TREATMENT: “What care could I receive?”

Your asthma treatment is based on the severity of your symptoms:

  • Mild intermittent: You have mild symptoms up to two days per week and up to two nights per month.
  • Mild persistent: You have symptoms more than twice weekly but only one symptom, if any, in a single day.
  • Moderate persistent: You have symptoms once daily and more than one night per week.
  • Severe persistent: You have symptoms all during the day on most days and often at night.

Your asthma treatment goal is long-term symptom control, meaning:

  • Few or no symptoms, attacks, or emergency visits to the doctor or hospital
  • No limits on physical activity
  • Minimal need to use quick-relief, or rescue, medication (see below)
  • Few or no side effects from asthma medication

As we’ve seen, the two main features of asthma are:

  • Chronic airway inflammation
  • Airway narrowing

Similarly, asthma treatment mainly involves two types of medications:

Controller medications, used daily over an extended period of time (long-term) to control asthma and keep it under control:

  • Reduce airway inflammation that can lead to symptoms
  • Help you have fewer and milder attacks
  • Cannot be used, and are not intended, to treat an asthma attack
  • May be inhaled or taken by mouth

Quick-relief (rescue) medications, used as needed to treat symptoms and attacks when they occur:

  • Quickly restore normal breathing by opening narrowed airways
  • Relieve the symptoms of an asthma attack
  • Must be taken as soon as you become aware of an asthma symptom
  • May be inhaled, taken by mouth, injected, or given intravenously

Remember these important keys to long-term asthma control:

  • Take your long-term controller medication every day and, when symptoms start use a quick-relief inhaler, as needed, to open airways.
  • Know your asthma triggers, and avoid them whenever possible.
  • Keep your quick-relief medication(s) within easy reach—at work, in several places at home, and, if you work out, in your gym bag—so you can treat symptoms without delay.
  • Learn to recognize the onset of asthma symptoms or an attack, and be sure you know what to do if they occur and when to call the doctor or get emergency medical help
  • Use your peak flow meter daily, as instructed, to keep track of whether or not your daily (long-term) controller medication is keeping the disease under control.

o   Peak flow meter readings can reveal airway narrowing before your symptoms worsen.

The bottom line: You need continuous daily treatment with long-term controller medication, even when you are not having symptoms or an asthma attack.

If you start having to use quick-relief medication more often—meaning you’re having more asthma symptoms and/or attacks:

  • Ask your doctor if a different controller medication may provide better control.

Your asthma action plan

Work with your doctor to create a written asthma action plan, a tool for:

  • Managing your asthma day to day, with the goal of preventing or reducing symptoms and attacks
  • Providing clear, step-by-step instructions for:

o   Avoiding triggers

o   Identifying flare-up symptoms early and treating them so they don’t get worse

o   Managing severe symptoms

o   Recognizing an asthma attack and getting emergency care

Always carry an updated copy of your action plan with you, and give a copy to:

  • A family member or friend who can come to your aid in an emergency
  • Also:

o   Post a copy in your home where it will be easily available to you and family members, such as in the kitchen.

o   Let people you spend time with know where they can find your action plan (for example, in your wallet) in case of an emergency.

Among many possible types of information, your action plan should list:

  • Emergency phone numbers and facility locations
  • Early symptoms of a flare-up and proper steps to take
  • Your daily asthma status

o   You may want to use a common method for recording this information: referring to yourself, each day, as in the “green” zone (doing well), “yellow” zone (getting worse), or “red” zone (medical alert).

o   This color system is also used on peak flow meters.

  • Your asthma triggers, and specific ways to prevent exposure to them
  • Steps to take if you have asthma symptoms or an asthma attack, including when to 1) call the doctor and 2) seek emergency care
  • The names and dosages of all your medications, the schedule and method(s) for taking them, and guidelines for when and how to increase the dose or add medication as needed

o   Make a note every time you use quick-relief medication.

o   Tell your doctor if you’re using more puffs in a week than he or she told you to expect.

  • Guidelines for exercising and/or doing sports
  • A schedule for using your peak flow meter to measure how well you can breathe, day to day
  • Your “personal best” peak flow meter reading (to compare with daily readings)
  • Guidelines for when to call your doctor about a peak flow reading

The information recorded in your action plan can provide early clues to how your asthma symptoms, triggers, and level of control are changing (or not) over time.

  • With this knowledge, your doctor can make treatment changes quickly in response to:

o   Worsening symptoms, calling for treatment to be stepped up

o   A period of good asthma control, which may mean treatment can be stepped down

Use this action plan every day. Update it each time you see the doctor or at least every six months. Every time it’s changed, give a new copy to your “emergency aid” friend and post a new copy in your home.

Doctors use a “stepwise” approach to starting asthma treatment and managing the disease:

  • As your asthma improves or worsens over time, treatment may be stepped down or up to help keep it under control.

