Principles of selecting therapy for patients with mild asthma. RAACI and RRO agreed recommendations

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The recommendations represent the rating scheme of the assessment and selection of therapy for patients with mild asthma. The variety of therapeutic options for the treatment of easy asthma can provide the achievement of the disease control, or if it is impossible to create a good continuity with the next steps of therapy. Fixed IGX/ KDBA and IGX/DBA combinations increase the compliance and effectiveness of therapy. The creation of therapy algorithms of mild asthma will be an important step to optimize medical care and to attract the attention of doctors to the problem of easy asthma. The goal of recommendations. To provide clinicians with based on the results of controlled clinical trials algorithms for mild asthma treatment.

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About the authors

S N Avdeev

FGBU «NRI of pulmonology» FMBA of Russia


Z R Aysanov

FGBU «NRI of pulmonology» FMBA of Russia

V V Arkhipov

FGBOU DPO RMAPO Ministry of health of Russia

A S Belevskiy

Russian national research medical University named after N.I. Pirogov Ministry of health of Russia

A A Viesel

FGBOU VO «Kazan state medical University MOH» Ministry of health of Russia

I V Demko

PO FGBOU VO «Krasnoyarsk state medical University Named after In. F. VoynoYasenetsky» Ministry of health of Russia

A V Emelyanov

FGBOU VO «Northwestern state medical University Named after I.M. Mechnikov» Ministry of health of Russia

N I Ilina

Institute of Immunology

O M Kurbacheva

Institute of Immunology

I V Leshchenko

FGBOU VO «Ural state medical University» Ministry of health of Russia

N M Nenasheva

FGBOU DPO RMAPO Ministry of health of Russia

S I Ovcharenko

FGAOU «First MSMU named after I.M. Sechenov» Ministry of health of Russia

R S Fassahov

GBOU DPO «Kazan state medical Academy» - a branch of FGBOU DPO RMAPO Ministry of health of Russia


