How Asthma Is Treated

Asthma is a complicated condition, one that has multiple causes, varying degrees of severity, and no cure. Therefore, treating asthma is a matter of managing it to ward off symptoms and prevent exacerbations (asthma attacks), typically with inhaled medications called controller inhalers, and relieving symptoms when they do occur with rescue inhalers.

Other management strategies include avoiding triggers, which are unique for each individual who has asthma and taking other lifestyle measures. For people with allergic asthma, allergy shots sometimes can help.

This article will provide an overview of the various types of asthma treatments.

Lifestyle Changes

Asthma symptoms do not simply happen—they occur in response to exposure to a trigger of some sort that causes the bronchi (airways) to constrict and the production of mucus to go into overdrive, inhibiting the flow of oxygen to the lungs. There are several things you can do in your daily life to help prevent this from happening.

Self-Monitor

An important part of identifying and understanding your asthma triggers is measuring and tracking your asthma symptoms. You can monitor your asthma using two different methods:

• Monitor your peak expiratory flow rate (PEFR): This is a measure of how quickly your lungs can expel air during a forceful exhalation following a deep inhale. It's measured using a portable device that you can use to regularly monitor your breathing status. PEFR changes can be an indication you should make changes in your medication or other treatment strategies.
• Track your symptoms: A record of when you have flare-ups and the circumstances in which they occur can reveal changes in the severity of your asthma and whether your medication is controlling it sufficiently.

Create an Asthma Action Plan

An asthma action plan is a written plan you create with your healthcare provider to help you obtain and maintain good asthma control.

Asthma action plans are generally divided into three zones: green, yellow, and red. Each zone relates to a different level of asthma control and what to do when you find yourself in those states.

• Green zone: Green means "good." This zone is where you want to be. You don't experience any symptoms while on your daily controller medication. Your PEFR is normal.
• Yellow zone: Mild to moderate symptoms. Your PEFR is slightly less than normal. This is when you'll need to use quick-relief medications.
• Red zone: This is the danger zone and a possible medical emergency. Your PEFR is less than 50% normal. You're having trouble breathing and your quick-relief medications are not helping.

Steer Clear of Triggers

The more able you are to avoid those things that set off or worsen your asthma symptoms, the better off you'll be.

Common asthma triggers include:

• Allergic allergens, such as dust mites, mold, and pet dander
• Certain health conditions, such as obesity and gastroesophageal reflux disease (GERD)
• Exercise
• Medications such as aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)
• Tobacco smoke

Before you banish your pup or attempt to battle dust mites, however, it's important to remember two key things, according to the National Institutes of Health (NIH) recommendations for asthma management:

1. Only if you or a family member has undergone testing and been diagnosed as allergic to a particular substance is it necessary to take mitigation measures.
2. If an allergy to a specific substance has been diagnosed, you should take multiple targeted steps to deal with it: A single strategy will not be sufficient.
   

Medications

Different types of asthma medicines help with different types of symptoms. The two most common types of asthma medications are controller medicines and quick-relief medicines. What you use and when depends on several factors, including how severe your asthma is.

Controller Medications

Asthma controller medicines are a variety of long-term asthma control medications. Some are used alone, while some are combined with other drugs.

Inhaled Corticosteroids

Inhaled corticosteroids (ICSs) are a mainstay of asthma treatment. They work by reducing many forms of airway inflammation. Three types of devices deliver inhaled medications:

• Metered-dose inhalers (MDIs)
• Dry powder inhalers (DPIs)
• Nebulizers

People who have moderate or severe persistent asthma must use ICS medications daily.

ICSs are safe and effective and have a low risk of side effects. They can be prescribed alone or as a combination product with two different medications.

Commonly used ICSs include:

• Flovent (fluticasone)
• Pulmicort (budesonide)
• Qvar (beclomethasone HFA)
• Asmanex (mometasone)

Long-Acting Beta-Agonists

Long-acting beta-agonists (LABAs) are inhaled medications that open the airways, acting as bronchodilators. They are preferred when inhaled steroids do not adequately control symptoms.

LABAs are not used as a single asthma medication but as an add-on therapy and often are combined with another asthma medication in a single inhaler. They should not be used for an acute asthma attack as they can mask a worsening of your asthma.

LABAs include:

• Brovana (arformoterol tartrate)
• Foradil (formoterol) 
• Perforomist (formoterol fumarate)
• Serevent (salmeterol)

Leukotriene Modifiers

Leukotriene modifiers are an alternative treatment for patients with mild persistent asthma. They can be used alone to treat mild persistent asthma or along with inhaled steroids to treat moderate to severe persistent asthma. One use is in controlling exercise-induced asthma. They are not used for short-term relief during a sudden asthma attack.

