The pharmacological management of asthma in adults: 2023 update

ABSTRACT

Introduction

The pharmacotherapy of asthma is a dynamic process that changes as our knowledge of the underlying pathophysiology and treatment of this disease continues to evolve. This implies the need for continuous revision of the recommendations of asthma guidelines and strategies.

Areas covered

This review summarizes the latest key practical information on the pharmacological management of asthma in adults. We provide the background to the 2023 update of the GINA strategy report, focusing on changes and discussing areas of uncertainty. We review current and emerging pharmacotherapy for uncontrolled asthma, including synthetic agents and new biologics, and provide expert perspectives and opinions on the treatment of uncontrolled asthma.

Expert opinion

The current pharmacological treatment of asthma, based on a step-by-step, control-based approach, with ICSs, LABAs and LAMAs being the mainstay generally provides good symptom control. Biologic therapies are often effective in treating T2_high severe asthma. However, there is still room for improvement, such as the discovery of new molecules that specifically target chronic inflammation and, most importantly, the ability to provide solutions to the various areas of uncertainty that still exist. Also finding solutions to improve the accessibility and affordability of rescue ICS in resource-constrained settings is critical.

KEYWORDS:

• Asthma
• biologics
• biomarkers
• Global initiative for asthma
• guidelines
• pharmacotherapy
• treatable traits

Article highlights

• Current asthma pharmacotherapy is well defined by guidelines and strategies, whose recommendations usually result in adequate symptomatic control.

• Asthma treatment is based on a step-by-step, control-based approach, with ICSs, LABAs, LAMAs, and biologics being the mainstay.

• In the GINA 2023 report, changes related to pharmacologic management are few and not substantial.

• There is still room for improvement, including the discovery of new molecules that specifically target chronic inflammation and the resolution of the various uncertainties in the therapeutic approach that still exist.

• Until such improvements are made, the best treatment approach for asthma remains proper implementation of the most recent guideline/strategy recommendations.

• Finding solutions to improve the accessibility and affordability of rescue ICS in resource-constrained settings is critical to optimizing asthma management.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.