Treatments for Asthma

The goals of treatment focuses primarily on:

  • Reducing the frequency and severity of symptoms
  • Limiting the impact asthma has on normal activities
  • Reducing the risk of future asthma attacks
  • Preventing progressive lung function impairment
  • Reducing the risk of side effects of asthma medication
  • Minimizing the need for hospitalization or emergency care.

The patient and the health professional need to work together to determine an asthma management plan which is the most effective for the individual in their current circumstances. Management plans need to be monitored regularly and changes are often made as the need arises.

Medication

In order to achieve a good level of asthma control, treatment will require several elements to be addressed. Usually, medication is required but the type and quantity needs to be carefully determined and evaluated in follow-up visits.

Environmental Factors

Environmental factors that can trigger or exacerbate asthma symptoms will also need to be discussed. Simple measures can often be implemented to help the sufferer avoid exposure to substances or conditions that negatively affect their asthma. Allergen immunotherapy may be considered for patients who have persistent asthma that is consistently linked to exposure to an allergen.

Doctors will strongly advise that all asthma patients avoid exposure to tobacco smoke as it is so irritating to the already sensitive airways that asthmatics have.

Comorbid Conditions

The presence of other coexisting conditions that may be contributing to the asthma symptoms should be looked into as treatment of these conditions may improve the patient’s ability to control their asthma. Potentially problematic coexisting conditions include:

Patient Education

Patient education is very important, as it is nearly impossible to have good control of asthma without the patient fully understanding their condition and knowing how to implement their asthma management pan. In order to treat asthma effectively, you need to understand the difference between long-term control and quick-relief medications and under what circumstances each should be used.

  • Long-term control medications such as inhaled corticosteroids (ICSs) prevent symptoms by reducing inflammation. They need to be taken every day as a standard preventative measure but they won’t provide rapid relief in the event of a flare-up of symptoms.
  • Quick-relief medications include short-acting beta2-agonists (SABAs) allow the muscles along the airway to relax which relieves symptoms. This type of medication does not provide long-term control but is meant to be used for rapid relief when symptoms occur. Generally, if SABAs are used more than twice a week (unless if needed for exercise-induced asthma) then long-term control medications need to be started or increased.

Patients also need to be educated on how best to avoid environmental factors that may affect their asthma.

Long-Term Monitoring

The doctor will need to monitor your symptoms over the long term in order to evaluate how well the asthma is being controlled. Treatment may need to be adjusted if asthma symptoms are still problematic despite adherence to the management plan. During the review, the doctor will also want to know if you are suffering any side effects or having problems with adhering to the treatment plan.

During follow-up visits the doctor will ensure that you are taking your medication in the correct manner. The doctor will also make sure that you are not having difficulty using the correct technique in administering the medication as poor technique can limit the benefits of the medications.

Asthma Action Plan

A written asthma action plan is an essential part of the treatment. The doctor will work with you to determine agreed treatment goals. You will be instructed on how to use the asthma action plan to maintain control of your asthma on a day-to-day plan as well as how to adjust the medication if symptoms become worse. The plan will also outline when to seek further urgent medical care.

A good relationship with your healthcare provider is essential as working together ensures the patient has a better chance of adhering to the treatment plan and hence, better long-term outcomes. A treatment plan needs to be tailored to and individual’s preference with regards to ability to stick to the plan and desired outcomes. Encouragement from the healthcare provider and family involvement builds patient confidence and provides them with the necessary support.

Managing Asthma during Pregnancy

While pregnant, a person’s asthma may improve or worsen and hence, their medication may need to be adjusted. It is safe for a pregnant woman to take inhaled corticosteroid (ICS) medication. Ultimately, it is safer for the mother and the unborn infant to use medication to properly control the asthma than to have poorly controlled asthma. Good lung function is essential as it allows adequate oxygen supply to the developing fetus. Inhaled corticosteroid medications are the recommended form of long-term control medication. Again, it is essential that exposure to tobacco smoke is avoided.

Physical Activity

Physical activity should not be avoided just because you have asthma and there is generally no limit to the level of participation. Short acting beta-agonists (SABAs) taken before exercising will prevent exercise-induced asthma in most patients. Leukotriene receptor antagonists (LTRAs), cromolyn or long acting beta-agonists (LABAs) may also be useful.

It is advisable to avoid using LABAs regularly to manage exercise-induced asthma as this is usually a sign that that the individual’s asthma is not properly controlled. In this situation, it is better to consider using long-term control medication where regular medication reduces overall airway inflammation.

Before performing any physical activity, it is a good idea to warm-up properly or even to wear a mask over your mouth if cold air tends to make you asthma symptoms worse.

Asthma and Surgery

It is important that you ensure that your doctor is aware of your asthma before you have surgery as asthma does increase the risk of having problems during or after surgery. The surgeon can help manage this risk by administering asthma medication before or during surgery to prevent symptoms developing.

Drugs

There are two main types of medications for treating asthma:

  • Control medications - used to prevent attacks
  • Quick-relief, or rescue, medicines - used during an asthma attack.

Long-Term Control Medicines

Long-term control medicines are also known as maintenance or controller medicines. This kind of medicine is most often prescribed for moderate to severe cases of asthma. Control medicines are the primary part of asthma treatment and are meant to be taken every day in order for them to be effective. Even if you feel well, it is still important to keep taking the medicine so that they will prevent symptoms or attacks from developing.

Long-term control medicines are generally anti-inflammatories that prevent asthma from occurring by keeping the airways free of swelling. This type of medication is not helpful in a situation where symptoms flare-up suddenly or an asthma attack develops - this is when rescue or quick-relief medicines are needed.

Long-term medicines come in different forms. Some are breathed in through an inhaling device, such as long-acting beta-agonists and steroids. Others are taken orally (by mouth). Your doctor will help you determine which is the most appropriate for you.

Quick-Relief Medicines

Quick-relief medicines are also known as rescue medicines and are generally taken when symptoms have already started or are about to start. When taken, they can provide temporary relief of symptoms by quickly opening swollen airways. For example, they can be taken if symptoms such as wheezing, coughing, breathing problems or even an asthma attack occur. They may also be used as a preventer for people affected by exercise-induced asthma by taking them before exercising.

