How Is Asthma Treated?

Asthma is a chronic lung condition characterized by inflammation and narrowing of the airways, leading to symptoms ranging from mild to severe, such as difficulty breathing and tightness in the chest.

While asthma cannot be cured, it can be effectively managed through various treatment options. These treatments aim to prevent and alleviate symptoms, reduce the frequency and severity of asthma attacks, and maintain optimal lung function. Inhaled medications, including corticosteroids to reduce inflammation and bronchodilators to relax the airway muscles, are commonly used to control asthma symptoms. Lifestyle modifications, such as identifying and avoiding triggers that can exacerbate asthma, also play a crucial role in managing the condition.

The management of asthma may involve a collaborative approach, with healthcare professionals such as primary care physicians, allergists, and pulmonologists overseeing your care. They will work together to develop a personalized treatment plan tailored to your specific needs, considering factors such as your symptoms, medical history, and individual circumstances. Regular monitoring, adjustments to medication dosages as needed, and ongoing communication with your healthcare team are important aspects of managing asthma effectively.

Medications

Medications play a vital role in the treatment of asthma by reducing inflammation, relaxing the airways, and managing symptoms. There are four main categories of asthma medications: quick-relief medications, long-term control medications, combination quick-relief and controller medications, and biologics.

Asthma medications can be taken through different methods. Inhalers, also known as puffers, deliver medication directly into the lungs as a spray mist. Nebulizers, on the other hand, convert liquid medication into a mist that is inhaled through a mask or mouthpiece. Injections or infusions are used for administering biologics, while oral medications are taken by mouth in the form of capsules, pills, or liquids.

Quick Relief Medicines

Quick-relief medications, also known as rescue or short-acting medications, provide immediate relief of asthma symptoms during an asthma attack. They are particularly useful for individuals with mild asthma or exercise-induced asthma. These medications work by relaxing the muscles surrounding the airways, helping to open them up and alleviate symptoms. It is recommended to carry a quick-relief inhaler at all times in case of an asthma attack.

Common quick-relief medications for asthma include:

1. Short-acting beta2-agonists (SABAs): SABAs rapidly open the airways by relaxing the surrounding muscles and clearing mucus from the lungs.

2. Short-acting anticholinergics: These medications relax the muscles around the airways, making breathing easier. Anticholinergics may be prescribed to individuals who cannot tolerate SABAs or may be used in combination with SABAs during emergencies.

3. Oral corticosteroids: These medications are taken by mouth in the form of capsules or liquid for a short period to reduce airway inflammation and swelling when symptoms persist for several days and other medications do not provide sufficient relief.

Long-term Control Medicines

Long-term control medications, also known as maintenance medications, are taken regularly to prevent and manage asthma symptoms over the long term. These medications are used even when asthma symptoms are not present, as they help reduce inflammation and keep the airways open. By doing so, they reduce the frequency and severity of asthma attacks and improve lung function.

Common long-term control medications for asthma include:

1. Inhaled corticosteroids: These medications are effective and safe for long-term control of asthma. They work by reducing inflammation and mucus production in the airways.
2. Long-acting inhaled beta2-agonists (LABAs): Similar to SABAs, LABAs relax the muscles in the airways to prevent asthma symptoms. They have a longer duration of action, up to 12 hours. However, they should never be used alone in emergencies and are typically prescribed in combination with inhaled corticosteroids if symptoms are not well-controlled.
3. Leukotriene modifiers: These medications, available in capsule or pill form, block the action of leukotrienes, which are inflammatory chemicals that can trigger asthma attacks. By reducing airway inflammation and swelling, leukotriene modifiers help control asthma symptoms.
4. Inhaled mast cell stabilizers: These medications prevent mast cells from releasing histamine and other inflammation-causing chemicals when exposed to allergens. By doing so, they help prevent inflammation and narrowing of the airways, particularly in cases of allergic asthma.

Combination Quick-Relief and Control Medicines

Quick-relief, controller, and combination medications combine a bronchodilator and a long-acting drug in a single inhaler to provide rapid relief and sustained control, respectively. Asthma sufferers with moderate to severe cases are often administered combination inhalers for both short- and long-term symptom alleviation and inflammation management. Current clinical recommendations for the treatment of asthma encourage the use of combination drugs; however, the FDA has not yet authorized such medicines for this purpose.

Biologics

Biologic medications are used to treat severe asthma that does not respond well to standard treatments. These medications target specific cells and antibodies in the body that are involved in triggering inflammation in response to asthma triggers. By targeting these specific pathways, biologics help to reduce the frequency of asthma attacks and the severity of symptoms.

Biologic medications are typically administered through injections or intravenous (IV) infusions, and they are usually given in a doctor’s office every few weeks. There are several biologic drugs available for the treatment of asthma:

• Cinqair (reslizumab)
• Nucala (mepolizumab)
• Xolair (omalizumab)
• Fasenra (benralizumab)
• Dupixent (dupilumab)
• Tezspire (tezepelumab-ekko)

To determine the most effective biologic for your condition, your healthcare provider may order blood tests or conduct other assessments to evaluate your specific needs and response to treatment. It’s important to work closely with your healthcare provider to find the most appropriate biologic medication and to monitor your asthma symptoms and overall response to the treatment.

