Asthma Medications and Biologic Therapies Quiz

Asthma Medications Overview

• Classes of medications for asthma include beta-2 agonists, glucocorticosteroids, leukotriene blockers, mast cell stabilizers, methylxanthines, and biologic agents
• Beta-2 agonists are divided into short-acting (SABAs) and long-acting (LABAs), with examples like albuterol and formoterol
• LABAs are preferred for long-term control in combination with low-dose inhaled corticosteroids (ICS), and they are not used without anti-inflammatory medications
• The SMART study observed increased risks of respiratory-related death or life-threatening experiences with salmeterol, leading to FDA warnings
• Other beta agonists like terbutaline and isoproterenol are only used in emergencies
• Adverse effects of beta-2 agonists include heart rate changes, tremors, nervousness, hypokalemia, and potential tolerance with chronic use
• Inhaled corticosteroids (ICS) are the most effective anti-inflammatory agents for asthma, improving responsiveness to beta2 agonists and lung function
• ICS are preferred for daily maintenance therapy, with low, medium, and high-dose regimens depending on asthma severity
• Adverse effects of ICS include oral candidiasis, dysphonia, reflex cough, and various systemic effects
• A specific example of low-dose ICS-formoterol prescription is provided, with stepwise instructions for use
• Systemic corticosteroids are indicated for significant asthma exacerbations and have potential adverse effects such as headache, palpitations, tachycardia, agitation, emesis, and seizures
• Biologic agents like omalizumab (Xolair) are used for moderate to severe asthma with poor ICS control, administered via subcutaneous injection based on IgE levels and weight

Biologic Therapies for Severe Asthma

• Omalizumab (Xolair) is indicated for poorly controlled moderate to severe asthma in patients with positive skin or in vitro testing for allergens, and adverse effects include pain at injection, headache, and rare anaphylaxis.
• Mepolizumab is a monoclonal antibody to IL-5, indicated to reduce exacerbations in severe asthma patients with blood eosinophil counts of 150/microL or greater, administered subcutaneously.
• Reslizumab, a monoclonal anti-IL-5 antibody, is indicated for severe eosinophilic asthma in patients age 18 or older, administered via IV infusion every 4 weeks.
• Benralizumab, an interleukin-5 receptor antagonist, is indicated for severe eosinophilic asthma and administered subcutaneously.
• Dupilumab blocks the effects of IL-4, indicated for moderate-to-severe eosinophilic asthma, administered subcutaneously every other week.
• Tezepelumab is a monoclonal antibody that binds to epithelial cytokine TSLP, indicated for severe asthma maintenance in patients ≥12 years of age, administered subcutaneously every 4 weeks.
• The Global Initiative for Asthma classifies and manages asthma severity based on impairment and risk of exacerbations, determining changes in therapy.
• Newly diagnosed patients with mild intermittent asthma are treated with infrequent symptom relief, while those with severe asthma are referred to asthma specialists.
• Biomarkers for T2/eosinophilic asthma include child onset allergic and adult onset hypereosinophilic asthma.
• Risk factors for death due to asthma include a history of severe attacks, prior ICU admissions, and recent ED visits, among others.
• Mild to moderate asthma exacerbations can be managed at home with SABA or GC (budesonide)-formoterol, with reassessment to determine the next steps.
• Intermediate and poor responses to SABA require ED management with possible admission, including inhaled beta agonist and anticholinergic via nebulizer.