Keep in mind that this type of medicine is only meant to be used occasionally when symptoms develop. If you find that you are using rescue medicines more than twice a week then it may be a good idea to talk to your doctor as your asthma may not be under control. If this is the case, it may be simply a matter of adjusting your daily dose of control medication.

Quick-relief medicines include inhaled short-acting bronchodilators that relax muscles around the airways causing them to open up and allow more air to flow through. They may also help clear mucus from the lungs by allowing it to more easily and be coughed up. Oral corticosteroids can also provide rapid relief and are generally used when symptoms of an asthma attack persist or when severe symptoms develop.

Are Steroid Medications Bad For You?

It is a commonly held perception that steroid medications are bad for you. However, inhaled corticosteroids (ICS) are the most effect type of medication for long-term control of persistent asthma. As the medication is inhaled, it goes straight to the lungs where it reduces inflammation. They usually need to be taken every day in order to achieve good control of symptoms and avoid asthma attacks.

Although corticosteroids may carry some risks, the benefits greatly outweigh these. By working closely with your doctor you can ensure that you are taking your medication correctly and using the lowest possible dose that will still give you adequate asthma control.

High doses of ICSs may be associated with an increased risk of mouth irritation and thrush that can be avoided by rinsing your mouth and spitting after using ICSs. Using a valved holding chamber or spacer if applicable for your inhaler device can also minimise this risk.

There is also a perception that ICSs will slow a child’s growth but this link is yet to be clearly determined. Growth rates in children are highly variable so it is unwise to assume that slowed growth is necessarily associated with ICS use, especially when doses are not particularly high. Furthermore, poorly controlled asthma can slow the growth rate in children.

Some patients fear that ICSs are addictive - this is not true. Similarly, there is no link between this form of medication and the anabolic steroids that some athletes controversially use to improve the performance.

Long-Acting Beta2-Agonists (LABAs)

Long-acting beta2-agonists, or LABAs, are usually used in addition to inhaled corticosteroids (ICSs) as it tends to be more effective than doubling the dose of ICSs. LABAs are not to be used as the only form of treatment to achieve long-term control and should be used in conjunction with ICSs.

A large clinical trial has shown that LABAs may carry a slightly increased of death when used in conjunction with ICSs compared to using a placebo in conjunction with ICSs. There is also a slightly increased risk of more sever exacerbations associated with use of LABA. This has resulted in the Food and Drug Administration placing a Black Box warning on all drugs containing LABA. Despite this, it is still considered more beneficial to the majority of patients to use LABA’s in conjunction with ICSs than to use higher doses of ICSs alone.

Which drugs are used to treat Asthma?

Various drugs are available for the treatment of asthma. E.g. Serevent is a prescription drug that is used to treat asthma symptoms.

Strength of Serevent: EQ 0.05MG BASE/INH

Date that Serevent was first approved by FDA: September 7, 1997

Therapeutic area that Serevent is used for: Respiratory

Ingredients of Serevent: Salmeterol Xinoate

What form is Serevent in: Powder

How is Serevent taken: Inhaled

Brand name of Salmeterol Xinafoate Powder: Serevent

Company that sells Serevent: Glaxo Group Ltd, one of largest drug companies in USA

Complete name of company that sells Serevent: GLAXO GROUP LTD DBA GLAXOSMITHKLINE

Alternative names for Serevent: Spiriva, Foradil

Conditions or diseases treated by Serevent: COPD, asthma

How much Serevent is sold worldwide? GSK sold 182 million pounds in 2011

How much Serevent is sold in the USA? GSK sold 62 million pounds in 2011

How much Serevent is sold in Europe? GSK sold 85 million pounds of Severent in 2011

How much Serevent is sold in emerging markets? GSK sold 3 million pounds of Severent in 2011 to emerging markets

How much Serevent is sold in the rest of the world? GSK sold 32 million pounds in 2011

Asthma Emergency

Sometimes your asthma symptoms will be so severe that your medicines will not help and your peak flow is less than half of what it normally is. This is when it is important to seek emergency help. It is important to not panic and to seek assistance as quickly as possible.

At the hospital, you will usually be given oxygen and high doses of medicine which may be delivered orally, through the airways or into the veins. In rare cases where breathing stops, intubation (a breathing tube placed down the throat) is required.

Asthma Treatment in the Elderly

Elderly people often take a number of medications so your doctor will need to know what medications you are on in order to avoid interaction between medicines.

Medications such as pain relievers, anti-inflammatories, aspirin and beta blockers may exacerbate asthma symptoms or affect how well asthma medications work.

Elderly asthma sufferers are often advised to take calcium and vitamin D supplements as inhaled corticosteroids can have a negative impact on bones and increase the risk of osteoporosis.

Signs That Your Asthma Symptoms Are Under Control

There are a number of things you can consider when trying to determine if your asthma is well controlled. Signs of good asthma control are:

  • Chronic asthma symptoms have improved and occur less than two days a week.
  • Good lung function is present.
  • Capable of a normal activity level.
  • Quick-relief medications are used infrequently - less than two days a week.
  • Achieving good quality sleep with asthma symptoms waking you no more than once or twice a month.
  • Emergency medical treatment has not been required.
  • One or less asthma attack each year that has required use of inhalation corticosteroids.
  • Peak flow is above 80% of your own best number.

Signs That Your Asthma Symptoms Are NOT Under Control

When evaluating the effectiveness of your asthma treatment, the following are some signs that may indicate that your asthma is poorly controlled:

  • Your symptoms are occurring more often and are increasing in severity.
  • Your symptoms are waking you up or having a negative impact on your sleep.
  • Your symptoms have caused you to miss work or school or you have had to limit you activities such as sport.
  • Your peak flow number fluctuates greatly or is notably lower than your personal best.
  • Your asthma medications do not seem to work well.
  • You are using your rescue medications too often i.e. more than twice a week.
  • You develop an asthma attack that requires emergency care.

Asthma Devices

Asthma medications can be delivered in a number of ways by using specific devices. As asthma primarily affects the airways, medications are more effective if they can be delivered directly to the lungs.

