What're the treatments for asthma?
Patients should be periodically examined and have their lung function measured by spirometry to make sure that treatment goals are being met. These goals are to prevent troublesome symptoms, to maintain lung function as close to normal as possible, and to allow patients to pursue their normal activities including those requiring exertion. The best drug therapy is that which controls asthmatic symptoms while causing few or no side-effects. Treatment is aimed at avoiding known
allergens and respiratory irritants and controlling symptoms and airway inflammation through medication. Allergens can sometimes be identified by noting which substances cause an allergic reaction. Allergy testing may also be helpful in identifying allergens in patients with persistent asthma. Common allergens include: pet dander, dust mites, cockroach allergens, molds, and pollens. Common respiratory irritants include: tobacco smoke, pollution, and fumes from burning wood or gas.
Treatment of asthma can be divided into long-term control and quick-relief medications. Long-term control medications are taken daily to maintain control of persistent asthma. They primarily serve to control airway inflammation. The quick-relief medications are taken to achieve prompt reversal of an acute asthma “attack” by relaxing bronchial smooth muscle. Drugs used to relieve acute asthma symptoms. Anyone experiencing a moderate or severe asthma attack should promptly be given medications that open the airways. Generally, these are bronchodilator called short-acting beta-adrenergic agonists (beta2-agonists). Others sometimes used in special cases include theophylline, and certain anticholinergic agents. None of these agents have any effect on the disease process itself. They are only useful for treating symptoms. Drugs used to control long-term persistent inflammation and prevent lung injury. For long-term control of the disease, patients with moderate to severe asthma require medications to control inflammation. Typically, these are patients who are taking the short-acting beta2 agonists more than twice a week. The standard agents for maintenance treatments are inhaled corticosteroids (commonly called steroids). Others include leukotriene-antagonists, and cromolyn. Combinations of steroids and other medications (such as long-acting beta2 agonists or leukotriene-antagonists) are proving to be effective for both treating and preventing asthma attacks in patients with moderate to severe asthma.
Pharmacological therapy for asthma is based on two classes of antiasthmatic drugs. The first are anti-inflammatory drugs, which suppress the inflammation that triggers the airways to narrow. The second are bronchodilators, which help to relax and widen (dilate) the airways. Within each of these two classes, several drugs are available. Anti-inflammatory drugs include corticosteroids (which are inhaled, taken by mouth, or given intravenously), leukotriene modifiers, and cromolyn. Bronchodilators include beta-adrenergic agonists and theophylline. Some people cannot control the symptoms by avoiding the triggers or using medication. For these people, immunotherapy (allergy shots) may help. Immunotherapy involves the injection of allergen extracts to "desensitize" the person. The treatment begins with injections of a solution of allergen given one to five times a week, with the strength gradually increasing. People with mild asthma (infrequent attacks) may use relief medication as needed. Those with persistent asthma should take control medications on a regular basis to prevent symptoms from occuring. A severe asthma attack requires a medical evaluation and may require hospitalization, oxygen, and intravenous medications.
A peak flow meter, a simple device to measure lung volume, can be used at home to help you "see an attack coming" and take the appropriate action, sometimes even before any symptoms appear. If you are not monitoring asthma on a regular basis, an attack can take you by surprise. Peak flow measurements can help show when medication is needed, or other action needs to be taken. Peak flow values of 50-80% of an individual’s personal best indicate a moderate asthma attack, while values below 50% indicate a severe attack.
Most asthma drugs are inhaled using special devices or nebulizers. The standard inhalers have used ozone-depleting chlorofluorocarbons as propellants, but alternative delivery methods and propellants are increasingly available that do not threaten the environment and may even be better in delivering the drugs. Metered-dose inhalers (MDIs) are the most common delivery system used today. To use an MDI, the patient first exhales completely, then places the MDI to the lips, forms a seal around the mouthpiece, and presses on the top of the canister to deliver a measured dose of medication while slowly inhaling. After inhaling slowly, the patient holds his or her breath for a full 10 seconds. Breath-actuated MDIs are a variation of the standard MDI. Instead of projecting the medication into the mouth by pressing on the canister, the patient forms a good seal around the mouthpiece and inhales slowly. Dry powder inhalers are used in patients under 5 years of age. A variety of these are available for specific medications, including beta2 agonists and corticosteroids. Nebulizers can be used with all classes of inhaled medications but are most commonly used with short-acting beta2 agonists and ipratropium bromide.
