Case review

A patient with mild asthma symptoms and a yearly flare-up

Case review

A patient with mild asthma symptoms and a yearly flare-up

Esha Joshi, Helen K. Reddel

Figures

© albina gavrilovic/ istockphoto.com
© albina gavrilovic/ istockphoto.com

Abstract

Tom is a 24-year-old long-distance runner with a history of childhood asthma. He takes regular inhaled corticosteroid treatment. He experiences mild symptoms that are mainly exercise-induced and easily relieved with inhaled salbutamol. He has one exacerbation per year requiring a short course of oral corticosteroid, but he has had no hospitalisations in the past for asthma. How do you manage his asthma and exercise-induced symptoms?

Key Points

  • People with mild asthma symptoms are still at risk of serious consequences, such as severe flare-ups, and some deaths from asthma occur in people with mild or infrequent symptoms.
  • Overuse of short-acting bronchodilators is associated with an increased risk of exacerbations and asthma death.
  • Taking even four to five short courses of oral corticosteroids over seven years is associated with a significantly increased incidence of osteoporosis, diabetes, pneumonia and other adverse outcomes.
  • Inhaled corticosteroid (ICS)-containing treatments markedly reduce exacerbation risk, particularly when combination ICS-formoterol (formerly eformoterol) is taken instead of short-acting beta-2-agonist (SABA) as the patient’s symptom reliever, either alone or with maintenance ICS-formoterol.
  • As-needed low-dose budesonide-formoterol, taken for symptom relief, is a new level 2 treatment option for managing mild asthma in adults and adolescents, as an alternative to regular daily low-dose ICS plus as-needed SABA.
  • Using SABA alone should only be considered in patients with asthma who have symptoms less than twice a month and no risk factors for exacerbations (including no exacerbation in the past year).
  • Vocal cord dysfunction, now called inducible laryngeal obstruction, can mimic asthma or can coexist in people with asthma.