Secondary prevention

Asthma exacerbations are best prevented by long-term treatment with inhaled corticosteroids (ICS), and add-on therapy as required. This should be in conjunction with treatment of modifiable risk factors such as avoidance of known asthma triggers (e.g., allergens and cigarette smoking) and treatment of comorbidities such as obesity and anxiety.[106][157]​​ Add-on medical therapy (most commonly with a long-acting bronchodilator) not only improves asthma control but has been shown to reduce asthma exacerbations.[158]

For adults who have persistent asthma, but who have suboptimal control of their asthma despite daily use of an ICS, the addition of an LTRA can help to reduce moderate and severe asthma exacerbations and improve lung function and asthma control compared with the same dose of ICS alone. However, current evidence does not support LTRAs as an ICS-sparing agent.[106]

The use of a written, personalised asthma action plan should be strongly encouraged to support self-management.[1][55][56][147] Asthma and Lung UK: adult asthma action plan Opens in new window​ The asthma action plan helps patients to recognise when their asthma is deteriorating and how to respond appropriately: for example, increasing usual reliever and controller treatment, starting a short course of oral corticosteroids, and determining when to seek medical help.[55]

Guidelines also recommend treating modifiable risk factors and comorbidities (e.g., smoking, obesity, anxiety) and giving advice about non-pharmacological therapies and strategies when appropriate (e.g., physical activity, weight loss, avoidance of triggers).[1][55][56]​ They also recommend checking inhaler technique and adherence frequently.[1][55][56]

Vaccination schedules vary by location; consult local guidance for recommendations. Further information on UK and US vaccines, and special patient populations, can be found in their respective vaccination schedules. UKHSA: complete routine immunisation schedule Opens in new window CDC: ACIP recommendations Opens in new window​​​ Specific UK considerations:

  • Pneumococcal vaccinations are recommended for people with severe persistent asthma (including those who require frequent hospitalisation).[159][160]

  • Annual influenza vaccinations are recommended for people with asthma in the UK. Despite previous concerns that influenza vaccines might precipitate asthma attacks, current evidence suggests that this risk is very low.[161] [ Cochrane Clinical Answers logo ] ​ Influenza vaccination has not been shown to protect against asthma exacerbations.[161]

  • All patients with poorly controlled asthma should be up-to-date with coronavirus disease 2019 (COVID-19) vaccination.[162]

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