People who self-manage their asthma using daily monitoring of peak air flow and adjusting their medications as needed have fewer hospitalizations, fewer unplanned doctors visits, and, generally, a better quality of life than those who rely only on the occasional physician or emergency room visit to control symptoms. Physicians recommend that patients with even mild asthma monitor their own conditions.
More information on asthma
What is asthma? - Asthma is a chronic inflammatory respiratory disease characterized by periodic attacks of wheezing, shortness of breath, and a tight feeling in the chest.
What types of asthma are there? - Types of asthma include child-onset asthma, adult-onset asthma, exercise-induced asthma, cough-variant asthma, occupational asthma, nocturnal asthma.
What's bronchial asthma? - Bronchial asthma is a disease of the lungs in which an obstructive ventilation disturbance of the respiratory passages evokes a feeling of shortness of breath.
What is exercise-induced asthma? - Exercise-induced asthma is a form of asthma that some people have during or after physical activity. Exercise-induced asthma is common.
What is adult-onset asthma? - Adult onset asthma generally is the onset of asthma for the first time in someone of middle age or older. Adult-onset asthma develops after age 20.
What is status asthmaticus? - Status asthmaticus is a severe asthma episode that does not respond to standard treatment. Status asthmaticus is caused by severe bronchospasm.
What causes asthma? - Asthma is caused by inhaling an allergen that sets off the chain of biochemical and tissue changes leading to airway inflammation, bronchoconstriction, and wheezing.
What're the asthma triggers? - Many risk factors have been linked to triggering asthma attacks. There are two basic types of asthma triggers, allergic triggers, non-allergic triggers.
Asthma and allergy - Asthma attacks (worsening of asthma symptoms) can be triggered by allergies. Allergy is the leading cause of asthma.
What is an asthma attack? - An asthma attack occurs when the small and medium-sized airways become inflamed and constricted after being exposed to a trigger.
Asthma in children - Asthma is the most common chronic condition of childhood. Asthma symptoms can interfere with many school activities for children.
Asthma and pregnancy - During pregnancy, asthma or asthma episodes will become worse for an estimated one-third of pregnant women, particularly women who have severe asthma.
Asthma in adults and older people - Identifying asthma in the elderly can be difficult because asthma symptoms can be confused with symptoms of heart or lung diseases.
What're the complications of asthma? - Uncontrolled asthma in pregnant women puts them at higher risk for complications that can include early labor, hypertension, gestational diabetes.
What are the symptoms of asthma? - The symptoms of asthma include labored breathing, constriction of the chest, coughing and gasping usually brought on by allergies.
What're the warning signs of asthma? - Most people with asthma have warning signs before symptoms appear. There are many warning signs of an asthma episode.
How is asthma diagnosed? - The diagnosis of asthma is made on the basis of typical symptoms and signs. Positive allergy tests support a diagnosis of asthma.
What're the treatments for asthma? - Treatment of asthma is aimed at avoiding known allergens and respiratory irritants and controlling symptoms and airway inflammation through medication.
What quick relief (rescue) medications cure asthma? - Short-acting beta-agonists are the most commonly used asthma rescue medications. Anticholinergics are another class of asthma drugs.
Long-term asthma control medications - Combinations of steroids and other medications are effective for both treating and preventing asthma attacks in patients with moderate to severe asthma.
What're asthma inhalers? - Most asthma drugs are inhaled using special devices or nebulizers. Two common types include dry powder asthma inhalers and metered-dose asthma inhalers.
What're asthma nebulizers? - Asthma nebulizers can be used with all classes of inhaled medications but are most commonly used with short-acting beta2 agonists and ipratropium bromide.
How to control acute asthma attacks? - Acute asthma is an acute exacerbation of wheezing, unresponsive to usually effective therapy and necessitating care in an emergency room or hospital ward.
How to manage chronic asthma symptoms? - The aims of management are to recognize asthma, to abolish symptoms, to restore normal or best possible long term airway function.
What asthma relievers are available? - Asthma reliever is a drug that provides relief from asthma symptoms and is the most commonly used asthma medication.
What asthma preventers are available? - Asthma preventers are to be used twice a day regardless of whether your child has symptoms of asthma.
What's the treatment for childhood asthma? - The goals of asthma therapy are to prevent child from having chronic and troublesome symptoms, to maintain child's lung function.
What's the treatment for asthma in the elderly? - Diagnosis and treatment of asthma can be more complicated in people age 65 and older than in those who are younger.
What can be done to prevent asthma? - Avoiding known allergens and respiratory irritants can reduce asthma symptoms. People with asthma should minimize risk for respiratory tract infections.