How Asthma Is Treated

Asthma is a complicated medical problem. Treatment often involves multiple medications, and each needs to be taken at the appropriate time. On top of that, the use of inhalers requires some manual dexterity that makes getting the needed medication to your lungs a little more difficult. Unlike pneumonia or an ear infection, there is no medication that will cure your asthma. Rather, asthma is managed and symptoms can be kept in check. The good news is that, with some education and time, you can do just that.

Home Remedies and Lifestyle

You need an asthma action plan. It is like a roadmap to good asthma control. It helps you do several things:

  • Avoid triggers
  • Recognize early warning signs of an asthma attack
  • Outline both your maintenance and acute symptom treatment
  • Manage asthma symptoms based on severity
  • Know when it’s time to head to the ER

Asthma action plans are generally divided into three zones: green (under control), yellow (asthma is getting worse), and red (seek medical help). Each zone relates to a different level of asthma control—and what to do when you find yourself in those states. An asthma action plan is also a communication tool between you and your (or your child's) doctor.

The Partnership for Clear Health Communication recommends that you ask and get answers to the following three questions from your healthcare provider. While this is especially important if you've been recently diagnosed with asthma, anyone with the condition (or any other, for that matter) can benefit from this if they are feeling unclear about how to best manage their treatment:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

Avoid Your Asthma Triggers

If you can avoid your asthma triggers, you might have fewer asthma symptoms and better asthma control. Tactics to use include minimizing household dust, reducing humidity to prevent mold spore growth, keeping the house clean of pet dander, using an air conditioner, keeping windows closed during pollen season, and wearing a face mask when outside in cold or dry air.

Monitoring Plan

An important part of identifying and understanding your asthma triggers is the development of an asthma monitoring plan. By measuring and tracking your asthma symptoms, you may recognize where and when they occur and whether they are getting better or worse. You can monitor your asthma using two different methods:

Quit Smoking

If you smoke, quit. Nearly one in four people with asthma smoke. This makes it very difficult to get your asthma under control. Quitting smoking is the single best thing you can do in this regard.

Control Heartburn

Acid reflux can irritate your airways and lead to worse asthma symptoms. Be sure to report any heartburn other symptoms of gastroesophageal reflux disease (GERD) to your doctor. Controlling it can help you control your asthma.

Exercise and Healthy Weight

You may have worse asthma symptoms if you are overweight, so achieving a healthy weight is a good goal. Exercise can help you keep your lungs and heart strong and may help prevent asthma symptoms.

Prescriptions

There are two types of asthma medications. Asthma controller medications prevent asthma symptoms when taken every day. Rescue medications are used for acute symptoms, including chest tightness, coughing, shortness of breath, and wheezing associated with asthma.

Long-Term Asthma Control Medications

Inhaled corticosteroids (ICS) work by reducing inflammation. They are inhaled using a metered dose inhaler (MDI), dry powder inhaler (DPI), or a nebulizer. They have long been the mainstay of asthma treatment in children and adults. ICS medications are used daily and take several days to reach their full benefit. They are safe and effective, with a low risk of side effects. These medications can be prescribed alone or may also be prescribed as a combination product with two different medications. Common types include Advair (fluticasone/salmeterol), Flovent (fluticasone), Pulmicort (budesonide), and Symbicort (budesonide/formoterol).

Long-acting beta agonists (LABAs) are inhaled medications that open the airways. They are preferred when your inhaled steroids are not adequately controlling your symptoms. LABAs are not used as a single asthma medication but as an adjunctive therapy. You may see them in combination inhalers. They should not be used for an acute asthma attack as they can mask a worsening of your asthma. LABAs include Brovana, Foradil, Perforomist, and Serevent.

Leukotriene modifiers are an alternative treatment for patients with mild persistent asthma and can be used as adjunctive therapy with inhaled steroids. One use is in controlling exercise-induced asthma. They include Accolate, Singulair, and Zyflo. Some people have reported psychological reactions to them, so any unusual reaction should be discussed with your doctor.

Intal (cromolyn sodium) and Tilade (nedocromil) are used as add-on controller medications and alternative treatment options for the treatment of asthma. While inhaled steroids are the treatment of choice, some people like these medications because they have a low incidence of side effects.

