Asthma cannot be completely cured but it can be effectively controlled through proper treatment and management. Asthma is a chronic disease that requires ongoing medical care. Unlike many diseases which get treated with little attention, asthma is much more complex to treat and therefore it must be managed in a comprehensive fashion. Asthma Treatment and Management plan is your complete asthma education and monitoring regime that should be drawn up with your doctor and religiously followed.
Because asthma varies from person to person, each asthma treatment and management plan is tailored as per the individual. By strictly following long term asthma treatment and management plan, you can lead a healthy symptom free life with no limitations on your daily activities.
Asthma treatment and management usually involves:
- Asthma triggers or environmental control: For avoiding or controlling your asthma triggers. Environmental trigger factors can have a big impact on the severity of your asthma. Other forms of treatment are less effective unless environmental control is also done in parallel. The section on Asthma Triggers shows how to avoid asthma triggers and control your environment.
- Asthma medications: For taking medicine to open your airways and reduce the inflammation in the airway linings. The most common types of asthma medications are bronchodilators and anti-inflammatory medicines. Bronchodilators are drugs which open up or dilate the constricted airways, while drugs aimed at reducing inflammation of the airways are called anti-inflammatories. Understanding your asthma medications and their various delivery methods is very essential.
- Asthma action plan: For guiding you to monitor and prevent your asthma episodes.
- Asthma education: For updating you with latest asthma information.
Goals of asthma treatment and management plan:
Your doctor’s first goal is to reduce and, if possible, eliminate asthma symptoms while allowing you to maintain a normal activity level. The second goal is to maintain your lung function as close to normal as possible. In many people with asthma, these two goals go hand-in-hand: asthma symptoms are often accompanied by abnormalities in lung function. However, some people have asthma symptoms even when their lung function tests are normal. Other people have no symptoms even when their lung function is very abnormal. Thus, your doctor might recommend treatment on the basis of either asthma symptoms or abnormal lung function (or both).
Following are some of the general goals that asthma treatment and management plan must achieve.
- Maintain normal activity levels, including exercise
- Have no symptoms or minor symptoms of daytime or nighttime asthma
- Maintain pulmonary function as close to normal levels as possible: Improved airflow as measured with a peak flow meter with least daily variation in PEFR
- Prevent irreversible airway obstruction
- Prevent acute attacks of asthma
- Prevent deaths from asthma
- Have no time off from school or work due to asthma
- Have least need for quick relief bronchodilator medicine.
- Have few or no side effects from asthma medicine
- Have no emergency room visits or hospitalizations
Proper asthma treatment and management should avert many emergency visits and hospital stays as well as much of the anxiety associated with asthma.
How is asthma treatment normally done?
Treatment of mild asthma usually tries to relieve occasional symptoms as they occur by use of short-acting, inhaled bronchodilators. Treatment of moderate or severe asthma, however, attempts to alleviate both the constriction and inflammation of the airways, through the use of both bronchodilators and anti-inflammatories.
Taking anti-inflammatory drugs (usually inhaled corticosteroids) daily for moderate to severe asthma is a relatively new approach to treating asthma. The idea behind it is that if the underlying inflammation of the airways is reduced, the bronchi may become less hyperreactive, making future attacks less likely. Such anti-inflammatory therapy, however, must be taken regularly in order to be effective.
For asthma which is strongly triggered by allergies, allergen avoidance can often greatly reduce the amount of medication needed to control the asthma. Taking anti-allergic medications or taking shots for allergy desensitization are other alternatives.
How is treatment done based on asthma severity?
Although there is no single treatment for everyone with asthma, there are some guidelines. Most doctors believe that the severity of asthma should determine the nature of treatment. Asthma severity is usually assessed on the basis of the frequency of daytime and nighttime symptoms, as well as breathing test results. For people with occasional symptoms and nearly normal lung function, using bronchodilator medication is often the only treatment necessary. If symptoms become more frequent, some type of anti-inflammatory medication will generally be required.
Most often this is an inhaled corticosteroid or leukotriene modifying drug. Sometimes cromolyn, sold under the brand name Intal, or nedocromil, sold under the brand name Tilade, is used, particularly in children. There is disagreement among doctors over which class of anti-inflammatory medication should be used first: Inhaled corticosteroids are more potent, but the leukotriene modifying agents may have fewer side effects. Factors such as the patient’s age and preference are important in making the decision.
If the treatment does not control symptoms, more anti-inflammatory medications might be necessary. In a small minority of people with asthma, the condition can only be controlled by long-term use of oral corticosteroids. Despite concern about the side effects of such therapy, the benefits of improved symptoms and lung function might outweigh the risks and side effects.
How is an acute asthma attack treated?
