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Asthma

Asthma Treatment

Asthma is treated by avoiding known asthma triggers, monitoring breathing, and taking medications to prevent attacks and treat any symptoms that might occur.

The National Health, Lung, and Blood Institute guidelines recommend the referral to an asthma care specialist for people with asthma who:

  • Have experienced a life-threatening asthma attack.
  • Have other conditions that complicate asthma or its diagnosis.
  • Have symptoms that are atypical or other conditions that complicate the diagnosis.
  • Remain unresponsive to therapy after 3 to 6 months of treatment.
  • Require additional allergy or lung function tests.

Asthma care specialists include:

  • Allergists (doctors who specialize in the diagnosis and treatment of allergies)
  • Pulmonologists (doctor who specialize in lung and respiratory disorders)
  • Doctors with additional asthma management-experience

New Asthma Guidelines

In 2007, the National Asthma Education and Prevention Program (NAEPP) issued the first comprehensive update in a decade to the clinical guidelines for the diagnosis and management of asthma. The guidelines emphasize the importance of asthma control and introduce new approaches for monitoring asthma. They focus on four components of asthma care: measures to assess and monitor asthma, patient education, control of environmental factors and other conditions that can worsen asthma, and medications.

The new guidelines emphasize the routine use of inhaled corticosteroids as the standard of care for most people with chronic persistent asthma. Asthma can be controlled for many children ages 5 to 11 with a low daily dose of inhaled corticosteroid, rather than combination treatments. The guidelines also stress the need for people to be taught how to use inhalers properly and take their controller medications even when they don't have asthma symptoms.

The new guidelines stipulate that:

  • All people with asthma should be monitored by a doctor every one to six months, regardless of symptoms.
  • Everyone should have a written asthma action plan with instructions for daily treatment and what to do if symptoms become worse.
  • Asthma care should include education that takes into account the person's cultural background and literacy level.
  • People should play an active role in managing their asthma.
  • A stepwise asthma treatment approach is recommended, with medication increased when asthma symptoms worsen and decreased, if possible, when asthma is under control.

Common asthma treatments include:

Preventive measures

Asthma preventative measures are designed to prevent or limit asthma attacks. The measures include visiting the doctor for regular checkups; developing an asthma action plan; monitoring breathing; keeping an asthma diary; avoiding asthma triggers; and taking asthma medications.

Visiting the doctor for regular checkups

It's important for people with asthma to visit their doctor regularly. If their symptoms change or they develop side effects to their medications, their doctor may prescribe different doses of their current medications or new medications. Moreover, if they develop new asthma triggers, their doctor can recommend new ways to avoid or limit exposure to these triggers.

Developing an asthma action plan

People work with their doctor to develop a personalized asthma action plan (asthma self-management plan) to control their asthma. The plan describes how to:

  • Monitor their breathing with a peak flow monitor.
  • Keep an asthma diary.
  • Take long-term control medications to prevent an asthma attack.
  • Take quick-relief medications to stop an asthma attack.
  • Get medical help if their asthma symptoms don't improve or if they worsen.

Monitoring breathing

People with asthma are advised to use a peak flow meter to monitor their breathing at home. A peak flow meter measures peak expiratory flow (PEF), which indicates how fast a person can exhale while breathing out as hard and fast as possible. The greater their airway obstruction is, the lower their PEF. Regular use of a peak flow meter can alert people to an impending asthma attack before their asthma symptoms become noticeable.

When their peak expiratory flow decreases, people should follow their asthma action plan to:

  • Start taking quick-relief medications as described in their asthma action plan.
  • Get medical help if the asthma symptoms don't improve or worsen.

Keeping an asthma diary

An asthma diary helps identify the early signs of an asthma attack. People keep track of their daily:

  • Peak expiratory flow readings
  • Asthma symptoms
  • Asthma trigger exposure
  • Quick-relief medications used

People should bring their asthma diary to each doctor visit. The doctor uses the information recorded to evaluate the effectiveness of the asthma action plan.

Avoiding asthma triggers

The best way for people to prevent an asthma attack from occurring is to avoid their asthma triggers. Unfortunately, identifying which substances trigger an asthma attack may not be easy. It helps to avoid or limit exposure to one suspected trigger at a time. If the asthma symptoms improve, this may indicate the substance is an asthma trigger.

