Severe Asthma: An Update for 2019

Adam D. Highley, MD; Craig Cookman, DO; Lee E. Morrow, MD, FCCP, ATSF; Mark A. Malesker, PharmD, FCCP, FCCP, FCCM, FASHP, BCPS

Disclosures

US Pharmacist. 2019;44(7):HS 2-HS 7.

The Pharmacist's Role

It is essential that pharmacists stay abreast of current asthma treatment guidelines and be conversant with contemporary pharmacotherapy for severe asthma. As part of the interdisciplinary team, pharmacists have a role in optimizing asthma management and improving therapeutic outcomes. Asthma disease education, patient self-assessment of control, and an understanding of asthma medications are key elements of each patient interaction. Pharmacists can demonstrate proper inhaler technique, assess refill requests, monitor for drug interactions, reinforce medication adherence, and assist with product selection and insurance coverage.

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Table 1. Inhaler Therapy for Asthma
SABAs
Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA,
ProAir RespiClick, ProAir Digihaler)
Levalbuterol (Xopenex HFA)
Epinephrine (Primatene Mist HFA)
SAMA
Ipratropium (Atrovent HFA)
SABA/SAMA Combination
Albuterol/ipratropium (Combivent Respimat)
Corticosteroids
Beclomethasone (QVAR HFA)
Budesonide (Pulmicort Flexhaler)
Ciclesonide (Alvesco)
Flunisolide (Aerospan HFA)
Fluticasone propionate (Flovent Diskus, Flovent HFA,
ArmonAir RespiClick)
Fluticasone furoate (Arnuity Ellipta)
Mometasone (Asmanex Twisthaler, Asmanex HFA)
LABA
Salmeterol (Serevent Diskus)
Corticosteroid/LABA Combination
Fluticasone propionate/salmeterol (Advair Diskus, Advair
HFA, Wixela Inhub, AirDuo RespiClick, generic)
Fluticasone furoate/vilanterol (Breo Ellipta)
Budesonide/formoterol (Symbicort)
Mometasone/formoterol (Dulera)
LAMA
Tiotropium (Spiriva Respimat)

HFA: hydrofluoroalkane; LABA: long-acting beta agonist; LAMA: long-acting antimuscarinic antagonist; SABA: short-acting beta agonist; SAMA: short-acting antimuscarinic antagonist.

Table 2. Classification of Asthma-Exacerbation Severity
Severity PEF Clinical Course
Mild	≥70% of predicted or personal best	Home care, use of SABA, and possible short course of oral corticosteroids
Moderate	40%-69% of predicted or personal best	Office or ED visit, frequent use of SABA, oral corticosteroids, and possible hospital admission
Severe	25%-39% of predicted or personal best	Hospitalization, frequent use of SABA, oral corticosteroids, and adjunct therapy
Life-threatening	<25% of predicted or personal best	Likely ICU admission, IV corticosteroids, and adjunct therapy