Metered-Dose Inhalers

The metered-dose inhaler is the most common way for medicine to be delivered into the lungs of an asthmatic. These devices consist of two parts - a mouthpiece and a canister that contains the medicine, stabilizers and a propellant. These inhalers are quite easy to use - simply put the mouthpiece in your mouth, press on top of the canister and inhale the released gas. The types of medicines that can be delivered in this manner include corticosteroids, bronchodilators or mast cell stabilizers.

Dry Powder Inhalers

Dry power inhalers are a non-aerosol alternative to metered-dose inhalers. They are more difficult to use as the patient is needs to inhale with considerable force in order to mobilize the powder from the device and into the lungs. If not enough force is used, sufficient amounts of powder won’t reach the lungs resulting in less effective control of asthma symptoms.

Nebulizer

A nebulizer allows for a larger, more continuous medication dose to be delivered. The medication is vaporised along with a saline solution to form a vapour that can then be breathed in. Nebulizers tend to be used in hospitals when patients are having trouble using a metered-dose inhaler.

Asthma Spacer

An asthma spacer is an additional attachment between the mouthpiece of the inhaler and the patient’s mouth. It allows the medicine to be held briefly after the canister is activated. This gives the patient a little more time to coordinate the actions required to deliver a dose. It also prevents medicine touching the sides of the mouth.

   •   •   •

Back to: « Asthma

Treatments for Asthma

How Is Asthma Treated and Controlled?

Asthma is a long-term disease that has no cure. The goal of asthma treatment is to control the disease. Good asthma control will:

  • Prevent chronic and troublesome symptoms, such as coughing and shortness of breath
  • Reduce your need for quick-relief medicines (see below)
  • Help you maintain good lung function
  • Let you maintain your normal activity level and sleep through the night
  • Prevent asthma attacks that could result in an emergency room visit or hospital stay

To control asthma, partner with your doctor to manage your asthma or your child's asthma. Children aged 10 or older—and younger children who are able—should take an active role in their asthma care.

Taking an active role to control your asthma involves:

  • Working with your doctor to treat other conditions that can interfere with asthma management.
  • Avoiding things that worsen your asthma (asthma triggers). However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.
  • Working with your doctor and other health care providers to create and follow an asthma action plan.

An asthma action plan gives guidance on taking your medicines properly, avoiding asthma triggers (except physical activity), tracking your level of asthma control, responding to worsening symptoms, and seeking emergency care when needed.

Asthma is treated with two types of medicines: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or "rescue," medicines relieve asthma symptoms that may flare up.

Your initial treatment will depend on the severity of your asthma. Followup asthma treatment will depend on how well your asthma action plan is controlling your symptoms and preventing asthma attacks.

Your level of asthma control can vary over time and with changes in your home, school, or work environments. These changes can alter how often you're exposed to the factors that can worsen your asthma.

Your doctor may need to increase your medicine if your asthma doesn't stay under control. On the other hand, if your asthma is well controlled for several months, your doctor may decrease your medicine. These adjustments to your medicine will help you maintain the best control possible with the least amount of medicine necessary.

Asthma treatment for certain groups of people—such as children, pregnant women, or those for whom exercise brings on asthma symptoms—will be adjusted to meet their special needs.

Follow an Asthma Action Plan

You can work with your doctor to create a personal asthma action plan. The plan will describe your daily treatments, such as which medicines to take and when to take them. The plan also will explain when to call your doctor or go to the emergency room.

If your child has asthma, all of the people who care for him or her should know about the child's asthma action plan. This includes babysitters and workers at daycare centers, schools, and camps. These caretakers can help your child follow his or her action plan.

Go to the National Heart, Lung, and Blood Institute's (NHLBI's) "Asthma Action Plan" for a sample plan.

Avoid Things That Can Worsen Your Asthma

Many common things (called asthma triggers) can set off or worsen your asthma symptoms. Once you know what these things are, you can take steps to control many of them. (For more information about asthma triggers, go to "What Are the Signs and Symptoms of Asthma?")

For example, exposure to pollens or air pollution might make your asthma worse. If so, try to limit time outdoors when the levels of these substances in the outdoor air are high. If animal fur triggers your asthma symptoms, keep pets with fur out of your home or bedroom.

One possible asthma trigger you shouldn’t avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.

The NHLBI offers many useful tips for controlling asthma triggers. For more information, go to page 2 of NHLBI's "Asthma Action Plan."

If your asthma symptoms are clearly related to allergens, and you can't avoid exposure to those allergens, your doctor may advise you to get allergy shots.

You may need to see a specialist if you're thinking about getting allergy shots. These shots can lessen or prevent your asthma symptoms, but they can't cure your asthma.

Several health conditions can make asthma harder to manage. These conditions include runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. Your doctor will treat these conditions as well.

Medicines

Your doctor will consider many things when deciding which asthma medicines are best for you. He or she will check to see how well a medicine works for you. Then, he or she will adjust the dose or medicine as needed.

Asthma medicines can be taken in pill form, but most are taken using a device called an inhaler. An inhaler allows the medicine to go directly to your lungs.

Not all inhalers are used the same way. Ask your doctor or another health care provider to show you the right way to use your inhaler. Review the way you use your inhaler at every medical visit.

Long-Term Control Medicines

Most people who have asthma need to take long-term control medicines daily to help prevent symptoms. The most effective long-term medicines reduce airway inflammation, which helps prevent symptoms from starting. These medicines don't give you quick relief from symptoms.

Inhaled corticosteroids. Inhaled corticosteroids are the preferred medicine for long-term control of asthma. They're the most effective option for long-term relief of the inflammation and swelling that makes your airways sensitive to certain inhaled substances.

Reducing inflammation helps prevent the chain reaction that causes asthma symptoms. Most people who take these medicines daily find they greatly reduce the severity of symptoms and how often they occur.

Inhaled corticosteroids generally are safe when taken as prescribed. These medicines are different from the illegal anabolic steroids taken by some athletes. Inhaled corticosteroids aren't habit-forming, even if you take them every day for many years.