An acute asthma attack is usually treated by the use of bronchodilators to reduce the constriction of the airways. Intravenous adrenalin and theophylline are often given in emergency rooms for this purpose, if short-acting bronchodilators given by nebulizer haven’t sufficiently controlled the attack.
Once the acute attack is over, anti-inflammatories may be used to reduce the inflammation of the airways. Inhaled steroids are usually the first choice, but for a sufficiently severe attack, oral steroids such as prednisone may also be given.
What is the strategy for asthma treatment?
Treatment of chronic asthma therefore involves regular use of anti-inflammatory drugs (preventer) to stabilize the disease along with the use of bronchodilator drugs (relievers) to provide relief from symptoms as and when these occur.
Your prescription will therefore have at least two drugs:
- An anti-inflammatory (preventer) drug, and
- A bronchodilator drug (reliever).
-> These have different purposes and cannot be substituted for one another.
-> And the best way to take these drugs is by inhalation.
Asthma treatment and management – what you must do?
- First and foremost have a positive frame of mind towards asthma – You can win over asthma, many others have done too
- Choose a doctor and have faith in him/her.
- Make an asthma management plan with your doctor and strictly adhere to it.
- Be fully educated about asthma in general
- Know what you must – know your asthma, for example, what your symptoms are and how and when they occur
- Know about your asthma medications
- Monitor your asthma at home with regular follow ups with your doctor.
- Try to identify asthma triggers you are sensitive to and prevent exposure to them.
- Remain updated on asthma by subscribing to asthma support groups, newsletters etc on internet
- Asthma education is the key, not only for you, but also for your family and care givers.
Asthma medications come in many forms: liquids, pills, powders, vapors, and injections. This is to cater to different age groups of asthma patients.
Asthma medication can be broadly divided into two categories: i) Bronchodilators (reliever) and ii) Anti-inflammatory (preventer).
These drugs relax the muscle ring around the air passages and thus increase their diameter. As a result, air is able to pass in and out with greater ease and the patient gets relief from his symptoms. Therefore, these drugs are also called relievers. These are extremely useful drugs because these provide quick relief in symptoms. Bronchodilators, however, do not treat the underlying airway inflammation, which is a key component of the disease.
In most cases, these drugs are prescribed to be taken only on an as-needed basis. That is, only when symptoms occur.
Following bronchodilators are generally used:
i) Adrenergic bronchodilators:
They are also known as beta-agonists or beta2-agonists. These asthma medications dilate the bronchial tubes and make breathing easier by relaxing the smooth muscle that constrict the bronchi (airways), which is why they are known as bronchodilators. Beta-agonists are available in both inhaled and oral forms, but the inhaled form is more effective and preferred and has fewer side effects than the oral forms. Therefore, you should know how to correctly use the inhaler for the drug to reach your lungs with full effect.
They are of two types,
a) Short-acting Beta-agonists are the most effective asthma medication for providing quick relief of asthma symptoms, but they do not affect the underlying inflammation in the bronchi and therefore do not provide long term control of asthma symptoms. The most common side effects from beta-agonists are muscle tremors, or shaking, and increased heart rate. These drugs are generally quite safe, even used on a regular basis. However, if you find that you need to use them frequently, it probably means that your asthma is not being adequately controlled and that you need additional treatment.
b) Long-acting Beta-agonists can help prevent asthma, but should not be used to relieve asthma symptoms because they are not as effective as quick relief medications. Side effects of these long-acting drugs include tremor, or shaking, and fast heartbeat. Side effects from the inhaled form are generally mild. Some parents complain that it causes irritability in children.
Examples (brand name in itallics):
- Short-acting beta-agonists: Salbutamol or Albuterol (Asthalin, Ventolin, Proventil), Bitolterol (Tornalate), Metaproterenol (Alupent), Pirbuterol (Maxair), Terbutaline (Bricanyl).
- Long-acting beta-agonists: Salmeterol (Serevent).
ii) Xanthine bronchodilators:
These drugs also relax the muscles of the airways thereby open up the airways. It is generally used to control nighttime asthma. Theophylline, an example of this type, is an oral or intravenous medication sometimes used to improve long-term control of asthma symptoms. It is most often used when other medications, such as inhaled corticosteroids, have not been adequate. It is rarely used by itself or before other kinds of medications have been tried because side effects can be serious. When the amount of the drug in the bloodstream reaches very high levels, these side effects can include seizures and irregular heart rhythms, which can be deadly. As a result, use of theophylline requires careful attention, particularly since many other medications can affect the level of theophylline in the blood stream. You should notify your doctor immediately if, while taking some form of theophylline, you experience nausea, vomiting or rapid heartbeat. Some people have headaches after beginning theophylline. Unless accompanied by other side effects, these headaches are unlikely to be serious and they often go away after taking the medication for a few days.