If you start having to use your quick-relief inhaler more often—meaning you are having more asthma symptoms and/or attacks:

  • Ask your health professional if you need different controller medication for long-term control.

Your doctor will select asthma medications for you based on:

  • Your age
  • Your symptoms and asthma severity
  • Your asthma triggers
  • Over time, which medications work best for you

The chart below describes the medications most commonly used to treat asthma.

Commonly Used Medications to Treat Asthma

Medications What Are They? How Do They Work? How Are They Given? What Else

Should I Know?

Inhaled Corticosteroids

Examples:

  • Fluticasone
  • Beclometha-sone
  • Ciclesonide

 

Asthma-symptom controllers Inflammation

Swelling and tightening

Various methods The “gold standard” for long-term asthma control.

Not all inhalers work the same way: If your child uses an inhaler, ask the doctor to demonstrate the correct way to use it.

Leukotriene Modifiers
Examples:

  • Montelukast
  • Zafirlukast
  • Zileuton
  Block effects of immune-system chemicals (leukotrienes) that cause asthma symptoms   These medications are also used to treat allergies. The body releases leukotrienes in response to contact with allergens (allergy triggers).
Long-Acting Beta Agonists

 

Examples:

  • Salmeterol
  • Formoterol
   

Reduce airway swelling

Open narrowed airways

  Generally used only in combination with inhaled corticosteroids
Mast Cell Stabilizer

  • Cromolyn

 

  Prevents release of mast cells, which cause inflammation

 

  May also be used intermittently to:

Prevent asthma symptoms during exercise

Prevent asthma symptoms when allergen exposure cannot be avoided

Theophylline

  • Theophylline
      Not generally used alone, but may be added to other asthma medications to improve treatment results
Combination Inhalers:

Corticosteroids and Long-Acting Beta Agonists (LABAs)

Examples:

  • Fluticasone
  • Salmeterol Budesonide
  • Mometasone
  • Formoterol
  BAs such as salmeterol and formoterol are generally used only in combination with inhaled corticosteroids.
Short-Acting Beta2-Agonists
Examples:

  • Albuterol
  • Levalbuterol
  • Pirbuterol

 

 

Quick asthma-symptom relievers Open Airways Albuterol:

  • Metered-dose inhaler  (MDI)
  • Tablet
  • Syrup
  • Nebulizer

Levalbuterol

  • Metered-dose inhaler  (MDI)
  • Nebulizer

Pirbuterol

Metered-dose inhaler  (MDI)

Typically the first choice for quick relief of asthma symptoms
Ipratropium Bromide

  • Ipratropium
Quick asthma-symptom relievers Open airways

 

Metered-dose inhaler  (MDI)

 

Nebulizer

The instructions for using this medication are complex and must be followed exactly.

Ask your child’s doctor to show you how to use it.

Read the Patient Information Leaflet.

Read the nebulizer instructions.

Oral and Injectable Corticosteroids
Examples:

  • Prednisone
  • Methylpred-nisolone
  Reduces airway

Inflammation

Prednisone

  • Tablet
  • Oral solution

Methylpred-nisolone

  • Tablet
  • Injection
Because of side effects, these medications are generally used only to treat severe asthma attacks.
Immunoglobulin E (IgE) Blocker—by prescription
Omalizumab
Helps block IgE, a naturally occurring substance in the body that can lead to asthma symptoms and attacks

 

Helps reduce the number of asthma attacks in those with allergic asthma who still have asthma symptoms even though they are taking inhaled steroids. Injection Used when asthma is not adequately controlled with other asthma medications.

 

Antihistamines and Decongestants—by prescription and OTC

 

Allergy-symptom relievers

 

Antihistamines block allergic responses to immune system triggers.

Decongestants shrink swollen tissues and blood vessels in your child’s nose.

 

A wide variety of formulations is available, including combination products containing both an antihistamine and a decongestant.

 

Always check with your child’s doctor before use of any of these products:

  • Long-term use of some products may worsen your child’s allergy symp-toms.
  • Some products may raise blood pressure, cause irritability or insomnia, or restrict flow of urine.
Allergy Shot Therapy (also called Immunotherapy) Allergy symptom reducer

Potential asthma development preventer

 

 

A series of injections is started with a very small amount of allergen (what the person is allergic to).

The injected amount is increased over time.

If the therapy works, the result is a greater tolerance for the allergen, leading to less severe allergic reactions when they occur.

A series of injections, given on a regular basis—for example (your child’s doctor may use a different schedule):

  • Once or twice a week for 3-6 months or until the maximum dose is reached, followed by:
  • Maintenance injections every 2 to 4 weeks for 3 to 5 years
Before starting allergy shot therapy, doctors do allergy testing to learn which allergens to use.

Allergy shot therapy for asthma is not used in children under age 5.

(Learn more about allergy testing here and in the chart, “Commonly Used Tests to Diagnose Asthma in Children Age 6 and Older.”)