They include:

• Accolate (zafirlukast)
• Singulair (montelukast)
• Zyflo (zileuton)

Add-on Controller Medications

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

Long-Acting Muscarinic Antagonists

Long‐acting muscarinic antagonists (LAMAs) are a class of long-acting bronchodilators initially developed to treat COPD. They may be prescribed for people with uncontrolled persistent asthma that doesn't respond to ICS therapy, but only if adding a long-acting beta-agonist is not appropriate for some reason.

Spiriva (tiotropium) is an example of a LAMA that may be used in asthma treatment.

Biologics

Most often given to people who have severe asthma, biologics alter the immune system so inflammation in the airways is reduced. They are shots or infusions given every few weeks. One such drug is Xolair (omalizumab).

Quick-Relief Medications

Quick-relief medications, also called short-term relief or rescue medications, relieve asthma symptoms within minutes. You take them at the first sign of symptoms.

Most often these medications are taken with an inhaler. Inhalers allow the drug to go directly to the lungs without affecting other systems in the body. They can be prescribed to be used alone or in conjunction with long-term, controller medications.

Short-Acting Beta-Agonists

Short-acting beta-agonists (SABAs) are the drug of choice for acute relief of asthma symptoms. They can also be used to prevent exercise-induced asthma. SABAs are inhaled bronchodilators, meaning they open (dilate) the airway (bronchi) by relaxing the muscles in the lungs.

Albuterol (Proair, Proventil, Ventolin) and levalbuterol (Xopenex) are the two most commonly prescribed SABAs.

Anticholinergics

Anticholinergic drugs 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 (ipratropium).

Oral Corticosteroids

Oral steroids are used for moderate and severe asthma exacerbations to help improve symptoms and to prevent the late-phase response of the allergic cascade.

Oral steroids are used only as a controller medication after multiple other medications fail. They can have significant side effects.

Over-the-Counter (OTC) Therapies

There are two commonly used OTC asthma inhalers: Primatene MIST HFA and Asthmanefrin (racepinephrine).

Remember, you should never stop your current asthma treatment or start an OTC asthma medication without talking to your healthcare provider first.

Primatene MIST HFA

Primatene MIST HFA is an epinephrine metered-dose inhaler (MDI). It is the only MDI product approved for OTC use by the FDA. 

While this OTC inhaler can temporarily relieve mild intermittent asthma symptoms, it does not reduce the inflammation that leads to asthma symptoms. Only prescription beta-agonist medicines can help control inflammation.

Asthmanefrin

Asthmanefrin (racepinephrine), on the other hand, is designed to treat the inflammation that leads to asthma attacks. Unlike Primatene MIST HFA, Asthmanefrin is not FDA-approved to treat asthma.

But this OTC asthma inhaler isn't for everyone. You shouldn't use it if you are taking monoamine oxidase inhibitors (MAOIs) or have certain medical conditions, including heart disease, diabetes, and thyroid issues.

Specialist-Driven Procedures

If medications alone aren't able to control your asthma well enough, some procedures might help.

Allergy Shots

Allergy shots, also known as immunotherapy, can benefit people with allergic asthma triggers. The shots are formulated by an allergy specialist to match your specific allergen triggers.

You get the shots regularly—every week at first, then once a month for several years. Over time, you react less to those allergen triggers.

Bronchial Thermoplasty

Bronchial thermoplasty (BT) is an outpatient bronchoscopic procedure that helps prevent airways from constricting in response to an asthma trigger. 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.

Studies have found the benefits of BT rarely outweigh the risk of short- and long-term side effects, however. For this reason, the NIH does not recommend the treatment for people over 18.

Complementary and 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. An example is Buteyko breathing. The exercises focus on decreasing both the volume and the number of breaths you take per minute. Some studies toward benefits of these breathing exercises. However, conclusions can't be made because the studies used different methods.

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.

Summary

There is no cure for asthma, but it's possible to control the condition and prevent flare-ups using a combination of treatments. Lifestyle changes, such as avoiding triggers, and using controller medications can reduce symptoms. Asthma attacks can be treated with rescue medications.

Prescription and over-the-counter options are available, but it's important to follow a healthcare provider's treatment plan—don't try to manage your asthma on your own. Monitoring your symptoms and having an asthma action plan can help you stay on top of your condition and know what to do when flare-ups arise.

It's no doubt that having asthma makes life more difficult. But with good asthma treatment, most people can do almost anything they 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.