- Theophylline (Aerolate)
iii) Anticholinergic bronchodilators:
These drugs are occasionally used as quick relief treatment and has very few side effects. It is less effective than short acting inhaled beta2-agonists. It can be useful in people who have problems or side effects from using short-acting inhaled beta2-agonists.
- Ipratropium (Atrovent)
These drugs reduce inflammation (swelling of airways lining due accumulation of fluid and cells). When taken regularly over a prolonged period, these drugs prevent further inflammation, which helps prevent asthma episodes. Therefore, these drugs are also called preventers. Anti-inflammatory drugs provide long term control of asthma. Most anti-inflammatory medications are generally administered on a daily basis and provide no immediate relief during an asthma episode.
Following types of anti-inflammatory medicines are available:
Corticosteroids refer to a class of steroid hormones produced by the adrenal gland (and to similar chemicals that can be manufactured).
a) Oral corticosteroids: Oral corticosteroids, taken by mouth in pill or liquid form, are the most potent agents available to reduce bronchial inflammation and control asthma.
Long-term use of oral corticosteroids is associated with a number of potentially serious side effects. Among the most common are osteoporosis, which is a disorder that results in a thinning of the bones; thinning of the skin and easy bruising; cataracts; and immune system suppression, which leads to an increased risk of certain kinds of infection. Corticosteroids can also slow growth in children. The likelihood and severity of side effects from oral corticosteroids increase with higher doses and longer periods of treatment. When used occasionally for relatively brief periods, such as seven to 10 days around the time of an asthma attack, oral corticosteroids are unlikely to have serious or long-term consequences. The most commonly used oral corticosteroids are methylprednisolone, which is sold under the brand name Medrol, and prednisone.
- Methylprednisolone (Medrol, Prednisone)
b) Inhaled corticosteroids – Inhaled corticosteroids are not as potent as oral corticosteroids, but are still effective in reducing bronchial inflammation. For many people they provide effective long-term asthma control. Since the medication is delivered directly to the bronchi, much lower dosages are necessary than when medication is taken by mouth, and there is little absorption of the inhaled medication. When used in low dosages, inhaled corticosteroids have remarkably few side effects, most of which are minor. In children, high dosages of inhaled corticosteroids may slow growth. There is some debate among doctors about whether higher dosages of inhaled corticosteroids cause significant side effects in adults, side effects such as osteoporosis or cataracts. There are many different types and brands of inhaled corticosteroids, but no one appears to work better than the others.
- Beclomethasone dipropionate (Beclovent, Vanceril, Vanceril DS, Becoride, Beclate), Budesonide (Budecort, Pulmicort), Fluticasone (Flovent), Flunisolide (Aerobid), Triamcinolone (Azmacort).
These are a new type of oral medication that has recently been approved in the United States for the treatment of asthma. Leukotriene modifiers interfere with the production or effects of leukotrienes, chemicals that appear to play a role in bronchial inflammation. Leukotriene modifiers may be considered as an alternative therapy to low doses of inhaled corticosteriods for children with mild persistent asthma, although the position of leukotriene modifiers in therapy has not been fully established. Leukotriene modifiers improve symptoms and pulmonary function and reduce the need for quick relief medications. Overall, these drugs appear to be somewhat less effective than inhaled steroids, but they seem to have fewer side effects. Leukotriene modifiers have been linked to a rare disease known as Churg-Strauss Syndrome, which is a form of vasculitis, or an inflammation of the blood vessels. However, researchers disagree over whether leukotriene modifiers cause the disease or simply expose it in patients who already have it. There have been only a few cases of Churg-Strauss in the United States. The risk of the disease is extremely small, and it should not discourage patients from using Leukotriene-modifying drugs if they could benefit from them.
- Zafirlukast (Accolate), Zileuton (Zyflo), Montelukast (Singulair)
These anti-inflammatory drugs are used over the long term to prevent asthma symptoms. They can also be used just before exercise to prevent exercise-induced symptoms. In general, these drugs are less effective than inhaled corticosteroids, but cause almost no significant side effects. They have been used most extensively in children because of their outstanding safety.
- Cromolyn sodium or disodium cromoglycate (Intal, Cromal), Nedocromil sodium (Tilade).
-> If you have any questions about the various treatments for asthma, be sure to speak to your pharmacist or other healthcare professional.
Anti-inflammatory drugs are the main drugs for long-term treatment of chronic asthma. Regular treatment with anti-inflammatory drugs results in:
- Reduced frequency and severity of daytime symptoms
- Reduced need for bronchodilator (reliever) drugs
- Reduced frequency of night-time symptoms
- Improved lung function
- Reduced frequency of emergency room visits
- Reduced frequency of hospitalizations
The most powerful drugs in this asthma medication group are the corticosteroids. To obtain these benefits, the correct dose has to be found. This requires regular lung function testing and check-ups by the physician. The patient also should be very regular in taking these drugs.
All about Corticosteroids