How Asthma Is Treated

Asthma is a complicated medical problem. Treatment often involves multiple medications, each of which 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 somewhat challenging. 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.

With some education, time, and dedication, you can do just that.

Your Asthma Action Plan

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

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)

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:

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

Lifestyle

Your day-to-day life can have a major impact on how you feel if you have asthma. While some habits are well-known to worsen symptoms and should be avoided, there are other everyday factors that can play into your asthma control too.

Avoid 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
Wearing a face mask when outside in cold or dry air

Monitor Symptoms

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:

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. Be sure to report any heartburn or 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.

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 the severity of your case.

otc asthma inhaler side effects — Illustration by Emily Roberts, Verywell

Long-Term Asthma Control Medications

There are several options of long-term asthma control medications, some of which can be used solo and some of which are used along with other medications.

Inhaled Corticosteroids (ICS)

Inhaled corticosteroids (ICS) have long been the mainstay of asthma treatment in children and adults. These drugs work by reducing inflammation and are inhaled using a metered dose inhaler (MDI), dry powder inhaler (DPI), or a nebulizer. ICS medications are used daily and take several days to deliver their full benefit.

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

Common types of inhaled corticosteroids include:

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

Note: 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 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 (arformoterol tartrate)
Foradil (formoterol)
Perforomist (formoterol fumarate)
Serevent (salmeterol)

Leukotriene Modifiers

Leukotriene modifiers are an alternative treatment for patients with mild persistent asthma and can be used alone to treat mild persistent asthma or as an adjunctive therapy 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)

Some people have reported psychological reactions to leukotriene modifiers, so any unusual symptoms should be discussed with your doctor.

Intal (cromolyn sodium) and Tilade (nedocromil)

These 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 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

Some may be prescribed one of these medications to be used alone, while others may use them in conjunction with long-term asthma medication.

Short-acting beta agonists (SABAs)

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.

If one is prescribed to you, keep it with you at all times to stop your asthma symptoms from getting worse, should they arise. Some of the SABAs include:

Proventil and Ventolin (albuterol)
Xopenex (levalbuterol)

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

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 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:

Heart disease
High blood pressure
Thyroid disease
Diabetes
Difficulty in urination

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.

Specialist-Driven Procedures

Allergy shots (immunotherapy) can be of benefit for those with allergic asthma triggers. The shots are formulated by an allergy specialist to match your specific allergen triggers.

You get the shots regularly, first every week, 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 your airways from 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.

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 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 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, 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.

Living With Asthma