Like many other medicines, though, inhaled corticosteroids can have side effects. Most doctors agree that the benefits of taking inhaled corticosteroids and preventing asthma attacks far outweigh the risk of side effects.

One common side effect from inhaled corticosteroids is a mouth infection called thrush. You might be able to use a spacer or holding chamber on your inhaler to avoid thrush. These devices attach to your inhaler. They help prevent the medicine from landing in your mouth or on the back of your throat.

Check with your doctor to see whether a spacer or holding chamber should be used with the inhaler you have. Also, work with your health care team if you have any questions about how to use a spacer or holding chamber. Rinsing your mouth out with water after taking inhaled corticosteroids also can lower your risk for thrush.

If you have severe asthma, you may have to take corticosteroid pills or liquid for short periods to get your asthma under control.

If taken for long periods, these medicines raise your risk for cataracts and osteoporosis (OS-te-o-po-RO-sis). A cataract is the clouding of the lens in your eye. Osteoporosis is a disorder that makes your bones weak and more likely to break.

Your doctor may have you add another long-term asthma control medicine so he or she can lower your dose of corticosteroids. Or, your doctor may suggest you take calcium and vitamin D pills to protect your bones.

Other long-term control medicines. Other long-term control medicines include:

  • Cromolyn. This medicine is taken using a device called a nebulizer. As you breathe in, the nebulizer sends a fine mist of medicine to your lungs. Cromolyn helps prevent airway inflammation.
  • Omalizumab (anti-IgE). This medicine is given as a shot (injection) one or two times a month. It helps prevent your body from reacting to asthma triggers, such as pollen and dust mites. Anti-IgE might be used if other asthma medicines have not worked well.

A rare, but possibly life-threatening allergic reaction called anaphylaxis might occur when the Omalizumab injection is given. If you take this medication, work with your doctor to make sure you understand the signs and symptoms of anaphylaxis and what actions you should take.

  • Inhaled long-acting beta2-agonists. These medicines open the airways. They might be added to inhaled corticosteroids to improve asthma control. Inhaled long-acting beta2-agonists should never be used on their own for long-term asthma control. They must used with inhaled corticosteroids.
  • Leukotriene modifiers. These medicines are taken by mouth. They help block the chain reaction that increases inflammation in your airways.
  • Theophylline. This medicine is taken by mouth. Theophylline helps open the airways.

If your doctor prescribes a long-term control medicine, take it every day to control your asthma. Your asthma symptoms will likely return or get worse if you stop taking your medicine.

Long-term control medicines can have side effects. Talk with your doctor about these side effects and ways to reduce or avoid them.

With some medicines, like theophylline, your doctor will check the level of medicine in your blood. This helps ensure that you’re getting enough medicine to relieve your asthma symptoms, but not so much that it causes dangerous side effects.

Quick-Relief Medicines

All people who have asthma need quick-relief medicines to help relieve asthma symptoms that may flare up. Inhaled short-acting beta2-agonists are the first choice for quick relief.

These medicines act quickly to relax tight muscles around your airways when you're having a flareup. This allows the airways to open up so air can flow through them.

You should take your quick-relief medicine when you first notice asthma symptoms. If you use this medicine more than 2 days a week, talk with your doctor about your asthma control. You may need to make changes to your asthma action plan.

Carry your quick-relief inhaler with you at all times in case you need it. If your child has asthma, make sure that anyone caring for him or her has the child's quick-relief medicines, including staff at the child's school. They should understand when and how to use these medicines and when to seek medical care for your child.

You shouldn't use quick-relief medicines in place of prescribed long-term control medicines. Quick-relief medicines don't reduce inflammation.

Track Your Asthma

To track your asthma, keep records of your symptoms, check your peak flow number using a peak flow meter, and get regular asthma checkups.

Record Your Symptoms

You can record your asthma symptoms in a diary to see how well your treatments are controlling your asthma.

Asthma is well controlled if:

  • You have symptoms no more than 2 days a week, and these symptoms don't wake you from sleep more than 1 or 2 nights a month.
  • You can do all your normal activities.
  • You take quick-relief medicines no more than 2 days a week.
  • You have no more than one asthma attack a year that requires you to take corticosteroids by mouth.
  • Your peak flow doesn't drop below 80 percent of your personal best number.

If your asthma isn't well controlled, contact your doctor. He or she may need to change your asthma action plan.

Use a Peak Flow Meter

This small, hand-held device shows how well air moves out of your lungs. You blow into the device and it gives you a score, or peak flow number. Your score shows how well your lungs are working at the time of the test.

Your doctor will tell you how and when to use your peak flow meter. He or she also will teach you how to take your medicines based on your score.

Your doctor and other health care providers may ask you to use your peak flow meter each morning and keep a record of your results. You may find it very useful to record peak flow scores for a couple of weeks before each medical visit and take the results with you.

When you're first diagnosed with asthma, it's important to find your "personal best" peak flow number. To do this, you record your score each day for a 2- to 3-week period when your asthma is well-controlled. The highest number you get during that time is your personal best. You can compare this number to future numbers to make sure your asthma is controlled.

Your peak flow meter can help warn you of an asthma attack, even before you notice symptoms. If your score shows that your breathing is getting worse, you should take your quick-relief medicines the way your asthma action plan directs. Then you can use the peak flow meter to check how well the medicine worked.

Get Asthma Checkups

When you first begin treatment, you'll see your doctor about every 2 to 6 weeks. Once your asthma is controlled, your doctor may want to see you from once a month to twice a year.

During these checkups, your doctor may ask whether you've had an asthma attack since the last visit or any changes in symptoms or peak flow measurements. He or she also may ask about your daily activities. This information will help your doctor assess your level of asthma control.

Your doctor also may ask whether you have any problems or concerns with taking your medicines or following your asthma action plan. Based on your answers to these questions, your doctor may change the dose of your medicine or give you a new medicine.

If your control is very good, you might be able to take less medicine. The goal is to use the least amount of medicine needed to control your asthma.

Emergency Care

Most people who have asthma, including many children, can safely manage their symptoms by following their asthma action plans. However, you might need medical attention at times.

Call your doctor for advice if:

  • Your medicines don't relieve an asthma attack.
  • Your peak flow is less than half of your personal best peak flow number.