Bronchial Thermoplasty

Bronchial thermoplasty (BT) is a medical procedure that may be recommended for individuals with severe, uncontrolled asthma. Over time, the muscle tissue lining the airways can thicken in severe asthma cases, leading to narrowed airways and worsening symptoms.

During a BT procedure, a thin bronchoscope tube is inserted through the mouth and into the airways. Once the tube is properly positioned, a small, heated electrode is used to apply heat to the smooth muscle tissue in the airways, effectively removing excess tissue. Typically, BT is performed in three separate sessions, with each session targeting a different area of the lungs. The goal of BT is to open the airways, reduce the frequency of asthma attacks, and alleviate other related symptoms.

Immunotherapy

Immunotherapy is a treatment approach that involves controlled exposure to allergens that trigger asthma symptoms, specifically in individuals with allergic asthma. Before starting immunotherapy, allergy testing is conducted to identify the specific allergens that provoke your symptoms and ensure the effectiveness of the treatment.

Immunotherapy typically consists of a series of injections or sublingual tablets containing gradually increasing doses of the allergens. The purpose is to build tolerance and desensitize the immune system to these allergens, thereby reducing allergic reactions. The duration of immunotherapy varies based on individual response, but it can span several years until allergy symptoms are minimized or eliminated.

Complementary and Alternative Medicine

Some CAM (complementary and alternative medicine) treatments have shown promise in symptom management. While complementary and alternative medicine (CAM) therapies cannot replace conventional medical care, they may improve patients’ health and well-being.

Acupuncture

Acupuncture is a practice rooted in traditional Chinese medicine that involves the insertion of thin needles into specific points on the body’s skin. While it is not considered a standalone treatment for asthma, some research suggests that acupuncture may provide benefits when used in conjunction with standard asthma treatments.

Studies have indicated that acupuncture may help reduce inflammation and improve asthma symptoms by potentially influencing the immune response and promoting relaxation. However, the evidence regarding its effectiveness for asthma is still limited and further research is needed to establish its therapeutic value.

Breathing Exercises

Breathing exercises and techniques, such as the Buteyko method, can be beneficial for managing asthma symptoms by promoting awareness and control of breathing patterns. These exercises aim to improve the efficiency of breathing and reduce hyperventilation symptoms.

Research suggests that breathing exercises can help relax the airways, increase tolerance to carbon dioxide, and improve lung function, particularly in individuals with mild to moderate asthma. By practicing breathing exercises, individuals may experience a reduction in asthma symptoms and a decreased need for medication.

In addition to their direct effects on respiratory function, breathing exercises may also have a positive impact on mental well-being. Asthma can be exacerbated by stress and anxiety, so the relaxation and mindfulness aspects of breathing exercises may help alleviate these psychological factors and indirectly improve asthma symptoms.

Lifestyle and Asthma Management

Making adjustments to your way of life is an integral aspect of asthma care and may have a significant impact on your ability to manage your symptoms, lessen the severity of asthma episodes, and increase your overall quality of life.

Avoid Triggers

Identifying and avoiding triggers that can trigger or exacerbate asthma symptoms is crucial for controlling the condition and preventing asthma attacks. By recognizing and minimizing exposure to these triggers, individuals with asthma can better manage their symptoms. Some common asthma triggers include:

• Cigarette smoke: Both firsthand and secondhand smoke can irritate the airways and trigger asthma symptoms. It is important to avoid smoking and minimize exposure to smoke by staying away from smoking areas and ensuring a smoke-free environment.
• Exercise: Physical activity, particularly intense or prolonged exercise, can induce asthma symptoms in some individuals. However, with proper management, individuals with exercise-induced asthma can still engage in physical activity. Pre-exercise warm-ups, using inhalers as prescribed, and working with healthcare professionals to develop an appropriate exercise plan can help reduce asthma symptoms during exercise.
• Medications: Certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), can trigger asthma symptoms in some individuals. It is important to inform healthcare providers about your asthma condition and any known triggers to avoid medications that may worsen your symptoms.
• Stress and strong emotions: Stress and intense emotions can contribute to asthma symptoms. Learning stress management techniques, practicing relaxation exercises, and seeking support from therapists or counselors can help manage stress and minimize its impact on asthma.
• Infections: Respiratory infections caused by viruses, such as influenza, the common cold, or respiratory syncytial virus (RSV), can trigger asthma attacks. Practicing good hygiene, getting vaccinated, and avoiding close contact with individuals who have respiratory infections can help reduce the risk of infection-related asthma exacerbations.
• Cold weather: Cold air can irritate the airways and trigger asthma symptoms in some individuals. Wearing a scarf or mask over the mouth and nose when outdoors in cold weather can help warm and humidify the air before breathing it in, reducing the risk of asthma symptoms.
• Acid reflux: Gastroesophageal reflux disease (GERD) and acid reflux can worsen asthma symptoms, especially during sleep. Managing acid reflux through lifestyle modifications, such as avoiding trigger foods and eating smaller, more frequent meals, can help alleviate associated asthma symptoms.

