Asthma

Managing and Treating Asthma

Often the best way to control asthma symptoms is to avoid whatever causes them.

Overview

Asthma triggers frequently include:

  • Allergens such as pollen, dust mites, cockroaches, molds and animal danders
  • Irritants in the air, such as smoke, air pollution, chemical fumes and strong odors
  • Medications, such as aspirin and acetaminophen
  • Extreme weather conditions
  • Exercise
  • Stress

Allergies are just one of the factors that can trigger asthma attacks. Not all people with asthma have allergies and there are many people who have allergies but do not have asthma.

Some ongoing health problems can trigger asthma symptoms or make them worse. These include obesity, obstructive sleep apnea, acid reflux, stress and depression. Let your allergist know if you have one of these conditions so you can discuss the best approach to control both your health problem and your asthma symptoms. Colds and sinus infections can also worsen your asthma.

Effective treatment of allergic asthma includes identifying and avoiding allergens that trigger symptoms, using drug therapies and developing an emergency action plan for severe attacks. Your allergist may also recommend that you monitor your asthma by using a peak flow meter. This small handheld device allows you to measure how much air you are able to push out through your lungs. If your airflow is low, your allergist may recommend changes to your treatment plan, such as additional behavioral or environmental changes or a different asthma medication.

Use Proper Asthma Medication

There are many effective medicines to treat asthma. Most people with asthma need two kinds: quick-relief medicines and long-term control medicines. Immunotherapy (allergy shots) can also be helpful.

Patients may be reluctant to take medication because of cost or the potential side effects. If you have such concerns, talk with your allergist. Your allergist will work with you to find the right medicine, or combination of medicines, to manage your asthma and will adjust the dosage based on your symptoms and control. The goal is to have you feel your best with the least amount of medicine.

Quick-relief medicines are taken at the first sign of symptoms for immediate relief:

  • Short-acting inhaled beta2-agonists
  • Anticholinergics

Both types of drugs are bronchodilators, meaning that they expand the passageways into the lungs (the bronchi), allowing more air in and out and improving breathing. They also help to clear mucus from the lungs by enabling the mucus to move more freely and get coughed out more easily.

If you have exercise-induced bronchoconstriction (EIB), also known as exercise-induced asthma, your allergist may recommend that you use these medicines before exercise or other strenuous physical activity.

Quick-relief medicines can stop asthma symptoms, but they do not control the airway inflammation that causes the symptoms. If you find that you need your quick-relief medicine to treat asthma symptoms more than twice a week, or two or more nights a month, then your asthma is not well controlled.

Long-term control medicines are taken every day to prevent symptoms and attacks:

  • Antileukotrienes or leukotriene modifiers
  • Cromolyn sodium and nedocromil
  • Inhaled corticosteroids
  • Long-acting inhaled beta2-agonists (always administered with another asthma-related drug)
  • Methylxanthines
  • Oral corticosteroids
  • Immunomodulators

These medicines are taken every day, even if you do not have symptoms. The most effective long-term control medicines reduce airway inflammation and help improve asthma control.

Corticosteroids and health risks

Steroids are powerful drugs that can be dangerous when not taken as prescribed. The best available medical research shows that when taken as directed, inhaled corticosteroids — a kind of steroid — are safe and well tolerated, and are one of the most effective medications for asthma treatment.

Some studies have suggested that inhaled corticosteroids may slightly reduce the rate of growth in children, perhaps by 1 centimeter (less than half an inch) per year. The reduction may be related to dosage and the length of time the child takes the drug. The long-term effects of any reduction in growth rate on final adult height is unknown. Any allergist prescribing corticosteroids to treat a child with asthma will recommend the lowest effective dose of these drugs and will monitor the child’s growth.

Your allergist will work with you to find the right medicine, or combination of medicines, to manage your asthma, and will adjust the dosage based on your symptoms and control. The goal is to have you feel your best with the least amount of medicine.

Discuss any concerns with your child’s allergist. Never change or discontinue prescribed asthma medications unless advised by your or your child’s doctor.

Immunotherapy

Two types of immunotherapy are available: allergy shots and sublingual (under the tongue) tablets.

  • Allergy shots: If your asthma is triggered by an allergy, you should consider allergy shots, which are very effective in relieving allergy symptoms and in some cases can actually cure your allergy. The treatment, which can take several years, builds up immunity to your offending allergens (pollens, dust mite, pets, mold). It works by injecting small amounts of the allergen in gradually increasing amounts over time. As the shots help the body build up a tolerance to the effects of the allergen, they eventually reduce and can even eliminate your allergy symptoms.
  • Sublingual tablets: This type of immunotherapy was approved by the Food and Drug Administration in 2014. Starting several months before allergy season begins, patients dissolve a tablet under the tongue daily. Treatment can continue for as long as three years. These medications should not be used in patients with severe or uncontrolled asthma. Only a few allergens (certain grass and ragweed pollens) can be treated now with this method, but it is a promising therapy for the future.

See an allergist, an asthma specialist

An allergist can help you learn more about your asthma and develop a treatment plan that works for you. You should see an allergist if:

  • Your asthma symptoms occur every day and often at night, limiting your activity.
  • You’ve had a life-threatening asthma attack.
  • Your goals for asthma treatment haven’t been met after three to six months, or your doctor believes that you aren’t responding to current treatment.
  • Your symptoms are unusual or hard to diagnose.
  • You have conditions such as severe hay fever or sinusitis that complicate your asthma or your diagnosis.
  • Additional tests are needed to find the causes of your symptoms.
  • You need more help and instruction on your treatment plan, medicines or asthma triggers.
  • Allergy shots might help you.
  • You need oral corticosteroid therapy or high-dose inhaled corticosteroids.
  • You’ve taken oral corticosteroids more than twice in one year.
  • You have been hospitalized because of your asthma.
  • You need help to identify your asthma triggers.

Consultation with an asthma specialist is recommended if your child is 4 years old or younger and has asthma symptoms every day and three to four nights or more a month. It should be considered if your child has symptoms three days or more a week and one to two nights a month.

Although asthma symptoms are controllable, a cure for asthma has remained elusive. Preventive treatment should minimize the difficulties caused by asthma and allow a normal, active lifestyle.

Asthma Guidelines - NHLBI 2007

In 2007, the National Heart Lung and Blood Institute/ National Asthma Education and Prevention Program updated earlier guidelines, with an emphasis on asthma control. Both of the documents listed here discuss various aspects of asthma management from the perspective of these guidelines.
For asthma severity guidelines, download the guide(s) below:

View the complete NHLBI/NAEPP Guidelines

Images with PDF link: 2007 NHLBI/NAEPP Guidelines at a Glance

This 16-page summary of the 2007 NHLBI Guidelines contains management tables by asthma severity and age at diagnosis. Stepwise treatment of childhood and adult asthma are included. Content published by Astra Zeneca.

ACAAI Instant Reference Guide for Health Care Professionals 

This 12-page summary, published by ACAAI along with Astra Zeneca, reviews the main components of the Expert Panel Report -3 (NHLBI) from 2007 and is suitable for health care professionals. Key elements of the updated guidelines are highlighted here, and include an emphasis on maintaining asthma control to allow maximum quality of life for those with asthma.

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