One study included difference in Mini-Asthma Quality of Life Questionnaire (Mini-AQLQ) response scores as a secondary efficacy endpoint. There was no significant difference between LABAs and tiotropium on asthma control as measured by ACQ (Table 2) 21, 33, 34. Four papers compared the effect of LABAs directly with tiotropium. reported that there was no difference of effect between tiotropium (5 µg and 2.5 µg) and placebo on ACQ score. Data for LAMA (tiotropium) are more varied (Table 2) 21, 27, 28, 29, 30, 31. The LTRA (montelukast) did not have an effect on asthma control when compared with placebo (measured by ACQ) (Table 2) 32. LABA (salmeterol) significantly improved asthma control when added to ICS compared with placebo (measured by Asthma Control Questionnaire ) 21. The search strings for LAMA studies generated 106 publications, of which 8 RCTs met the criteria for inclusion in this review 21, 22, 27, 28, 29, 30, 31. The search strings for LTRA studies generated 54 publications, of which 3 RCTs met the criteria for inclusion in this review 24, 25, 26. The search strings for LABA studies generated 164 publications, of which 1 meta-analysis and 4 additional RCTs met the criteria for inclusion in this review 16, 21, 22, 23. The literature search identified 14 relevant publications that met the inclusion criteria for this review: 2 Cochrane reviews and 12 additional randomised controlled trials (RCTs) that were not included within the Cochrane reviews. 2) therefore, addition of an add-on therapy may be considered to be a more effective and safer treatment strategy 11, 12, 13. In addition, evidence suggests that the ICS dose–response curve is relatively flat, with 80–90% of the maximum achievable therapeutic effect in adult asthma obtained at 200–250 μg of fluticasone propionate or equivalent (Fig. Add-on treatments may therefore be required 9. In addition, most of the clinical benefit of ICS use is seen at low doses. However, if asthma remains uncontrolled despite medium-dose ICS, increasing the dose of ICS may not be appropriate due to an increased risk of local and systemic side effects and variation in individual ICS dose-responsiveness between patients. Inhaled corticosteroids (ICS) are considered an effective long-term controller treatment in the management of asthma 10. The Global Initiative for Asthma (GINA) strategy recommends a stepwise approach to asthma management in order to achieve symptom control and prevent future risks, including exacerbations, loss of lung function, and side effects of medication (Fig. Reducing asthma symptoms and future risk through correct add-on therapy and management in patients who remain uncontrolled despite treatment is a major challenge for those working in both secondary and primary care. Physicians may underestimate the prevalence and severity of symptoms and overestimate the degree to which the patient’s asthma is controlled, meaning the patient may not receive adequate medication to achieve control of their disease 2, 7. It has been suggested that patients may overestimate and thus inaccurately report their level of disease control, because they accept and tolerate a certain level of symptoms, assuming them to be an inevitable consequence of asthma 7, 8. Many patients with asthma remain symptomatic, despite treatment, for multiple different reasons 2, 3, 4, 5, 6.

This information could aid decision-making in primary care, supporting the use of add-on therapy to ICS to help improve lung function, control asthma symptoms and prevent exacerbations.Īsthma is a serious global health issue that affects all age groups, with a reported 339 million sufferers worldwide, presenting a number of challenges for primary care physicians 1. In children, results were positive and comparable between therapies, but data are scarce. In adults, LAMAs and LABAs provide a greater improvement in lung function than LTRAs as add-on to ICS. We explore the challenges of asthma management in primary care and review outcomes from randomised controlled trials and meta-analyses comparing the long-acting muscarinic antagonist (LAMA) tiotropium with long-acting β 2-agonists (LABAs) or leukotriene receptor antagonists (LTRAs) as add-on to ICS in patients with asthma. However, many patients remain poorly controlled, and evidence-based algorithms to decide on the best order and rationale for add-on therapies are lacking. The Global Initiative for Asthma recommends a stepwise approach to adjust asthma treatment to the needs of individual patients inhaled corticosteroids (ICS) remain the core pharmacological treatment.

Lama laba vs symbicort