Asthma: keys to optimal long-term control

A chronic inflammatory disease

Asthma is a chronic inflammation of the bronchi that becomes hyperreactive. Dyspnea attacks, wheezing, nocturnal cough, chest tightness. Triggers: allergens, infections, exercise, cold air, pollution, tobacco, stress.

Long-term Solutions

Inhaled corticosteroids (ICS) – budesonide, fluticasone – are the cornerstone. They reduce inflammation and prevent attacks. To be taken daily, even without symptoms.

Combination ICS + long-acting beta-2 agonist (formoterol, salmeterol) if ICS alone is insufficient. Antileukotrienes (montelukast) and tiotropium are possible supplements.

Acute Solutions

Short-acting beta-2 agonists (salbutamol, terbutaline): 2 to 4 puffs in case of discomfort. If needed more than twice a week, the long-term treatment is insufficient.

Severe Asthma

Biotherapies have transformed the prognosis: omalizumab (anti-IgE), mepolizumab/benralizumab (anti-IL-5), dupilumab (anti-IL-4/13). They allow many patients to reduce or stop oral corticosteroids.

Daily Management

Written action plan, correct inhalation technique (90% of patients perform it incorrectly), trigger avoidance, flu vaccination, smoking cessation, adapted physical activity.