The main goal of asthma treatment is long-term symptom control. This means reducing your asthma attacks and the need for emergency care. With well-controlled asthma, you may have no limits on physical activity, minimal need for quick-relief medication and few or no side effects from asthma medication. The treatment plan for adult asthma 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.
Medications Used to Treat Adult Asthma
Asthma treatment involves two types of medication. Long-term (or controller) medications are those that you use every day to reduce asthma attacks. Quick-relief (or rescue) medications are ones that you use at the first sign of an asthma attack to quickly open airways.
Controller medications: These reduce airway swelling. They can reduce asthma attacks but are not used to treat an attack. Types of controller medications include:
- Inhaled corticosteroids (fluticasone, beclomethasone, ciclesonide): These are the most common medications for long-term asthma control. They reduce airway inflammation, swelling and tightening.
- Leukotriene modifiers (montelukast,zafirlukast, zileuton): These medications block the effects of immune-system chemicals (leukotrienes) that cause asthma symptoms.
- Long-acting beta agonists (salmeterol, formoterol): These inhaled medications reduce airway swelling and open narrowed airways. These medications are not used alone but rather in combination with inhaled corticosteroids.
- Mast cell stabilizer (cromolyn): This medication is usually given by breathing in a mist with the aid of a nebulizer. The medication prevents release of cells that cause inflammation.
- Bronchodilator (theophylline): This oral medication opens up breathing tubes. It may be taken with other asthma medications to improve treatment results.
Types of rescue medications include:
- Short-acting beta agonists (albuterol, aevalbuterol, pirbuterol): These inhaler medications quickly relieve asthma symptoms and open airways. They are usually the first choice for fast relief.
- Bronchodilator (ipratropium): This is an inhaler that quickly relieves asthma symptoms by relaxing and opening airways.
- Oral and injectable corticosteroids (prednisone, methylprednisolone): These medications are used for severe asthma attacks. They reduce airway inflammation. Because of side effects, these medications are used only for a short time.
If you have allergic asthma, other treatments may include:
- Antihistamines and decongestants: These medications are available by prescription or over-the-counter to relieve allergy symptoms. Antihistamines block allergic responses to immune system triggers. Decongestants shrink swollen tissues and blood vessels in the nose. Some combination products contain both an antihistamine and a decongestant.
- Immunotherapy: This treatment involves a series of injections that start with a very small amount of an allergen. The injected amount is increased over time until you develop a greater tolerance for the allergen. This leads to less severe allergic reactions.
- Immune system modulator (Omalizumab): This medication is given by injection every few weeks for people with severe allergies and asthma. It blocks the allergic response.
To help ensure you make the right treatment decisions when asthma symptoms or attacks occur, you will need to work with your doctor to create an asthma action plan. You will need to learn your asthma triggers. You may also learn how to use a peak flow meter to monitor your breathing. You should keep a diary of all your asthma symptoms. This information will help your doctor adjust your treatment over time.
General Guidelines for Long-Term Asthma Control
- Take your long-term controller medication every day.
- Know your asthma triggers, and avoid them whenever possible.
- Keep your quick-relief/rescue medication(s) within easy reach so you can treat symptoms fast.
- Learn to recognize the onset of asthma symptoms or an attack, and be sure you know what to do if this occurs and when to call the doctor or get emergency medical help.
- Use your peak flow meter as instructed to keep track of whether your daily controller medication is keeping your asthma under control.
- Get your flu and pneumonia vaccinations.
- Keep all your follow-up appointments.
The bottom line: You need continuous daily treatment with long-term controller medication, even when you are not having symptoms or an asthma attack.