There is no cure for asthma. The goal of management is to achieve control of the disease. This includes the following:
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Prevent chronic and recurring symptoms such as night cough
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Reduce the use of medications.
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Maintenance of lung function
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Maintenance of regular activities.
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Prevention of severe asthma attacks requiring hospitalization or emergency room visits
Practical tips to control asthma:
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Control other conditions that can aggravate asthma
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Avoid Known Allergens
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Maintain an active lifestyle
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Have an action plan in case of asthma attacks
The asthma action plan should include the medication regimen, prevention of triggers, monitoring of asthma attacks, and actions to take if asthma symptoms become more severe despite treatment. Eg. When to go to the Hospital Emergency Department for treatment
asthma medications
Asthma medications can be broadly divided into medications that provide long-term control and medications that provide rapid relief of asthma symptoms.
Both types of medicines aim to reduce inflammation in the airways to control asthma.
Initial treatment depends on the severity of your asthma. Follow-up treatment depends on how well the patient follows the asthma action plan and how effective the action plan is.
Keep in mind, however, that your asthma action plan will vary with changes in your lifestyle and social environment because different social exposures result in exposure to different allergens in your environment.
Dosage adjustment of the medication should be at the discretion of your primary care physician. If you have adjusted the dose of the medicine on your own, you should inform your GP immediately to facilitate proper titration of the medicine dose at each doctor visit.
The doctor will always try to use the least amount of medication necessary to achieve control of your asthma, so it is imperative that the doctor is aware of the amount of medication you have been using.
Certain patient groups require more intensive titration regimens, such as pregnant women, young children, or patients with special needs.
Asthma Action Plan
Each asthma action plan should be designed for the individual patient. The plan should include the medication regimen, prevention of triggers, monitoring of asthma attacks, and actions to take if asthma symptoms become progressively severe.
It is best to work with your primary care doctor to write your asthma action plan. The plan must describe all of the above in detail.
For children, parents and caregivers should be aware of the child’s asthma action plan. This should include babysitters, daycare workers, parents, schools and organizers of children’s outdoor activities.
Trigger Avoidance
A large number of allergens have been documented to be related to asthma. For the individual patient, the most important thing is to know what triggers your asthma. After that, learn what steps to take when your asthma flares up.
Simple common sense is essential. For example, if you have a known allergy or sensitivity to pollen, limit your exposure to pollen and stay indoors if necessary. If you are sensitive to pets or pet fur, do not keep pets in your home or allow pets in your bedroom.
It should be noted that physical activity can also trigger asthma attacks. However, it is recommended that asthmatics exercise regularly because, in the long run, exercise will help control asthma. Talk to your GP if you experience asthma attacks when you are physically active. There are medications available to control asthma during exercise.
In the event that your asthma is strongly correlated with allergens that cannot be avoided (for example, dust), your primary care physician may recommend the use of allergy medications.
asthma medications
Talk to your primary care doctor about the right medications to control your asthma. Your primary care physician will adjust the dose of the medications as needed. If you have adjusted the dose yourself, you should inform your primary care physician at your next visit.
Generally speaking, asthma medications can be in pill form, injectable, or as a nebulized drug that is inhaled through the use of an inhaler. Nebulized drugs are inhaled directly into the lungs where they exert their effects.
Please note that the use of inhalers will require a certain technique and must be taught by a physician or a trained health care provider.
Medications aimed at long-term control
Chronic asthmatics will need medication to achieve long-term control of their asthma. These medicines work slowly and reduce inflammation in the airways.
inhaled corticosteroids
Inhaled corticosteroids are most commonly used for long-term control of asthma. They work by reducing inflammation in the airways of the lungs. Daily use of inhaled corticosteroids will greatly reduce the severity and frequency of symptoms.
The most common side effect of inhaled corticosteroids is oral thrush. The use of a spacer when using the inhaled corticosteroid may reduce the incidence of oral candidiasis. Check with your primary care doctor if you are not sure how to use a spacer. Simple rinsing of the mouth after consuming inhaled corticosteroids may also reduce the incidence of oral candidiasis.