Biologics or immunomodulators are injected shots or infusions given every few weeks. These drugs are most often given for people who have allergies and severe asthma. They alter your immune system so you don't get as much inflammation of your airways. One such drug is Xolair (omalizumab).

Theophylline and other methylxanthines are an older type of bronchodilator that are taken as a pill, capsule, or liquid. They are less used today, but may be used along with ICS.

Quick-Relief (Rescue) Medications

Short-acting beta agonists (SABAs) are inhaled bronchodilators that are the drug of choice for the acute relief of asthma symptoms. They are also used to prevent exercise-induced asthma. You will want to keep this medication with you at all times to stop your asthma symptoms from getting worse. Some of the SABAs include Proventil and Ventolin (albuterol), Xopenex (levalbuterol), and Maxair (pirbuterol).

Signs that your asthma is poorly controlled include having to use your rescue inhaler more than twice per week, having symptoms more than two days per week, or waking up at night more than twice per month due to your asthma symptoms. Speak with your doctor if any of these apply to you as your asthma action plan needs adjustment.

Anticholinergics act as a bronchodilator and are often used in combination with SABAs in the acute treatment of asthma symptoms in the emergency room or hospital. An example of an anticholinergic is Atrovent.

Oral steroids are used for the treatment of moderate and severe asthma exacerbations to help improve symptoms and to prevent the late phase response of the allergic cascade. Oral steroids are only used as a controller medication after multiple other medications fail. They can have significant side effects.

Over-the-Counter (OTC) Therapies

The use of OTC epinephrine-based inhalers for asthma is controversial. Asthmanefrin (racepinephrine) is one such product, and it is used with an atomizer inhaler. It acts as a bronchodilator, relaxing inflamed muscles and functionally enlarging the airways of the lung. You should not use Asthmanefrin if you have any of the following conditions:

Organizations such as the American College of Asthma, Allergy & Immunology, the American Association for Respiratory Care, the American Thoracic Society and the National Association for Medical Direction of Respiratory Care do not want OTC inhalers to be included in asthma treatment guidelines. They do not feel that over-the-counter epinephrine products are safe for the treatment of asthma.

Surgeries and Specialist-Driven Procedures

Bronchial thermoplasty (BT) is an outpatient bronchoscopic procedure that helps prevent your airways constricting when you are exposed to asthma triggers. It is available for people with severe persistent asthma that is not well controlled with inhaled corticosteroids and long-acting beta-agonists.

In a BT procedure, a special catheter is inserted into the medium-sized airways of the lung during bronchoscopy. Heat energy is released to reduce the amount of smooth muscle in those airways. The procedure is repeated on three or more days, each day treating a different area of the lung. Many patients find that they have less of a reaction to their allergic asthma triggers and fewer emergency room visits.

Allergy shots (immunotherapy) can be of benefit for those with allergic asthma triggers. They are formulated by an allergy specialist to match your specific allergen triggers. You then get the shots regularly, first every week, then once a month for several years. Over time, you react less to those allergen triggers.

Complementary Alternative Medicine (CAM)

The National Center for Complementary and Integrative Health notes that conventional medical treatments are best for effectively managing asthma symptoms. They report that there are no complementary health approaches that have good evidence that they can relieve asthma.

Breathing exercises are aimed at reducing hyperventilation and regulating breathing. Buteyko breathing exercises were developed by Ukrainian physician Konstantin P. Buteyko in the 1960s. They focus on decreasing both the volume and the number of breaths you take per minute. While some studies point towards benefits, reviews of those studies have not allowed any conclusions to be drawn because the studies used different methods.

While some complementary therapies may work simply due to the placebo effect, experts warn that this can be dangerous in the case of asthma. A 2011 study found that patients reported fewer asthma symptoms after taking a placebo inhaler and a simulated acupuncture treatment. However, their lung function did not improve, leaving them at risk. Even actual acupuncture has shown no difference over sham acupuncture in relieving asthma symptoms.

A Word From Verywell

It's no doubt that having asthma makes life more difficult. But with good asthma treatment, there is no reason you cannot do almost anything you want day to day. You need to educate yourself about your asthma treatment and begin developing your treatment team. Then lean on them to evolve your treatment plan so that it works best for your life and your symptoms.

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