Controller medications

(JAMA 2020;324:2301)

• ICS Rx of choice. Superior to LAMA if sputum w/ ≥2% eos (NEJM 2019;380:2009). PO steroids may be needed for severely uncontrolled asthma; avoid if possible b/c of systemic side effects.

• LABA (eg, salmeterol, formoterol) safe & ↓ exacerb. when added to ICS (NEJM 2018;378:2497)

• Long-acting inh antimuscarinics (LAMA; eg, tiotropium, umeclidinium): may consider if sx despite ICS+LABA (JAMA 2018;319:1473)

• Leukotriene receptor antagonists (LTRA): some Pts very responsive, esp. ASA-sens and exercise-induced. Warning for serious neuropsychiatric effects, including suicide.

• Nedocromil/cromolyn: limited use in adults. Useful in young Pts, exercise-induced bronchospasm; ineffective unless used before trigger or exercise exposure.