Call 9-1-1 for emergency care if:

At the hospital, you'll be closely watched and given oxygen and more medicines, as well as medicines at higher doses than you take at home. Such treatment can save your life.

Asthma Treatment for Special Groups

The treatments described above generally apply to all people who have asthma. However, some aspects of treatment differ for people in certain age groups and those who have special needs.

Children

It's hard to diagnose asthma in children younger than 5 years. Thus, it's hard to know whether young children who wheeze or have other asthma symptoms will benefit from long-term control medicines. (Quick-relief medicines tend to relieve wheezing in young children whether they have asthma or not.)

Doctors will treat infants and young children who have asthma symptoms with long-term control medicines if, after assessing a child, they feel that the symptoms are persistent and likely to continue after 6 years of age. (For more information, go to "How Is Asthma Diagnosed?")

Inhaled corticosteroids are the preferred treatment for young children. Montelukast and cromolyn are other options. Treatment might be given for a trial period of 1 month to 6 weeks. Treatment usually is stopped if benefits aren't seen during that time and the doctor and parents are confident the medicine was used properly.

Inhaled corticosteroids can possibly slow the growth of children of all ages. Slowed growth usually is apparent in the first several months of treatment, is generally small, and doesn't get worse over time. Poorly controlled asthma also may reduce a child's growth rate.

Many experts think the benefits of inhaled corticosteroids for children who need them to control their asthma far outweigh the risk of slowed growth.

Older Adults

Doctors may need to adjust asthma treatment for older adults who take certain other medicines, such as beta blockers, aspirin and other pain relievers, and anti-inflammatory medicines. These medicines can prevent asthma medicines from working well and may worsen asthma symptoms.

Be sure to tell your doctor about all of the medicines you take, including over-the-counter medicines.

Older adults may develop weak bones from using inhaled corticosteroids, especially at high doses. Talk with your doctor about taking calcium and vitamin D pills, as well as other ways to help keep your bones strong.

Pregnant Women

Pregnant women who have asthma need to control the disease to ensure a good supply of oxygen to their babies. Poor asthma control increases the risk of preeclampsia, a condition in which a pregnant woman develops high blood pressure and protein in the urine. Poor asthma control also increases the risk that a baby will be born early and have a low birth weight.

Studies show that it's safer to take asthma medicines while pregnant than to risk having an asthma attack.

Talk with your doctor if you have asthma and are pregnant or planning a pregnancy. Your level of asthma control may get better or it may get worse while you're pregnant. Your health care team will check your asthma control often and adjust your treatment as needed.

People Whose Asthma Symptoms Occur With Physical Activity

Physical activity is an important part of a healthy lifestyle. Adults need physical activity to maintain good health. Children need it for growth and development.

In some people, however, physical activity can trigger asthma symptoms. If this happens to you or your child, talk with your doctor about the best ways to control asthma so you can stay active.

The following medicines may help prevent asthma symptoms caused by physical activity:

  • Short-acting beta2-agonists (quick-relief medicine) taken shortly before physical activity can last 2 to 3 hours and prevent exercise-related symptoms in most people who take them.
  • Long-acting beta2-agonists can be protective for up to 12 hours. However, with daily use, they'll no longer give up to 12 hours of protection. Also, frequent use of these medicines for physical activity might be a sign that asthma is poorly controlled.
  • Leukotriene modifiers. These pills are taken several hours before physical activity. They can help relieve asthma symptoms brought on by physical activity.
  • Long-term control medicines. Frequent or severe symptoms due to physical activity may suggest poorly controlled asthma and the need to either start or increase long-term control medicines that reduce inflammation. This will help prevent exercise-related symptoms.

Easing into physical activity with a warmup period may be helpful. You also may want to wear a mask or scarf over your mouth when exercising in cold weather.

If you use your asthma medicines as your doctor directs, you should be able to take part in any physical activity or sport you choose.

People Having Surgery

Asthma may add to the risk of having problems during and after surgery. For instance, having a tube put into your throat may cause an asthma attack.

Tell your surgeon about your asthma when you first talk with him or her. The surgeon can take steps to lower your risk, such as giving you asthma medicines before or during surgery.

Source: NHLBI (NIH)1

   •   •   •

Whether you’re young or older, it’s important to know how to manage your asthma. Work with your doctor to develop a written asthma action plan. (Here’s a sample asthma action plan from NIH). Your action plan should spell out the daily treatment plan to help control your asthma. This may include recommendations for medications and for avoiding exposure to your triggers. The action plan should also give specific instructions for what to do when asthma symptoms start and what actions to take if symptoms worsen, including when to seek medical attention, go to the hospital, or call an ambulance.

“Patients with asthma should have an action plan, so they know if they’re getting into trouble and what to do about it,” Freemer says.

For some patients, Freemer notes that a hand-held device called a peak flow meter can help you monitor your asthma. You blow into the device to measure how strongly your lungs can force air out. If the meter shows that your air flow is lower than normal, you can use your action plan to adjust your treatment.

“There are 2 main types of medicines for managing asthma: quick-relief and long-term controllers,” says Levine. Quick-relief medicines—such as short-acting bronchodilator inhalers—are used to relax the muscles in the airways to make it easier to breathe within a few minutes. If exercise is an asthma trigger, doctors may recommend taking this medicine 5 to 15 minutes before exercise or strenuous activity.

Long-term control medicines—such as inhaled corticosteroids—are used every day to help control symptoms and prevent asthma attacks. “Inhaled corticosteroids are recommended as the preferred long-term control medications for most children and adults,” says Freemer. “Taken daily, they help reduce inflammation to control the disease.”

If young children have trouble taking inhaled medications, there are masks and other devices that can help. Some kids are given a nebulizer, a portable machine that releases medicine in a mist.

Source: NIH News in Health (NIH)2

   •   •   •

A recent study found that people with asthma and allergies may be able to alleviate asthma symptoms by reducing allergen levels in their homes.

“Some simple measures—washing bedding in hot water, vacuuming and steam-cleaning, and using high-efficiency particulate air purifiers (HEPA) and mattress and pillow covers that do not allow allergens to pass through—can decrease the levels of household allergens,” Gergen says.