Once an asthma trigger is identified, it may not be easy to avoid it. Techniques that help people avoid or limit their exposure to the following common asthma triggers include:

  • Cockroaches
    • Fix water leaks.
    • Seal food waste.
    • Store food in sealable containers.
    • Use bait pesticides if control measures aren't successful.
  • Dust and dust mites:
    • Replace carpeting with hardwood floors or linoleum.
    • Remove dried flowers and stuffed animals.
    • Use washable curtains and blinds.
    • Use dust mite proof mattress and pillow covers.
    • Wash bedding in hot water (above 130°F)
    • Use a HEPA air filter and vacuum.
    • Dust and vacuum at least weekly and wear a face mask if necessary.
  • Exercise
    • Discuss an exercise program with a healthcare provider.
    • Try to exercise at least 30 minutes each day.
    • Wear a face mask when exercising in cold temperatures.
  • Gastroesophageal reflux disease (GERD)
    • People with GERD should discuss treatment options with their doctor
    • Treat GERD symptoms quickly.
  • Medications
    • Ask a doctor to recommend substitutions for any medication triggers.
  • Mold
    • Don't keep plants indoors.
    • Regularly clean basements, bathrooms, and kitchen.
    • Use a dehumidifier or air conditioner
  • Occupational triggers
    • People who suspect a work chemical is triggering their asthma attacks should request a copy of the company's Material Safety Data Sheet (MSDS), which provides a list of hazardous materials used at the company. The document is required by the Occupational Safety and Health Administration (OSHA).
    • Then review the MSDS with a healthcare worker.
  • Pets
    • If possible, choose pets without feathers or fur.
    • Regularly bathe and groom pets.
    • Keep pets out of the bedroom.
  • Respiratory infections
    • Monitor air flow and asthma symptoms regularly.
    • Take medications as instructed in the asthma action plan.
    • In case of the flu, contact a doctor to see if an antiviral medication is needed to shorten the duration of the flu.
    • If emergency asthma symptoms develop, seek medical help immediately.
  • Respiratory irritants in the home or car:
    • Use an air conditioner.
    • Close windows.
    • Change heating and cooling system filters often.
    • Don't allow smoking in the house or car.
    • Have the air conditioner and furnace checked annually.
  • Smoke
    • Ask family members and friends not to smoke indoors.
    • Avoid buildings that permit smoking.
    • Avoid wood smoke.
  • Strong emotions
    • Use relaxation techniques to calm emotions.
  • Strong odors and perfumes
    • Don't use perfumed products.
    • Wear a face mask when using products with strong odors.
  • Sulfite preservatives
    • Avoid food or beverages that list sulfites on their labels

Taking asthma medications

People with asthma can avoid or reduce the severity of their asthma attacks by taking:

  • Long-term control medications as prescribed, even when they feel healthy.
  • Quick-relief medications based on their peak expiratory flow readings or early asthma symptoms.

Medications

People work closely with their doctors to identify which medications do the best job of controlling their symptoms and limiting the number of asthma attacks. Asthma medications can help:

  • Prevent or stop an asthma attack.
  • Lessen the severity of the asthma attack.
  • Lower the medication dose needed to control asthma symptoms.

Many asthma medications are inhaled, which sends the medications directly to the lungs. It's important for people to know how to use their asthma inhaler correctly.

Most people with asthma are treated with a combination of:

People should ask their doctor or pharmacist in advance for possible drug side effects or interactions. They should also inform their doctor or pharmacist of all prescription and over-the-counter medicines they are taking.

The following list of medications isn't inclusive. Additional information, side effects, and drug interactions can be obtained by clicking the name of the highlighted medications. A doctor should be notified if any severe reactions occur.

Long-term control medications

People with persistent asthma take long-term control asthma medications daily to prevent asthma attacks. It takes several weeks for these medications to take effect. Common long-term control asthma medications include:

Inhaled corticosteroids

Inhaled corticosteroids prevent airway inflammation and lessen the frequency of asthma attacks. By delivering the medication directly to the airways, they have a low risk of the side effects common with oral corticosteroids. Inhaled corticosteroids are available in the following solutions: metered dose inhaler (MDI), dry powder inhaler (DPI), and nebulizer. Examples include:

Because inhaled corticosteroids may affect the growth of some children, children taking these medications should have their growth rate monitored regularly.

Leukotriene inhibitors

Leukotriene inhibitors (modifiers) reduce the production or block the action of leukotrienes, a substance released during an asthma attack. Leukotrienes are believed to be responsible for the symptoms of an asthma attack. Leukotriene inhibitors can decrease the number of asthma attacks when used with other medications, such as inhaled corticosteroids. Examples include:

Anti-IgE therapy

Anti-IgE therapy treats the effects of immunoglobulin E, an antibody responsible for allergic reactions. The therapy is given by injection to people with moderate to severe persistent asthma whose symptoms are inadequately controlled by inhaled corticosteroids. Examples include:

  • Omalizumab (Xolair)