  1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2016. Available from: www.
  2. Djukanovic R., Wilson J.W, Britten K.M. et al. Effect of an inhaled corticosteroid on airway inflammation and symptoms in asthma. Am. Rev. Respir. Dis. 1992, v. 145, p. 669-674.
  3. Bousquet J., Chanez P., Lacoste J.Y et al. Eosinophilic inflammation in asthma. N. Engl. J. Med. 1990, v. 323, p. 1033-1039.
  4. Boulay M.E., Boulet L.P. Discordance between asthma control clinical, physiological and inflammatory parameters in mild asthma. Respir. Med. 2013, v. 107, p. 511-518.
  5. Calhoun W.J., Sutton L.B., Emmett A., Dorinsky P.M. Asthma variability in patients previously treated with ß2-agonists alone. J. Allergy Clin. Immunol. 2003, v. 112, p. 1088-1094.
  6. Dusser D., Montani D., Chanez P. et al. Mild asthma: an expert review on epidemiology, clinical characteristics and treatment recommendations. Allergy. 2007, v. 62, p. 591-604.
  7. Doz M., Chouaid C., Com-Ruelle L. et al. The association between asthma control, health care costs, and quality of life in France and Spain. BMC Pulm. Med. 2013, v. 22, р. 13-15.
  8. Com-Ruelle L., Crestin B., Dumesnil S. [L’asthme en France selon les stades de sévérité] (in French). Paris: CREDES 2000, rapport no 1290.
  9. Ненашева Н.М., Буриев Б.Б. Особенности атопической бронхиальной астмы у взрослых. Рос. Аллергол. Журн. 2009, № 4, с. 12-17.
  10. Архипов В.В., Григорьева Е.В., Гавришина Е.В. Контроль над бронхиальной астмой в России: результаты многоцентрового наблюдательного исследования НИКА. Пульмонология. 2011, № 6, с. 80-86.
  11. Rabe K.F., Adachi M., Lai C.K. et al. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J. Allergy. Clin. Immunol. 2004, v. 114, р. 40-47.
  12. Myrphy K.R., Meltzer E.O., Blaiss M.S. et al. Asthma management and control in the United States: Results of the 2009 Asthma Insight and Management survey. Allergy Asthma Prot. 2012, v. 33, р. 54-54.
  13. Salmeron S., Liard R., Elkharrat D. et al. Asthma severity and adequacy of management in accident and emergency departments in France: a prospective study. Lancet. 2001, v. 358, р. 629-635.
  14. Miller M.K., Lee J.H., Miller D.P., Wenzel S.E. Recent asthma exacerbations: a key predictor of future exacerbations. Respir. Med. 2007, v. 101, р. 481-489.
  15. Haselkom T., Fish J.E., Zeiger R.S. et al. Consistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J. Allergy Clin. Immunol. 2009, v. 124, р. 895-902, e1-4.
  16. Osborne M.L., Pedula K.L., O’Hollaren M. et al. Assessing future need for acute care in adult asthmatics: the Profile of Asthma Risk Study: a prospective health maintenance organization-based study. Chest. 2007, v. 132, р. 1151-1161.
  17. Burks A.W., Tang M., Sicherer S. et al. ICON: food allergy. J. Allergy Clin. Immunol. 2012, v. 129, р. 906-920.
  18. Fitzpatrick S., Joks R., Silverberg J.I. Obesity is associated with increased asthma severity and exacerbations, and increased serum immunoglobulin E in inner-city adults. Clin. Exp. Allergy. 2012, v. 42, р. 747-759.
  19. Bousquet J., Khaltaev N., Cruz A.A. et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA2LEN and AllerGen). Allergy. 2008, v. 63, Suppl., р. 86:8-160.
  20. Ulrik C.S. Peripheral eosinophil counts as a marker of disease activity in intrinsic and extrinsic asthma. Clin. Exp. Allergy. 1995, v. 25, р. 820-827.
  21. Murphy V.E., Clifton V.L., Gibson P.G. Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes. Thorax. 2006, v. 61, р. 169-176.
  22. Levy M.L., Hardwell A., McKnight E., Holmes J. Asthma patients’ inability to use a pressurised metered-dose inhaler (pMDI) correctly correlates with poor asthma control as defined by the global initiative for asthma (GINA) strategy: a retrospective analysis. Prim. Care Respir. J. 2013, v. 22, р. 406-411.
  23. Melani A.S., Bonavia M., Cilenti V. et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir. Med. 2011, v. 105, р. 930-938.
  24. Why asthma still kills: the National Review of Asthma Deaths (NRAD) Confidential Enquiry report. Royal College of Physicians, London, 2014. Available from: http://www.rcplondon.
  25. Barnes P. Effect of beta agonists on inflammatory cells. J. Allergy Clin. Immunol. 1999, v. 104, p. 10-17.
  26. Cazzola M., Page C.P., Rogliani P., Matera M.G. β2-agonist therapy in lung disease. Am. J. Respir. Crit. Care Med. 2013, v. 187, p. 690-696.
  27. Jen R., Rennard S., Sin D. Effects of inhaled corticosteroids on airway inflammation in chronic obstructive pulmonary disease: a systematic review and meta-analysis. International journal of chronic obstructive pulmonary disease. 2012, v. 7, p. 587-595.
  28. Pauwels R.A., Pedersen S., Busse W.W. et al. Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial. Lancet. 2003, v. 36, p. 1071-1076.
