title: Symptom-based controller therapy: a new paradigm for asthma management.
abstract: Appropriate management of persistent asthma, according to US and international guidelines, requires daily use of controller medications, most generally, inhaled corticosteroids (ICS). This approach, although effective and well established, imposes burdens of treatment and side effects onto asthma patients. A growing body of evidence suggests that patients with persistent asthma need not be managed with daily ICS, but rather can use them on an intermittent basis, occasioned by the occurrence of symptoms sufficient to warrant treatment with a rescue inhaler. Large, randomized, controlled studies, over a range of asthma severity, and in a range of ages from pediatrics to adults, suggest that, in well-selected patients, a symptom-based approach to administering controller therapy may produce equivalent outcomes, while reducing exposure to ICS. The concept of providing anti-inflammatory treatment to the patient, at the time inflammation is developing, is termed 'temporal personalization'. The evidence to date suggests that symptom-based controller therapy is broadly useful in selected asthma patients, and is a management approach that could be incorporated into US and international guidelines for asthma.
authors.affiliation: Division of Allergy and Clinical Immunology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Divekar
authors.forename: Bill T
authors.initials: BT
authors.lastname: Ameredes
authors.forename: William J
authors.initials: WJ
authors.lastname: Calhoun
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D006801:Humans; D009330:Nebulizers and Vaporizers
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents
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