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 medications, which also are inhaled.

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.

Lifestyle

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 a number of things you can do in your daily life to help prevent this from happening.

Steer Clear of Triggers

The better able you are to avoid certain things that cause you to have symptoms, the less likely you are to experience them (obviously). This is especially true of indoor allergens such as dust mites, mold, and pet dander.

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 (updated in December 2020):

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.

That said, the NIH recommends a variety of interventions for common indoor allergens.

Monitoring

An important part of identifying and understanding your asthma triggers is measuring and tracking your asthma symptoms. In doing so, 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:

• 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. It's important to be aware if your PEFR changes, as this can be an indication you should make changes in your medication or other treatment strategies.
• Tracking and reviewing 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.

Asthma Action Plan

This is a written list of all you should be doing to obtain and maintain good asthma control, including:

• Avoid triggers
• Recognize early warning signs of an asthma attack
• Outline both your maintenance and acute symptom treatments—and know when to use them
• 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, each of which relates to a different level of asthma control and what to do when you find yourself in those states.

• Green (under control)
• Yellow (asthma is getting worse)
• Red (seek medical help)

Quit Smoking

Nearly one in four people with asthma smoke. This makes it very difficult to get your asthma under control. If you smoke, quitting 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. Report any heartburn or other symptoms of gastroesophageal reflux disease (GERD) to your doctor. Controlling it can help you control your asthma.

Exercise and Maintain a Healthy Weight

You may have worse asthma symptoms if you are overweight, so maintaining 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 and are used regularly—typically every day. Rescue medications relieve acute symptoms at the time they occur. Most often these medications are taken with an inhaler, which allows the drug to go directly to the lungs without affecting other systems in the body, although there are situations in which oral asthma medication is necessary.

Some asthma medications are bronchodilators, which open up (dilate) and relax constricted airways so you can breathe easier. These come in long-acting and short-acting varieties.

What you use and when depends on several factors, including how severe your asthma is.

Controller Medications

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

Inhaled Corticosteroids (ICSs)

Inhaled corticosteroids (ICS) are a mainstay of asthma treatment; they work by reducing inflammation. These drugs are inhaled through a metered dose inhaler (MDI), dry powder inhaler (DPI), or a nebulizer. People who have moderate or severe persistent asthma must use ICS medications daily.

Inhaled steroids 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.

Common inhaled corticosteroids include:

• Advair (fluticasone/salmeterol)
• Flovent (fluticasone)
• Pulmicort (budesonide)
• Symbicort (budesonide/formoterol)

Theophylline and other methylxanthines are an older type of bronchodilator that are taken as a pill, capsule, or liquid. Theophylline can be used alone or in combination with other asthma controller therapies.

Long-Acting Beta Agonists (LABAs)

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)

Intal (cromolyn sodium) and Tilade (nedocromil)

These are used as add-on controller medications 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 (LAMAs)

These 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.

Although LAMAs have been found to be as effective as LABAs, they are associated with side effects, especially for people who are Black. Spiriva (tiotropium) is an example of a LAMA that may be used in asthma treatment.

Biologics and Immunomodulators

Most often given to people who have allergies and severe asthma, these drugs alter the immune system so inflammation in the airways is reduced. They are delivered via injections or infusions given every few weeks. One such drug is Xolair (omalizumab).

Quick-Relief (Rescue) Medications

These may be prescribed to be used alone or in conjunction with long-term asthma medication.

Short-Acting Beta Agonists (SABAs)

SABAs are inhaled bronchodilators. They're the drug of choice for acute relief of asthma symptoms. They are also used to prevent exercise-induced asthma.

If your doctor prescribes a SABA for you, keep it with you at all times, as you never know when symptoms may develop. Commonly used SABAs include:

• Proventil and Ventolin (albuterol)
• Xopenex (levalbuterol)

Anticholinergics

These 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 Steroids

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

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:

• Heart disease
• High blood pressure
• Thyroid disease
• Diabetes
• Difficulty in urination

Specialist-Driven Procedures

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

Allergy shots (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 (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 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, which was developed by Ukrainian physician Konstantin P. Buteyko in the 1960s. The exercises focus on decreasing both the volume and the number of breaths you take per minute. While some studies point toward 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 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.

Frequently Asked Questions

What is uncontrolled asthma?

You can use the “rule of twos” to tell if your asthma control is working: If you have symptoms or have to use your inhaler more than twice a week, if you wake up from sleep with symptoms more than twice a month, or if you refill your quick-relief medication more than twice a year, you may have uncontrolled asthma. Over time, uncontrolled asthma can lead to irreversible changes in your lungs and breathing as well as other serious health problems.

What is severe asthma?

People with severe asthma have symptoms that are not adequately controlled by standard asthma medications. They may wake up nightly due to their symptoms and need to use a short-acting inhaler several times a day. Their symptoms are also likely to interfere with physical or daily activities.

How do biologic medications help asthma?

Biologics are a newer class of drugs that are generally reserved for people with severe asthma. By blocking specific aspects of the body’s immune system and inflammation response, biologics can reduce asthma symptoms and improve quality of life. Examples include Xolair, Dupixent and Nucala.

A Word From Verywell

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.