  29. Reddel H.K., Busse W.W., Pedersen S. et al. Should recommendations about starting inhaled corticosteroid treatment for mild asthma be based on symptom frequency: a post-hoc efficacy analysis of the START study. Lancet. 2016, v. 29, pii: S0140-6736(16)31399-X.
  30. The Childhood Asthma Management Program Research Group. Long-term effects of budesonide or nedocromil in children with asthma. N. Engl. J. Med. 2000, v. 343, p. 1054-1063.
  31. O’Byrne P.M., Barnes P.J., Rodriguez-Roisin R. et al. Low dose inhaled budesonide and formoterol in mild persistent asthma: the OPTIMA randomized trial. Am. J. Respir. Crit. Care Med. 2001, 15, v. 164, p. 1392-1397.
  32. Powell H., Gibson P.G. Inhaled corticosteroid doses in asthma: an evidence-based approach. Med. J. Aust. 2003, v. 178, p. 223-225.
  33. Powell H., Gibson P. High dose versus low dose inhaled corticosteroid as initial starting dose for asthma in adults and children (review). Cochrane Database Syst. Rev. 2003, v. 4, p. 992-999.
  34. Kim H.S., Moon J.W., Chung S.M., Lee J.H. A short-term investigation of dysphonia in asthmatic patients using inhaled budesonide. J. Voice. 2011, v. 25, p. 88-93.
  35. Thomas M.S., Parolia A., Kundabala M., Vikram M. Asthma and oral health: a review. Aust. Dent. J. 2010, v. 55, p. 128-133.
  36. Van Grunsven P.M. The magnitude of fear of adverse effects as a reason for nonparticipation in drug treatment: a short review. J. Asthma. 2001, v. 38, p. 113-119.
  37. Jentzsch N.S., Camargos P., Sarinho E.S., Bousquet J. Adherence rate to beclomethasone dipropionate and the level of asthma control. Respir. Med. 2012, v. 106, p. 338-343.
  38. Lacasse Y., Archibald H., Ernst P., Boulet L.P. Patterns and determinants of compliance with inhaled steroids in adults with asthma. Can. Respir. J. 2005, v. 12, p. 211-217.
  39. Price D., Fletcher M., van der Molen T. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ. Prim. Care Respir. Med. 2014, v. 12, p. 24:14009.
  40. Partridge M.R., van der Molen T., Myrseth S.E., Busse W.W. Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study. BMC Pulm. Med. 2006, v. 13, p. 6-13.
  41. Rabe K.F., Vermeire P.A., Soriano J.B., Maier W.C. Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study. Eur. Respir. J. 2000, v. 16, p. 802-807.
  42. Sovani M.P., Whale C.I., Oborne J. et al. Poor adherence with inhaled corticosteroids for asthma: can using a single inhaler containing budesonide and formoterol help? Brit. J. General Practice. 2008, v. 58, p. 37-43.
  43. Boushey H.A., Sorkness C.A., King T.S. et al. Daily versus as-needed corticosteroids for mild persistent asthma. N. Engl. J. Med. 2005, 14, v. 352, p. 1519-1528.
  44. Aalbers R., Vogelmeier C., Kuna P. Achieving asthma control with ICS/LABA: A review of strategies for asthma management and prevention. Respir. Med. 2016, v. 111, p. 1-7.
  45. Papi A., Canonica G.W., Maestrelli P. et al. Rescue use of beclomethasone and albuterol in a single inhaler for mild asthma. N. Engl. J. Med. 2007, v. 356, p. 2040-2052.
  46. Ramsay C.F., Pearson D., Mildenhall S., Wilson A.M. Oral montelukast in acute asthma exacerbations: a randomised, double-blind, placebo-controlled trial. Thorax. 2011, v. 66, p. 7-11.
  47. Watts K., Chavasse R.J. Leukotriene receptor antagonists in addition to usual care for acute asthma in adults and children. Cochrane Database Syst. Rev. 2012, v. 5, Cd006100.
  48. Ng D., Salvio F., Hicks G. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/ or chronic asthma in adults and children. Cochrane Database Syst. Rev. 2004, v. 2, CD002314.
  49. Chauhan B.F., Ducharme F.M. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children. Cochrane Database Syst. Rev. 2012, v. 5, CD002314.
  50. Philip G., Nayak A.S., Berger WE. et al. The effect of montelukast on rhinitis symptoms in patients with asthma and seasonal allergic rhinitis. Curr. Med. Res. Opin. 2004, v. 20, p. 1549-1558.
  51. Wilson A.M., Dempsey O.J., Sims E.J., Lipworth B.J. A comparison of topical budesonide and oral montelukast in seasonal allergic rhinitis and asthma. Clin. Exp. Allergy. 2001, v. 31, p. 616-624.
  52. Guevara J.P., Ducharme F.M., Keren R. et al. Inhaled corticosteroids versus sodium cromoglycate in children and adults with asthma. Cochrane Database Syst. Rev. 2006, CD003558.
  53. Sridhar A.V., McKean M. Nedocromil sodium for chronic asthma in children. Cochrane Database Syst. Rev. 2006, CD004108.
  54. Price D., Popov T.A., Bjermer L. et al. Effect of montelukast for treatment of asthma in cigarette smokers. J. Allergy Clin. Immunol. 2013, v. 131, p. 763-771.
  55. Laube B.L., Janssens H.M., de Jongh F.H. et al. What the pulmonary specialist should know about the new inhalation therapies. Eur. Respir. J. 2011, v. 37, p. 1308-1331.



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