Source: NIH News in Health (NIH)3

   •   •   •

If you’re 1 of the 23 million Americans who suffer from asthma, you might get some relief by taking steps to reduce indoor allergen levels and modifying your lifestyle to avoid the ill effects of air pollution.

Source: NIH News in Health (NIH)4

   •   •   •

Treating Asthma in Kids

3 groups, each receiving a different daily therapy for their asthma: a low dose inhaled corticosteroid (Flovent); a combination of an even lower dose inhaled corticosteroid along with a bronchodilator (Advair and Serevent); and an oral anti-leukotriene tablet (Singulair).

Source: NIH News in Health (NIH)5

   •   •   •

Mild persistent asthma brings symptoms like wheezing, coughing, or chest tightness more than twice a week but not daily, or wakes you up more than two nights a month. National treatment guidelines recommend daily long-term control medication to prevent symptoms, along with quick-relief medication (inhaled bronchodilator) as needed to treat acute symptoms.

Source: NIH News in Health (NIH)6

   •   •   •

Women with asthma should always try to avoid asthma triggers.

  • Known asthma triggers include pollen, mold and tobacco smoke.
  • Know your triggers and learn how to avoid them.
  • Work with your doctor to develop an asthma action plan that will help you take your medications correctly and avoid your asthma triggers.

Source: CDC Features7

   •   •   •

Although asthma cannot be cured, it is possible to manage asthma successfully to reduce and prevent asthma attacks, also called episodes. Successful asthma management includes knowing the warning signs of an attack, avoiding things that may trigger an attack, and following the advice of your healthcare provider.

Using what you know about managing your asthma can give you control over this chronic disease. When you control your asthma, you will breathe easier, be as active as you would like, sleep well, stay out of the hospital, and be free from coughing and wheezing.

Source: CDC Features8

   •   •   •

With your healthcare provider's help, you can make your own asthma management plan so that you know what to do based on your own symptoms.

Use your asthma medicine as prescribed and be aware of common triggers in the environment known to bring on asthma symptoms, including smoke (including second-hand and third-hand cigarette smoke), household pets, dust mites, and pollen. Limit or avoid exposure to these and other triggers whenever possible.

The important thing to remember is that you can control your asthma.

Source: CDC Features9

   •   •   •

It is important for affected individuals to have a comprehensive asthma treatment plan and regular follow-up with their physician. Early diagnosis and removal from the impacted damp office environment can cure asthma caused by workplace exposures.

Source: CDC NIOSH10

   •   •   •

For individuals with new-onset asthma or worsening of stable pre-existing asthma that is suspected to be related to the indoor environment, controlling or eliminating the sources of indoor contaminants, along with optimal medical treatment, may lead to symptoms of improvement or resolution.

Source: CDC NIOSH11

   •   •   •

At present the cause of asthma is not known and there is no cure.

However, asthma is treatable: medications, asthma management and education are improving all the time. With appropriate treatment and a personal commitment to good self-management, most people with asthma can lead normal, active lives. Indeed, many are high-achieving sports people.

The Australian Government, through the Asthma Management Programme, promotes the 3+ visit plan as the best practice model of care for people with moderate to severe asthma.

Source: Queensland Health12

   •   •   •

At present the cause of asthma is not known and there is no cure.

However, asthma is treatable: medications, asthma management and education are improving all the time. With appropriate treatment and a personal commitment to good self-management, most people with asthma can lead normal, active lives. Indeed, many are high-achieving sports people.

The Australian Government, through the Asthma Management Programme, promotes the 3+ visit plan as the best practice model of care for people with moderate to severe asthma.

Source: Queensland Health13

   •   •   •

Asthma is treated with two kinds of medicines: quick-relief medicines to stop asthma symptoms and long-term control medicines to prevent symptoms.

Source: MedLinePlus (NIH)14

   •   •   •

What should you do if you think you may have asthma?

Discuss your symptoms with a provider. Not every type of asthma needs intensive treatment.

We always try to improve asthma both by changing the immune response (through medications, diet, etc.) and by identifying and removing the environmental triggers that cause the immune response.

Source: MedLinePlus Magazine (NIH)15

   •   •   •

How is asthma treated?

Treatment plans can include taking prescribed medicine and avoiding your asthma triggers. You can breathe in some medicines and take other medicines as a pill. Asthma medicines come in two types—quick-relief and long-term control. Quick-relief medicines control the symptoms of an asthma attack. Long-term control medicines help you have fewer and milder attacks, but they don’t help during an asthma attack.

 

Source: MedLinePlus Magazine (NIH)16

   •   •   •

Severe symptoms can be fatal, so it's important to treat symptoms when you first notice them, so they don't become severe.

It is also important to take day-to-day actions to prevent symptoms from starting. Avoid things that bring on symptoms and take proper treatment. Many people benefit from daily medicine to control asthma and prevent attacks. With proper treatment, most people can expect to have few symptoms, if any, day or night.

Source: MedLinePlus Magazine (NIH)17

   •   •   •

If you or a family member has asthma, it’s important that you know what medicines can help control the asthma and what to do in an asthma attack.

Ask your doctor to talk to you about these things.

Source: New Zealand Health18

   •   •   •

Asthma is treated with inhalers (puffers). There are four types:

  1. Preventers (used every day) - these reduce swelling and narrowing inside your airways
  2. Symptom controllers (used twice daily) - these are long acting (12 hours) and keep your airways relaxed
  3. Combinations - these contain both preventer and symptom controller medicines
  4. Relievers (used during an attack) - these relax and open your airways.

Inhalers are usually used with a spacer (a clear plastic tube), which helps you breathe the medicine into your lungs. The spacer makes the inhaler easier to use.

Your doctor, nurse or asthma educator will work out the right types of inhalers for you and show you how to use them.

A peak flow meter may be also be used to measure any changes in your asthma control.

Source: New Zealand Health19

   •   •   •

Treatments

Asthma is usually treated by using an inhaler, a small device that lets you breathe in medicines.

