Ann Allergy Asthma Immunol. 2021 Aug 13:S1081-1206(21)00572-X. doi: 10.1016/j.anai.2021.08.014. Online ahead of print.
OBJECTIVE: To provide an overview of the risk factors and mechanisms underlying asthma exacerbations and the role of inhaled corticosteroids in preventing exacerbations.
DATA SOURCES: Queries for asthma exacerbations and inhaled corticosteroids were conducted using PubMed, searching for primary articles and reviews.
STUDY SELECTION: Studies written in English, with a focus on well-designed randomized controlled clinical trials.
RESULTS: Asthma exacerbations remain a major source of morbidity, with future exacerbations most likely among patients with prior exacerbations and among those with peripheral blood eosinophilia. Exacerbations are often triggered by viral respiratory tract infections, but recent evidence support non-viral triggers as well. In terms of exacerbation prevention, several approaches to inhaled corticosteroid therapy have been demonstrated to be effective, including intermittent high dose ICS without use of background controller in preschool children with recurrent episodic wheezing, intermittent high dose ICS without use of background controller in adults with mild asthma, and as needed ICS dosing whenever rescue treatment is needed among children, adolescents, and adults with mild asthma not receiving daily controller therapy.
CONCLUSION: Inhaled corticosteroids are highly effective in preventing exacerbations of asthma. Multiple dosing strategies have been demonstrated to reduce exacerbation risk, allowing for a personalization of approaches based upon individual patient phenotypes and preferences.