GÜLFEM ELİF ÇELİK, ÖMÜR AYDIN, EBRU DAMADOĞLU, AYŞE BAÇÇIOĞLU, SEÇİL KEPİL ÖZDEMİR, SEVİM BAVBEK, DANE EDİGER, FERDA ÖNER ERKEKOL, BİLUN GEMİCİOĞLU, SACİDE RANA IŞIK, AYŞE FÜSUN KALPAKLIOĞLU, ALİ FUAT KALYONCU, GÜL KARAKAYA, METİN KEREN, DİLŞAD MUNGAN, İPEK KIVILCIM OĞUZÜLGEN, FÜSUN YILDIZ, İNSU YILMAZ, ARZU YORGANCIOĞLU
Thoracic Research and Practice - 2023;24(6):309-324
Introduction of inhaled corticosteroids (ICS) has been the cornerstone of the long-term management of asthma. ICSs either alone or in combination with long-acting beta-2 agonists have been shown to be associated with favorable asthma outcomes. However, asthma control is still reported to be below expectations all around the world. Research in the last decades focusing on the use of ICS/formoterol both as maintenance and as needed (maintenance and reliever therapy approach) showed improved asthma outcomes. As a result of recent developments, Turkish Asthma Guidelines group aimed to revise asthma treatment recommendations. In general, we recommend physicians to consider the risk factors for poor asthma outcomes, patients’ compliance and expectations and then to determine “a personalized treatment plan.” Importantly, the use of short-acting beta-2 agonists alone as a symptom reliever in asthma patients not using regular ICS is no longer recommended. In stepwise treatment approach, we primarily recommend to use ICS-based controllers and initiate ICS as soon as possible. We define 2 different treatment tracks in stepwise approaches as maintenance and reliever therapy or fixed-dose therapy and equally recommend each track depending on the patient’s risks as well as decision of physicians in a personalized manner. For both tracks, a strong recommendation was made in favor of using add-on treatments before initiating phenotype-specific treatment in step 5. A strong recommendation was also made in favor of using biologic agents and/or aspirin treatment after desensitization in severe asthma when indicated.
