Page 32 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 32
glucocorticoids and rely on SABAs for symp- Summary
tom relief, a phenomenon more intense in
severe asthma forum 1: severe asthma - basic and clinical views mild asthma. However, SABAs do not ad- The long journey of corticosteroids in asth-
dress the underlying inflammatory process ma started in early 1950s. Despite their severe
and they do not protect against exacerbations. adverse effects, the parenteral and oral forms
On the contrary SABA overuse is related to of these agents were a life changing medica-
high asthma mortality.68,69 tion for asthmatics, whose treatment options
were almost non-existent until then. Twenty
SYGMA 1 and SYGMA2 are both mul- years later, the first inhaled steroids proved to
ticenter, phase III, randomized, double-blind, be effective and safer, limiting the use of oral
52-week, placebo-controlled studies, involv- agents to more severe stages of disease and
ing asthma patients who were assessed as during asthma exacerbations. Personalized,
needing GINA step 2 treatment. In the SYG- phenotype-based treatment approaches using
MA 1 study, patients were randomly sepa- combinations of ICS with LABA, newer in-
rated into three subgroups: i) terbutaline as halation devices and, when needed, biologics
needed group, ii) budesonide-formoterol as for severe asthma are the new reality for all
needed group, and iii) budesonide-formoter- asthma patients. For the majority of patients,
ol regular maintenance group.70 This study the target is to obtain control of asthma with
showed that, budesonide-formoterol as need- the least (optimal) dose of ICS that each pa-
ed treatment was superior to terbutaline in tient requires. ICSs combined with LABAs
outcomes as asthma control and severe ex- remain the cornerstone of asthma therapy.
acerbations and equivalent to maintenance
budesonide, but with an 83% lower medi- References
an daily ICS dose. In SYGMA 2, the regu-
lar use of low dose ICS budesonide plus SABA 1. Global Initiative for Asthma. Global
as needed was tested against low dose budeso- Strategy for Asthma Management and
nide-formoterol as needed in asthmatics with Prevention [Internet]. [place unknown]:
mild asthma. In this study, BUD/FORM as Global Initiative for Asthma, c2021.
needed was non-inferior to BUD alone for re- Available from: https://ginasthma.org/.
ducing severe asthma exacerbations but re-
sulted in 75% lower median daily ICS dose.71 2. Marketos SG, Ballas CN. Bron-
These data resulted in fundamental chang- chial asthma in the medical litera-
es in the treatment of intermittent and mild ture of Greek antiquity. J Asthma.
asthma, the biggest changes since the ini- 1982;19(4):263-9.
tial development of GINA recommenda-
tions almost three decades ago (1995): The 3. Cserháti E. The history of bronchi-
2019 guidelines proposed that adults and ad- al asthma from the Renaissance till the
olescents with mild asthma should prefera- beginning of the twentieth century.
bly be treated with ICS-containing regimens: Acta Physiol Hung. 2005;92(2):181-92.
as-needed low-dose ICS-formoterol in Step 1
and as needed low-dose ICS plus as-needed 4. Hide Salter H. On asthma: its pa-
SABA or as-needed low-dose ICS-formoterol thology and treatment. London: John
in Step 2. And this was the last major advance Churchill; 1860.
in asthma treatment confirming the essential
role of ICS in treatment even in mild stages of 5. Schwartz RS. Paul Ehrlich’s mag-
the disease.72 ic bullets. N Engl J Med. 2004 Mar
11;350(11):1079-80.
6. Osler W. The Principles and Practice of
Medicine. New York: D. Appleton and
Company, 1892. 1079 p.
7. Diamant Z, Diderik Boot J, Chris-
tian Virchow J. Summing up 100
tom relief, a phenomenon more intense in
severe asthma forum 1: severe asthma - basic and clinical views mild asthma. However, SABAs do not ad- The long journey of corticosteroids in asth-
dress the underlying inflammatory process ma started in early 1950s. Despite their severe
and they do not protect against exacerbations. adverse effects, the parenteral and oral forms
On the contrary SABA overuse is related to of these agents were a life changing medica-
high asthma mortality.68,69 tion for asthmatics, whose treatment options
were almost non-existent until then. Twenty
SYGMA 1 and SYGMA2 are both mul- years later, the first inhaled steroids proved to
ticenter, phase III, randomized, double-blind, be effective and safer, limiting the use of oral
52-week, placebo-controlled studies, involv- agents to more severe stages of disease and
ing asthma patients who were assessed as during asthma exacerbations. Personalized,
needing GINA step 2 treatment. In the SYG- phenotype-based treatment approaches using
MA 1 study, patients were randomly sepa- combinations of ICS with LABA, newer in-
rated into three subgroups: i) terbutaline as halation devices and, when needed, biologics
needed group, ii) budesonide-formoterol as for severe asthma are the new reality for all
needed group, and iii) budesonide-formoter- asthma patients. For the majority of patients,
ol regular maintenance group.70 This study the target is to obtain control of asthma with
showed that, budesonide-formoterol as need- the least (optimal) dose of ICS that each pa-
ed treatment was superior to terbutaline in tient requires. ICSs combined with LABAs
outcomes as asthma control and severe ex- remain the cornerstone of asthma therapy.
acerbations and equivalent to maintenance
budesonide, but with an 83% lower medi- References
an daily ICS dose. In SYGMA 2, the regu-
lar use of low dose ICS budesonide plus SABA 1. Global Initiative for Asthma. Global
as needed was tested against low dose budeso- Strategy for Asthma Management and
nide-formoterol as needed in asthmatics with Prevention [Internet]. [place unknown]:
mild asthma. In this study, BUD/FORM as Global Initiative for Asthma, c2021.
needed was non-inferior to BUD alone for re- Available from: https://ginasthma.org/.
ducing severe asthma exacerbations but re-
sulted in 75% lower median daily ICS dose.71 2. Marketos SG, Ballas CN. Bron-
These data resulted in fundamental chang- chial asthma in the medical litera-
es in the treatment of intermittent and mild ture of Greek antiquity. J Asthma.
asthma, the biggest changes since the ini- 1982;19(4):263-9.
tial development of GINA recommenda-
tions almost three decades ago (1995): The 3. Cserháti E. The history of bronchi-
2019 guidelines proposed that adults and ad- al asthma from the Renaissance till the
olescents with mild asthma should prefera- beginning of the twentieth century.
bly be treated with ICS-containing regimens: Acta Physiol Hung. 2005;92(2):181-92.
as-needed low-dose ICS-formoterol in Step 1
and as needed low-dose ICS plus as-needed 4. Hide Salter H. On asthma: its pa-
SABA or as-needed low-dose ICS-formoterol thology and treatment. London: John
in Step 2. And this was the last major advance Churchill; 1860.
in asthma treatment confirming the essential
role of ICS in treatment even in mild stages of 5. Schwartz RS. Paul Ehrlich’s mag-
the disease.72 ic bullets. N Engl J Med. 2004 Mar
11;350(11):1079-80.
6. Osler W. The Principles and Practice of
Medicine. New York: D. Appleton and
Company, 1892. 1079 p.
7. Diamant Z, Diderik Boot J, Chris-
tian Virchow J. Summing up 100