The main types are:

  • reliever inhalers - used when needed to quickly relieve asthma symptoms for a short time
  • preventer inhalers - used every day to prevent asthma symptoms occurring

Some people also need to take tablets.

Read more about how asthma is treated and living with asthma.

Source: NHS Choices UK20

   •   •   •

Treatment

There's currently no cure for asthma, but treatment can help control the symptoms so you're able to live a normal, active life.

Inhalers - devices that let you breathe in medicine - are the main treatment. Tablets and other treatments may also be needed if your asthma is severe.

You'll usually create a personal action plan with your doctor or asthma nurse. This includes information about your medicines, how to monitor your condition and what to do if you have an asthma attack.

Inhalers

Inhalers can help:

  • relieve symptoms when they occur (reliever inhalers)
  • stop symptoms developing (preventer inhalers)

Some people need an inhaler that does both (combination inhalers).

Reliever inhalers

Most people with asthma will be given a reliever inhaler. These are usually blue.

You use a reliever inhaler to treat your symptoms when they occur. They should relieve your symptoms within a few minutes.

Tell your GP or asthma nurse if you have to use your reliever inhaler 3 or more times a week. They may suggest additional treatment, such as a preventer inhaler.

Reliever inhalers have few side effects, but they can sometimes cause shaking or a fast heartbeat for a few minutes after they're used.

Asthma UK has more information on reliever inhalers.

Preventer inhalers

If you need to use a reliever inhaler often, you may also need a preventer inhaler.

You use a preventer inhaler every day to reduce the inflammation and sensitivity of your airways, which stops your symptoms occurring. It's important to use it even when you don't have symptoms.

Speak to your GP or asthma nurse if you continue to have symptoms while using a preventer inhaler.

Preventer inhalers contain steroid medicine. They don't usually have side effects but can sometimes cause:

You can help prevent these side effects by using a spacer- a hollow plastic tube you attach to your inhaler - as well as by rinsing your mouth or cleaning your teeth after using your inhaler.

Asthma UK has more information on preventer inhalers.

Combination inhalers

If using reliever and preventer inhalers doesn't control your asthma, you may need an inhaler that combines both.

Combination inhalers are used every day to help stop symptoms occurring and provide long-lasting relief if they do occur.

It's important to use it regularly, even if you don't have symptoms.

Side effects of combination inhalers are similar to those of reliever and preventer inhalers.

Asthma UK has more information on combination inhalers.

Tablets

You may also need to take tablets if using an inhaler alone isn't helping control your symptoms.

Leukotriene receptor antagonists (LTRAs)

LTRAs are the main tablets used for asthma. They also come in syrup and powder form.

You take them every day to help stop your symptoms occurring.

Possible side effects include tummy aches and headaches.

Asthma UK has more information on LTRAs.

Theophylline

Theophylline may also be recommended if other treatments aren't helping to control your symptoms.

It's taken every day to stop your symptoms occurring.

Possible side effects include headaches and feeling sick.

Asthma UK has more information on theophylline.

Steroid tablets

Steroid tablets may be recommended if other treatments aren't helping to control your symptoms.

They can be taken either:

  • as an immediate treatment when you have an asthma attack
  • every day as a long-term treatment to prevent symptoms - this is usually only necessary if you have very severe asthma and inhalers don't control your symptoms

Long-term or frequent use of steroid tablets can occasionally cause side effects such as:

You'll be monitored regularly while taking steroid tablets to check for signs of any problems.

Asthma UK has more information on steroid tablets.

Source: NHS Choices UK21

   •   •   •

Other treatments

Other treatments, such as injections or surgery, are rarely needed but may be recommended if all other treatments aren't helping.

Injections

For some people with severe asthma, injections given every few weeks can help control the symptoms.

The main injections for asthma are:

  • omalizumab (Xolair)
  • mepolizumab (Nucala)
  • reslizumab (Cinqaero)

These medicines aren't suitable for everyone with asthma and can only be prescribed by an asthma specialist.

The main side effect is discomfort where the injection is given.

Asthma UK has more information on Xolair and new treatments for severe asthma.

Source: NHS Choices UK22

   •   •   •

Surgery

A procedure called bronchial thermoplasty is very occasionally used as a treatment for severe asthma.

It involves passing a thin, flexible tube down your throat and into your lungs. Heat is then used on the muscles around the airways to help stop them narrowing and causing asthma symptoms.

There's some evidence to suggest this may reduce asthma attacks, but it's a relatively new treatment and the long-term effects aren't yet fully understood.

Asthma UK has more information on bronchial thermoplasty.

Source: NHS Choices UK23

Emergencies: Asthma

Severe asthma attacks may require emergency care, and they can be fatal.

Source: NHLBI (NIH)24

   •   •   •

If you or your family member is struggling for breath, or unable to speak or cry, call 111 immediately.

Source: New Zealand Health25

Treatments for Asthma

Housecleaning: Allergens in Homes Linked to Asthma

A little housecleaning may help to reduce asthma symptoms in people who have both asthma and allergies. A national survey found that allergy-triggering substances, called allergens, are quite common in most homes. Households with asthmatic people are more likely to have higher levels of multiple allergens.

Asthma is one of the most common chronic ailments in the U.S. It affects more than 22 million people. Asthma can be triggered by a wide range of allergens.

More research is needed to understand the factors that contribute to asthma. Regular household cleaning, however, is a simple way to help reduce exposure to allergens. If someone in your family has asthma, you may be able to improve their symptoms by reducing allergen levels in your home.

Source: NIH News in Health (NIH)26

   •   •   •

Buteyko breathing technique: Buteyko is a breathing technique developed to help people with asthma.

Source: Queensland Health27

Management of Asthma

Asthma can be controlled by taking medicine and avoiding the triggers that can cause an attack. You must also remove the triggers in your environment that can make your asthma worse.

Source: CDC28

   •   •   •

Indoor Allergens & Asthma

What steps can you take to reduce indoor allergens and prevent asthma attacks?

