Choice of therapy for patients who do not achieve control over bronchial asthma on basic therapy with medium doses of inhaled glucocorticosteroids/long-acting β2-agonists. Resolution of the Expert Council

Recently, new drugs for the treatment of bronchial asthma (BA) have been registered in the Russian Federation: fixed triple combinations, which include inhaled corticosteroids (ICS), long-acting β 2 -agonists (LABA) and anticholinergics, high-dose combinations of beclomethasone dipropionate (BDP) and formoterol (FORM) in the form of an extrafine metered-dose aerosol, which allows prescribing 800 mcg of extrafine BDP and 24 mcg of FORM per day. The aim of publishing the resolution of the Expert Council “Choice of therapy for patients who do not achieve control over bronchial asthma on basic therapy with medium doses of inhaled corticosteroids/long-acting β 2 -agonists” was to compare possible ways of therapy optimization and propose criteria for choosing therapeutic alternatives based on the individual clinical and phenotypic characteristics. Conclusion. If a patient does not achieve asthma control (or had asthma exacerbations over the past year) with alternative therapy at step 4, it is advisable to switch to a maintenance and relief therapy (MART) regimen with fixed combination of inhaled corticosteroids/formoterol and with medium doses of ICS in the maintenance part of the regimen. In patients with poor control on alternative therapy with a medium dose of ICS, it is advisable to consider increasing the dose of ICS as part of an ICS/LABA combination or as part of a triple combination instead of switching to MART. Switching to a medium- or high-dose triple combination is especially useful for patients with fixed obstruction and when bronchial asthma is combined with chronic obstructive pulmonary disease. In patients who require high-dose therapy, it is advisable to consider prescribing high doses of ICS using an extrafine combination of BDP/FORM (400/12 mcg in the morning and evening). If MART with a medium dose of ICS does not prevent exacerbations, provide normal spirometry results and/or good control of symptoms, MART in combination with an anticholinergic drug should be used at step 5. If triple therapy or high doses of ICS/LABA are insufficiently effective, biological therapy should be considered.