Treatment and Prevention
There's no cure for asthma. It's a chronic condition that can last a lifetime.
The goal of asthma treatment is to keep you as symptom-free as possible. This includes being able to engage in normal activities, keeping the use of rescue medications down (less than 2 days per week), and reducing episodes of worsening asthma. This goal can be reached by most people with asthma.
There are three main things you can do to treat asthma:
- avoid triggers
- use "preventer" (also called "controller") medications such as corticosteroids (e.g., beclomethasone*, budesonide, ciclesonide, or fluticasone), leukotriene receptor antagonists (e.g., montelukast or zafirlukast), or mast cell stabilizers (e.g., sodium cromoglycate)
- alleviate symptoms using "reliever" (or "rescue") medications such as bronchodilators (e.g., albuterol, salbutamol, formoterol, terbutaline, or ipratropium)
Asthma triggers
Avoiding triggers is your first defense against an asthma attack. Below are some common asthma triggers and their remedies. Making simple lifestyle changes to avoid your asthma triggers can go a long way toward preventing attacks.
- pollen (grasses, trees, weeds): Keep doors and windows closed and use air conditioning to keep pollen out.
- dust mites (found in carpet, furniture, pillows): Use special coverings for mattresses and pillows. Remove carpets in bedrooms. Wash bedding in very hot water. Keep humidity in the room between 30% and 40%.
- animal hair and dander: Pet removal is the best way to avoid pet allergen. If you have pets, keep them out of bedrooms and off furniture.
- mold: Get a dehumidifier to eliminate mold. Avoid freshly cut grass.
- environment (smoke, pollution, cold air): Stop smoking and avoid all smoky areas. Stay indoors when the outside air quality is poor. Cover your nose and mouth in cold weather.
- exercise: Use your reliever medication 10 to 15 minutes before exercising. Warm up and cool down for 3 to 5 minutes.
- cigarette smoke: Avoid all forms of cigarette smoke.
Although avoiding triggers is an important part of asthma management, it is not always possible to escape them completely. Therefore, medications are often needed to prevent and treat asthma symptoms.
Asthma prevention medications
The most effective asthma prevention medications are called corticosteroids (e.g., beclomethasone, budesonide, ciclesonide, or fluticasone), which are inhaled through a "puffer" or inhaler. They are designed to decrease the swelling or inflammation in your airways. It usually takes a week or two for these medications to get the swelling and inflammation under control. They don't provide fast relief of asthma symptoms, but they will help prevent future symptoms. They control inflammation, which is the underlying cause of asthma. It is important to continue using these kinds of medicines even when the symptoms seem to be under control.
If corticosteroids do not control your asthma symptoms, your doctor may suggest that you use a long-acting bronchodilator (e.g., salmeterol, formoterol) along with your corticosteroid. Your doctor may also suggest that you use a combination inhaler that contains both a corticosteroid and a long-acting bronchodilator.
For some people, leukotriene receptor antagonists (e.g., montelukast, zafirlukast) may be used to help control asthma. These medications work by blocking a chemical from causing inflammation in the airways. If your asthma is caused by allergies and your asthma symptoms have not been controlled with corticosteroids, your doctor may suggest allergy shots or an injectable medication called omalizumab.
People with asthma symptoms often need treatment that provides immediate relief. Bronchodilators (e.g., albuterol, salbutamol, formoterol, or terbutaline) work quickly to relax the muscles around the airways and allow you to breathe more easily. These are reliever medications that treat the symptoms but not the underlying cause. If you are using relievers more than 2 times a week (not including before exercise), talk to your doctor or health care professional. You may need some changes in your medications.
While asthma itself is not preventable, the vast majority of people with asthma should be able to lead totally normal lives if they do what it takes to control their asthma with lifestyle adjustments and medications.
If your doctor has given you a preventive medication to use every day, follow the instructions carefully. If you use it as suggested, it should control the swelling in your airways and reduce your asthma symptoms over the long term.
Using your inhaler
Since asthma medications are often inhaled through a puffer, they require extra knowledge and care on your part. Asthma inhalers have to be used properly to get the right amount of medication into your lungs.
Learning how to use inhalers properly can take some practice. Ask your doctor or health care professional to check to see if you are using your inhaler properly. If you are using a metered-dose inhaler (MDI), which is a pressurized inhaler, your doctor may recommend a spacer device that fits on your inhaler to make it easier for you to ensure that more of your medication is reaching your lungs. Spacers also help to reduce some of the side effects of inhaled corticosteroids. Spacer devices are not needed for dry-powdered devices that are not pressurized.
As part of your asthma treatment plan, your doctor may suggest that you use a peak flow meter. A peak flow meter helps you to monitor your lung function and it gives an indication of how well your asthma is controlled. It will also help you monitor how well your medications are working, recognize when you need to adjust your medications as recommended by your doctor or health care professional, and know when to get emergency medical attention.
Keeping a diary of your asthma symptoms is also an important way to monitor your asthma control.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Andrew Schriber, MD, FCCP, Specialist in Pulmonary, Critical Care, and Sleep Medicine, Virtua Memorial Hospital, Mount Holly, New Jersey. Review provided by VeriMed Healthcare Network.