maintenance dose of ICS (budesonide) combined with a LABA (formoterol), whereby patients were permitted to use additional inhalations of the combination ICS and LABA.

- How the different therapeutic concepts result in long-term control, what the side effects are in the long term, and whether, in addition to the clinical symptoms, laboratory findings are also important as a therapeutic criterion are all unknown.

Ned Tijdschr Geneeskd. 2006;150:237-41