Asthma Treatment In Children And Adolescents With Fixed Combination Of Inhaled Corticosteroid (Ics)/Long-Acting Beta 2 Agonist (Laba). An Update

According to the current German asthma guidelines, the treatment of first choice for adult patients with bronchial asthma from therapy stage 3 onwards is a fixed combination of inhaled corticosteroid (ICS) and formoterol. The ICS/formoterol combination is recommended for long-term treatment as well as for symptom control and is called single maintenance and reliever therapy (sMART). This recommendation is also valid for adolescents. For children <= 11 years old very few data are available and additionally there is no medication licensed for sMART use in this age group (as of July 2021). There is a real paradigm shift in the treatment of mild asthma: since the fourth edition of the national treatment guidelines (NVL) on asthma and in the addendum 2020 of the S2k guidelines on asthma it is recommended to prescribe a fixed combination of ICS and formoterol for adults with mild asthma even at stage 1, with the aim to have the anti-inflammatory component present in any case and thereby to reduce future risks. Accordingly, a fixed combination of ICS and formoterol is a treatment option in stages 1 and 2 for adolescents, particularly taking into account that poor adherence to long-term treatment with low-dose ICS is a frequent problem in this age group. There is no such treatment recommendation for children up to the age of 12 years due to a lack of data: in this case, regular anti-inflammatory therapy with low-to medium-dose ICS should be initiated early and a short-acting 2-agonist for symptom control should be added. The most recent recommendations of the Global Initiative for Asthma (GINA) already go one step further (https://ginasthma.org/ginareports/).