Patients who have severe asthma may need oral corticosteroids instead of inhaled corticosteroids to achieve sufficient control of their asthma. Unlike inhaled corticosteroids, which can be taken for years, oral corticosteroids will have significant side effects if used for long periods of time.
Long-term use of oral corticosteroids increases the risk of diabetes, osteoporosis, cataracts, and abnormal metabolic activity.
Consult with your GP to weigh the risks and benefits before taking oral corticosteroids.
Other long-term medications:
These include:
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Cromolyn: This medication prevents inflammation of the airways and is used as a nebulized medication delivered through an inhaler.
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Omalizumab: This medication is a form of immunotherapy and works against immunoglobulin E (anti-IgE), which causes the airways to narrow. This medicine is usually given as an injection once or twice a month and prevents the immune system from reacting to asthma triggers. However, it is not a first-line treatment for asthma and may not be offered upfront by your primary care doctor.
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Inhaled long-acting beta2-agonists: These drugs are usually taken along with inhaled corticosteroids to achieve a synergistic effect on expanding the lumen of the lung airways.
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Leukotriene modifiers: These are oral medications that reduce inflammation in the airways.
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Theophylline: Theophylline can be taken orally or by injection and works to open the airways in the lungs.
Be aware that there is a chance that symptoms may return if long-term medications are stopped suddenly. Also, all long-term medications will have side effects. Talk to your GP before starting long-term treatment regimens.
Fast Acting Medications
Short-acting beta 2 agonists are usually the first-line drugs in this group. They are often administered in a nebulized form through an inhaler. They work by relaxing the muscles of the respiratory tract, thus allowing a greater passage of air.
Fast-acting medications should be consumed as soon as symptoms appear.
If the medication is required for more than 2 days a week, you should tell your doctor to further strategize your asthma action plan.
Asthmatics are advised to carry their quick-relief inhaler with them at all times.
It should be noted that these medications do not reduce airway inflammation and therefore cannot replace long-acting medications.
Documentation of asthma progression
Regular peak flow use and regular visits to your primary care physician will be the primary means of documenting asthma progression.
As a general rule, asthma is well controlled if:
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Symptoms occur no more than 2 days a week.
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Symptoms do not disturb sleep more than twice a month.
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There are no limitations to your daily activities.
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Quick-relief medications are required less than 2 days a week.
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Less than one severe asthma attack per year requiring oral steroids
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Peak flow meter readings are held at 80% of baseline level
peak flow meter
Your primary care physician will instruct you on the use of a peak flow meter.
When used, the peak flow meter measures the maximum rate of airflow leaving the lungs during exhalation. Periodic measurements will allow the progression of asthma to be documented and it is recommended that the patient record their peak flow every morning.
During the initial phase after diagnosis, it is important to determine the baseline peak flow. This is often touted as the patient’s “Personal Best” peak flow reading. Future asthma control is based on this baseline. Good control of asthma with maintenance of peak flow up to at least 80% of the initial value.
Periodic peak flow readings also help predict impending asthmatic attacks. Peak flow readings that progressively deteriorate often indicate an impending attack and should be incorporated into your Asthma Action Plan.
medical reviews
Frequent medical check-ups with your GP every fortnight are the norm during the initial phase of treatment. Once your asthma is controlled, your primary care doctor may choose to see you for a longer period of time.
During medical checkups, important information required by your primary doctor includes:
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Asthma attack frequency
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Changes in symptoms
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Changes in peak flow readings
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Changes in daily activities such as exercise tolerance.
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Difficulties with adherence to the Asthma Action Plan
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Problems with current medications
Emergency situations
Seek medical advice if:
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Regular medications fail to treat an asthma attack.
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Peak flow readings drop to less than 50% of baseline
Go to the nearest hospital emergency room right away if:
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You experience severe shortness of breath to the point where walking becomes difficult
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Your lips and tongue turn bluish.
Asthma: a lifelong problem
There is no cure for asthma. Successful asthma management requires the patient to play an active role in asthma control by following an asthma action plan.
Your primary doctor is your best partner in developing your asthma action plan. The action plan will remind you of your medication regimen, triggers, and protocols to follow when asthma symptoms develop or worsen. Even children should be involved in creating your action plan because it’s individual effort that counts in long-term asthma care.
Asthma will not go away. But it can be controlled.