Regular Exercise

Living with asthma does not mean you have to avoid physical activity altogether. In fact, regular exercise can have numerous benefits for individuals with asthma. Engaging in exercise can help improve lung function, enhance cardiovascular health, strengthen the immune system, maintain a healthy body weight, and reduce stress levels.

If you experience asthma symptoms during vigorous exercise, it is important to find the right balance and choose activities that are suitable for your condition. Starting with low-intensity exercises such as walking, yoga, or tai chi can be beneficial. These activities promote gentle movement, help improve flexibility and breathing control, and are less likely to trigger asthma symptoms.

Before engaging in physical activity, it is advisable to consult with your healthcare provider to develop an exercise plan that suits your individual needs. They can provide guidance on appropriate warm-up exercises, recommend specific breathing techniques to manage asthma symptoms, and assess if you require any adjustments to your medication regimen.

Carrying your emergency inhaler with you during exercise provides peace of mind, as you will have quick access to medication if needed. Additionally, monitoring your symptoms and being aware of your limits will help you gauge the intensity of exercise that is comfortable for you. Gradually increasing the duration and intensity of your workouts over time, with proper guidance, can help you safely incorporate more challenging activities into your routine.

Remember to listen to your body and adjust your activities as necessary

Use a Peak Flow Meter

A peak flow meter is a valuable tool for monitoring lung function in individuals with asthma. This handheld device measures how well air moves out of the lungs, providing an objective measurement of lung performance. By regularly using a peak flow meter, you can detect changes in your breathing patterns, even before symptoms of asthma appear.

The daily use of a peak flow meter allows you to track your peak flow readings over time. By recording these measurements, you can identify patterns and trends in your lung function. This information can be helpful in assessing the effectiveness of your asthma medications, identifying triggers that may worsen your symptoms, and making informed decisions about your treatment plan.

It’s important to note that using a peak flow meter requires effort and cooperation, which can be challenging for some individuals, particularly children and older adults who may have reduced lung capacity or difficulty performing the required maneuvers. In such cases, alternative methods of monitoring lung function, as advised by healthcare professionals, may be recommended.

While a peak flow meter can provide valuable insights into your asthma management, it is not a requirement for everyone with asthma to have one at home. The decision to use a peak flow meter should be made in consultation with your healthcare provider, taking into consideration your individual needs, capabilities, and treatment plan.

Develop an Asthma Action Plan

An asthma action plan is a personalized guide that helps you manage your asthma effectively. Developed in collaboration with your healthcare provider, it outlines the necessary steps to control your asthma symptoms and respond to changes in your condition. A comprehensive asthma action plan may include the following components:

• Triggers: A list of known triggers that can worsen your asthma symptoms, such as allergens, pollutants, or exercise.
• Symptom tracking: Instructions on how to monitor and track your symptoms, including recording peak flow readings, coughing, wheezing, or shortness of breath.
• Medications: A detailed list of your prescribed asthma medications, including dosage, frequency, and specific instructions on how and when to take them.
• Contact information: Emergency phone numbers, such as your healthcare provider’s office, nearby hospital, or ambulance services.

The asthma action plan is typically divided into three color-coded zones:

• Green zone: Indicates that your asthma is well-controlled. Your peak flow reading is 80% or more of your best peak flow level, and you have minimal or no symptoms. In this zone, you can continue with your regular medications and daily activities.
• Yellow zone: Signals that your asthma is not well-controlled, and your symptoms may be worsening. Your peak flow reading is between 50% and 80% of your best peak flow level. In this zone, specific instructions are provided for adjusting your medication or initiating additional treatments to regain control of your symptoms.
• Red zone: Indicates a severe asthma episode or exacerbation. You are experiencing significant breathing difficulties, your usual medications are not providing relief, and your peak flow reading is less than 50% of your best peak flow level. In the red zone, immediate medical attention is required, and emergency measures may need to be taken.

Your healthcare provider will guide you on the appropriate steps to take within each zone. They will explain how to adjust medication dosages, when to seek medical assistance, and any additional strategies or interventions to manage your symptoms effectively.

Living With Asthma

Maintaining a high quality of life with asthma requires diligent adherence to prescribed treatments and the adoption of asthma-friendly lifestyle habits. If your asthma isn’t adequately managed, it might lead to irreversible lung damage, and your medications won’t be as effective in treating it.16

The good news is that there are effective therapies for asthma that may keep lungs healthy, reduce symptoms, and stop attacks before they start. You can better manage and control your asthma if you and your doctor work together to create an asthma action plan and you visit your doctor often to monitor your progress. Most individuals with asthma may lead normal, fulfilling lives with the help of modern medicines.

A Quick Review

Lifelong management of asthma is often necessary for symptom management, attack prevention, and stable lung function. Medications to relieve asthma symptoms quickly and keep asthma under control for the long term are used to treat asthma. Avoiding asthma triggers, maintaining a regular exercise routine, and adhering to an asthma action plan are all crucial components of asthma treatment.