  • Use HEPA air filtration devices to reduce airborne allergens. Change HVAC filters at least once every quarter, or more frequently if your home has a lot of dust.
  • Wash sheets and blankets in hot water every week.
  • Put mattresses, pillows, and box springs in allergen-proof covers.
  • Vacuum carpets and upholstered furniture every week.
  • Reduce humidity to under 50% and check for leaks/water damage to reduce mold.
  • Eliminate pest infestations to reduce cockroach or mouse allergen exposure.
  • Limit dog and cat exposure in the home.

Source: MedLinePlus Magazine (NIH)29

   •   •   •

Asthma varies from student to student and often from season to season or even day by day. Students who have asthma should have a written asthma plan and appropriate medicine at school to prevent symptoms. At times, physical activity programs for these students may need to be temporarily modified, such as by varying the type, intensity, duration, and/or frequency of activity. At all times, students who have asthma should be included in activities as much as possible. Remaining behind in the gym or library or frequently sitting on the bench can set the stage for teasing, loss of self-esteem, unnecessary restriction of activity, and low levels of physical fitness.

Source: MedLinePlus Magazine (NIH)30

   •   •   •

Asthma Action Plan

Use this plan, together with your doctor, to write down how to manage your child's asthma, routinely on a daily basis and during an attack. This Asthma Action Plan can also be ordered from the National Heart, Lung, and Blood Institute: http://catalog.nhlbi.nih.gov/catalog/facet/Diseases-and-Conditions/term/Asthma

Source: MedLinePlus Magazine (NIH)31

   •   •   •

Identify and avoid your triggers

It's important to identify possible asthma triggers by making a note of where you are and what you're doing when your symptoms get worse.

Some triggers can be hard to avoid, but it may be possible to avoid some, such as dust mites, pet fur and some medicines. See allergy prevention for more information.

Speak to your doctor or asthma nurse for advice if you think you've identified a trigger for your symptoms.

Asthma UK has more about asthma triggers.

Source: NHS Choices UK32

   •   •   •

Regular check-ups

You'll have regular contact with your doctor or asthma nurse to monitor your condition.

These appointments may involve:

  • talking about your symptoms - for example, if they're affecting your normal activities or are getting worse
  • a discussion about your medicines - including if you think you might be experiencing any side effects and if you need to be reminded how to use your inhaler
  • breathing tests

It's also a good chance to ask any questions you have or raise any other issues you want to discuss.

You may be asked to help monitor your condition between appointments. For example, you may be advised to check your peak flow if you think your symptoms may be getting worse.

Your personal action plan should say what to do if your symptoms get gradually or suddenly worse. Contact your doctor or asthma nurse if you're not sure what to do.

Source: NHS Choices UK33

Treatment Failure: Asthma

Since a poor response to inhaled corticosteroids often runs in families, scientists suspected that genes play a role.

Variation in a gene called GLCCI1 seemed to be linked to a poor response to inhaled corticosteroids.

Source: NIH News in Health (NIH)34

   •   •   •

Everyone's Different

  • Certain allergy and asthma medicines work well for some but not at all for others.

Source: NIH News in Health (NIH)35

   •   •   •

References

  1. Source: NHLBI (NIH): nhlbi.nih.gov/ health/ health-topics/ topics/ asthma/ treatment
  2. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ issue/ jun2014/ feature1
  3. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ 2008/ May/ docs/ 01features_02.htm
  4. ibid.
  5. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ 2007/ March/ docs/ 02capsules.htm
  6. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ 2005/ June2005/ docs/ 02capsules.htm
  7. Source: CDC Features: cdc.gov/ features/ 7things-womens-health/ index.html
  8. Source: CDC Features: cdc.gov/ features/ AsthmaAwareness/ index.html
  9. ibid.
  10. Source: CDC NIOSH: cdc.gov/ niosh/ topics/ indoorenv/ moldsymptoms.html
  11. ibid.
  12. Source: Queensland Health: conditions.health.qld.gov.au/ HealthCondition/ condition/ 8/ 29/ 9/ asthma
  13. Source: Queensland Health: conditions.health.qld.gov.au/ HealthCondition/ condition/ 15/ 29/ 9/ asthma
  14. Source: MedLinePlus (NIH): medlineplus.gov/ asthma.html
  15. Source: MedLinePlus Magazine (NIH): medlineplus.gov/ magazine/ issues/ fall17/ articles/ fall17pg24.html
  16. Source: MedLinePlus Magazine (NIH): medlineplus.gov/ magazine/ issues/ fall17/ articles/ fall17pg26.html
  17. Source: MedLinePlus Magazine (NIH): medlineplus.gov/ magazine/ issues/ fall13/ articles/ fall13pg12-13.html
  18. Source: New Zealand Health: health.govt.nz/ your-health/ conditions-and-treatments/ diseases-and-illnesses/ asthma
  19. ibid.
  20. Source: NHS Choices UK: nhs.uk/ conditions/ Asthma/ 
  21. Source: NHS Choices UK: nhs.uk/ conditions/ asthma/ treatment/ 
  22. ibid.
  23. ibid.
  24. Source: NHLBI (NIH): nhlbi.nih.gov/ health/ health-topics/ topics/ asthma
  25. Source: New Zealand Health: health.govt.nz/ your-health/ conditions-and-treatments/ diseases-and-illnesses/ asthma
  26. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ 2008/ April/ docs/ 02capsules.htm
  27. Source: Queensland Health: conditions.health.qld.gov.au/ HealthCondition/ condition/ 15/ 29/ 9/ asthma
  28. Source: CDC: cdc.gov/ asthma/ 
  29. Source: MedLinePlus Magazine (NIH): medlineplus.gov/ magazine/ issues/ fall17/ articles/ fall17pg26.html
  30. Source: MedLinePlus Magazine (NIH): medlineplus.gov/ magazine/ issues/ fall13/ articles/ fall13pg14.html
  31. Source: MedLinePlus Magazine (NIH): medlineplus.gov/ magazine/ issues/ fall13/ articles/ fall13pg16.html
  32. Source: NHS Choices UK: nhs.uk/ conditions/ asthma/ living-with/ 
  33. ibid.
  34. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ issue/ nov2011/ capsule1
  35. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ 2005/ June2005/ docs/ 01features_01.htm

   •   •   •

Note: This site is for informational purposes only and is not medical advice. See your doctor or other qualified medical professional for all your medical needs.