title: [Asthma exacerbations: pharmacological prevention].
abstract: Asthma exacerbations are responsible for many emergency medical interventions and account for a significant proportion of the health costs of the disease. Increased airway inflammation is a key feature of exacerbations in asthma and therefore inhaled corticosteroids (ICS) are considered as first-line therapy for long-term asthma control. ICS have been demonstrated to reduce the risk of asthma exacerbations, as well as improving lung function. Oral leukotriene receptor antagonists also reduce the incidence of asthma exacerbations but are less effective than ICS. In patients with inadequately controlled persistent asthma despite low-dose ICS, the addition of a long-acting inhaled beta-agonist (LABA) should be considered. LABA should not be given alone and should always be associated with ICS in asthma. The anti-immunoglobulin E antibody, omalizumab, reduces severe exacerbations and emergency visits in patients with severe allergic asthma. In clinical trials measurement of the inflammatory response in induced sputum could provide information concerning appropriate drug therapy. Asthma-associated comorbidities should be investigated and treated, particularly in severe asthma. Despite a high prevalence of both gastro-oesophageal reflux and allergic rhinitis among patients with asthma, treatment with proton-pump inhibitors or nasal corticosteroids does not reduce the rate of asthma exacerbations.
authors.affiliation: Laboratoire de pharmacologie pulmonaire, UPRES EA220, hôpital Foch, université Versailles--Saint-Quentin-en-Yvelines, Suresnes, France.
authors.forename: S
authors.initials: S
authors.lastname: Grassin-Delyle
authors.forename: P-O
authors.initials: PO
authors.lastname: Girodet
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D001249:Asthma / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007252:Influenza Vaccines / Q000009:adverse effects; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D009330:Nebulizers and Vaporizers; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D016540:Smoking Cessation
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D000319:Adrenergic beta-Antagonists; D018927:Anti-Asthmatic Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007252:Influenza Vaccines; D020024:Leukotriene Antagonists; D010726:Phosphodiesterase Inhibitors; D010975:Platelet Aggregation Inhibitors; D007073:Immunoglobulin E; D001241:Aspirin