Long-acting beta agonists

Long-acting beta agonists are usually prescribed for moderate and severe persistent asthma. These inhaled bronchodilators help widen airways in the lungs and make breathing easier by relaxing the smooth muscle that surrounds the airways. Long-acting beta agonists are typically taken with inhaled corticosteroids. Their effectiveness typically lasts for 12 hours. Examples include:

Cromolyn and nedocromil

Cromolyn and nedocromil are inhaled medications that help prevent mild or moderate asthma attacks for some people, and help prevent asthma triggered by environmental pollutants and exercise. Examples include:

  • cromolyn sodium (Intal)
  • nedocromil sodium inhalation (Tilade)

Theophylline

Theophylline is a bronchodilator taken daily in pill form to relieve nighttime asthma symptoms. Examples include:

People taking theophylline need to have their blood monitored regularly to determine the level of the drug in their blood system.

Combination corticosteroids and bronchodilators

A combination of steroids and bronchodilators may be prescribed, using either separate inhalers or a single inhaler. It's important for people taking this medication to seek immediate medical attention if they experience signs of worsening asthma and find that their fast-acting inhaler is not working as well. Examples include:

Quick-relief medications

All people with asthma use quick-relief medications (rescue or short-term medications) for the immediate relief of asthma symptoms. People who take quick-relief medications at the first signs of asthma symptoms usually feel the effects within a few minutes.

Beta2 agonists

Beta2 agonists are short-acting bronchodilators. These inhaled medications start working within minutes and are taken every 4 to 6 hours. Examples include:

Corticosteroids

Corticosteroids are taken by mouth or intravenously (into a vein) for quick-relief of asthma attacks or for severe asthma. Corticosteroids may take from several hours to a several days to be fully effective. Examples include:

Asthma inhalers

Asthma inhalers are handheld, portable devices that deliver medicine directly to a person's lungs. A spacer may be used with an inhaler to increase its effectiveness by ensuring that more medication reaches the lungs (instead of the back of the mouth). People should ask their healthcare provider how to use their inhaler. Examples include:

  • Metered-dose inhalers (MDIs)
    Metered-dose inhalers are the most widely used asthma inhalers. The inhaler consists of a pressurized canister containing the medication and a mouthpiece. MDIs use a propellant to deliver a specific amount of medication into the lungs. People press down on the inhaler, and breathe a mist of medicine into their lungs.
  • Dry powder inhalers (DPIs)
    Dry powder inhalers don't require a propellant. DPIs are breath activated and deliver medication to the lungs as people inhale through the device. People need to inhale more rapidly than with a metered-dose inhaler. DPIs are not suitable for infants, small children, people with severe asthma, or during a severe asthma attack
  • Nebulizers
    A nebulizer changes asthma medication from a liquid to a mist form. The devices are larger than MDIs and DPIs, and require an electrical outlet or an internal battery. Home nebulizers are particularly effective in delivering medication to infants, small children, and people who cannot use inhalers with spacers.

Treating Children

A doctor develops a child's asthma action plan based on the child's history and severity of asthma. Asthma medications approved for younger children may be prescribed in smaller doses based on the child's age and weight. A nebulizer is typically used for infants and very young children who require inhaled medications.

Complementary and Alternative Medicine

Alternative medicine refers to those medical and healthcare treatments that are not part of traditional medicine. Complementary medicine combines traditional and alternative treatments.

The following nontraditional therapies may help people with asthma. Some of these therapies haven't been well studied, and little information is available about their effectiveness, side effects, and drug interactions. It's important to discuss any of these therapies with a doctor before trying them. 

Boswellia

Early testing indicates that the herb boswellia might reduce the frequency of asthma attacks and improve breathing.

Butterbur

There is some evidence that the herb butterbur might be effective in treating asthma.

Relaxation techniques

The following relaxation techniques are designed to relieve stress:

  • Acupuncture
    Acupuncture inserts sharp, thin needles into the body to adjust the body's energy flow into healthier patterns.
  • Deep breathing
    Deep breathing (diaphragmatic breathing) is a relaxation technique that involves breathing deeply into the lungs by flexing the diaphragm instead of the shallower flexing of the rib cage.
  • Biofeedback
    Biofeedback uses special equipment to train people how to regulate their involuntary body functions related to stress, such as heart rate, blood pressure, or brain wave patterns.
  • Qi gong
    Qi gong is an ancient Chinese system of breathing techniques, exercises, meditations, and postures designed to improve and enhance the body's health and vitality.
  • RESPeRATE Blood Pressure Lowering Device
    RESPeRATE is an FDA-approved portable electronic device that helps relieve stress naturally by helping people to master the technique of paced breathing.
  • Yoga
    Yoga is a Hindu system that is believed to prevent diseases by a combination of breathing techniques, meditation, and physical exercises designed to strengthen the body and calm the nervous system.