Treatment and medicines
If you have asthma your airways are always inflamed. The lining of the airways – the breathing tubes leading into the lungs – becomes swollen, inflamed and clogged with mucus and fluid. The muscles around the airways can tighten when something triggers your symptoms. Inhaled allergens or irritants like secondhand smoke and air pollution are acting like sandpaper on the raw surfaces. You begin to cough and wheeze as you struggle to breathe. This is called bronchospasm.
Even though we cannot cure asthma, we can control it. Each case of asthma is different, so you and your doctor need to create an asthma treatment plan just for you. It is your asthma; you have to tell your doctor what you want to achieve. This plan will have information about your asthma triggers and instructions for taking your medicines.
What is necessary to know about asthma medicines?
Inhaled medications go straight to the airways, using one of three types of delivery devices:
- metered-dose inhaler (MDI): use an pressurized aerosol canister inserted into a plastic mouthpiece to deliver a fine spray to inhale
- dry powder inhaler (DPI): deliver medicine as a dry powder using a special inhaler; most DPIs require a forceful inhalation
- nebulizer: breaks liquid medicine into a mist that can be inhaled slowly; babies and toddlers should always use a mask with their nebulizer
Oral medications swallowed as pills, tablets or liquids reach the airways by circulating through the bloodstream.
The right medications for you depend on a number of things — your age, symptoms, asthma triggers and what works best to keep your asthma under control.
There are four basic types of asthma medications:
- Bronchodilators relax and open the airways to relieve wheezing, coughing, choking and shortness of breath
- Anti-inflammatories reduce and prevent lung inflammation – the inflammation is always there. The quiet part of asthma that you can’t see or hear
- Combined medications of a bronchodilator and anti-inflammatory in one device
- Leukotriene modifiers block the action of leukotrienes, mediators involved in immune system responses
- Anti-IgE monoclonal antibodies (Omalizumab)block the IgE antibodies that cause allergy symptoms.
- Quick-relief (short-acting) bronchodilators (beta2-agonists) relax and open the airways and make it easier to breathe within a few minutes. You also can use short-acting bronchodilators to prevent exercise-induced bronchospasm. Quick-relief bronchodilators should be used to relieve breathing at the first sign of symptoms – the earlier you use the medication, the less you are likely to need.
A wide range of bronchodilators as metered-dose inhalers (MDI) and dry powder inhalers (DPI) are available.
- Anticholinergics (also called muscaranic antagonists) relieve cough, sputum production, wheeze and chest tightness associated with chronic lung diseases.
If you need to use a quick-relief bronchodilator more and more often during the week, that’s a sign of ongoing inflammation; anti-inflammatory medications are needed.
- Long-acting (12-hour) bronchodilators relax and open the airways for up to 12 hours. These medications are recommended only as add-on therapy for those already using anti-inflammatory medication to treat asthma. Do not use more than once every 12 hours.
- Theophylline comes as a tablet, capsule, solution and syrup. This medicine helps open the airways by relaxing the smooth muscles.
Anti-inflammatories treat inflammation. Anti-inflammatory medications also protect against the damaging effects of airway inflammation. After using an anti-inflammatory medication, you won’t you won’t see or feel any immediate changes. That’s because it takes time for airway swelling to subside and the mucus and excess fluid to clear out of the airways. These medications usually need to be taken every day to prevent symptoms and attacks from occurring.
- Inhaled corticosteroids are the most effective long-term therapy available for asthma. They reduce and prevent fluid and excess mucus and swelling in the airways. Because it is inhaled, the medicine goes directly to the inflamed airways. Corticosteroids are still the gold standard in asthma therapy. You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a relatively low risk of side effects and are generally safe for long-term use. These long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment.
Patients are often stop using inhaled corticosteroids or other medications when they are symptom-free and feel well. To prevent symptoms and attacks from occurring your corticosteroid inhaler has to be taken regularly every day.
- Oral corticosteroids will be used to treat acute asthma exacerbations or severe asthma. They are usually prescribed only for short periods of time (5-14 days) to prevent unwanted side effects.
- Nonsteroidal anti-inflammatory medications such as chromones, mast cell stabilizers, help reduce inflammation and decrease allergic cell reactions.
- Leukotriene modifiers. These oral anti-inflammatory medications help relieve asthma symptoms for up to 24 hours. It prevents airways from swelling when they come into contact with an asthma trigger.
Combination inhalers: These medications contain a long-acting beta agonist along with a corticosteroid and are usually prescribed as daily medications. Long-term control medications (corticosteroids) reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. If you need both of these medicines, this is a convenient way to take them together.
If you have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your basic daily therapy is working properly, you shouldn't need to use your quick-relief inhaler very often. Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more often than your doctor recommends, see your doctor. You probably need to adjust your anti-inflammatory medication.
may help if your asthma is triggered or worsened by allergies.
- Immunotherapy/Allergy shots. Immunotherapy gradually reduces your immune system reaction to specific allergens.
- Anti-IgE: Omalizumab (Xolair). This medication, given as an injection every two to four weeks, is specifically for people who have allergies and severe asthma. It prevents you from reacting to allergic triggers. It does this by blocking the antibody that causes allergies.
This very specific treatment can be used for severe asthma that doesn't improve with corticosteroids or other long-term asthma medications. Bronchial thermoplasty heats the insides of the airways in the lungs with an electrode, reducing the smooth muscle inside the airways. This limits the ability of the airways to tighten, making breathing easier and possibly reducing asthma attacks.
Treat by severity for better control: A stepwise approach
Your treatment should be flexible and based on changes in your symptoms, which should be assessed thoroughly each time you see your doctor. Then your doctor can adjust your treatment accordingly.
If your asthma is well-controlled, your doctor may prescribe less medicine. If your asthma isn't well-controlled or is getting worse, your doctor may increase your medication and recommend more-frequent visits.
Levels of asthma control
|Very poorly controlled
|Symptoms such as coughing, wheezing or shortness of breath||Two days a week or fewer||More than two days a week||Daily and throughout the night|
|Nighttime awakenings||Two times a month or fewer||One to three times a week||Four times a week or more|
|Effect on daily activities||None||Some limits||Extremely limiting|
|Quick-relief inhaler use to control symptoms||Two days a week or fewer||More than two days a week||Several times a day|
|Lung test readings||More than 80% of your predicted personal best||60 to 80% of your predicted personal best||Less than 60% of your predicted personal best|
Asthma Action or Asthma Management plan
Ask your doctor to create an asthma action plan with you that outlines in writing when to take certain medications or when to increase or decrease the dose of your medications based on your symptoms. Also include a list of your triggers and the steps you need to take to avoid them.
Here are some examples: