Asthma Treatment and Medications - Health Tips

Asthma treatment is made based on the patient's history, physical examination, and spirometry results.  It is important to obtain a thorough history looking for triggers such as nasal allergies, sinusitis, GERD, and food allergies. Patients are treated with medications based on the frequency and severity of their symptoms. Asthma is broken down into categories which include mild intermittent asthma, mild persistent, moderate persistent, and severe persistent. Treatment is a step-up and step-down approach base on the signs and symptoms of the disease. Treatment included inhaled corticosteroids (ICS), leukotriene modifying agents, long-acting bronchodilators, short-acting bronchodilators(SABA), oral steroids, allergy immunotherapy, and biologics. Patients are instructed that if using their SABA  greater than 2-3 times a week then their asthma is not well controlled.  Biologics are available for moderate to severe asthmatics by their phenotypes which are biomarkers that help delineate what biologic is right for our patients to help control their asthma.     

Here at Sozo Health and Wellness we like to focus on maximum health-related quality of life. Our goal is to make sure that asthma does not prevent you from living an active life. Asthma well controlled should not prevent you from playing sports, being active outside with the rest of the gang or from being 1st chair in the horn section. Care is individualized with the first step being identifying triggers. We work with the patient on reducing those triggers. Depending on the presentation or airway constriction, we may have to use pharmacotherapy such as oral steroids, inhaled corticosteroids, and albuterol to control the disease. 

We always want to use the least amount of medication as possible to make sure your asthma is well controlled. So we may have to start off with more than 1 medication. As we get the asthma under control we try to work on decreasing medications or at least the medication dose. When asthma is at its worse it may take more to get it under control but then we can work on lifestyle and environmental changes that will allow us to decrease the need for medications. 

Asthma is a complex disease with many causes.  Treatment of asthma needs to be individualized with one's lifestyle being considered for optimal management.  A careful history and physical exam is important.  Although steroids are effective, the overuse of steroids can cause other medical problems.  *********************************************************************************************************************************************************************************

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Because asthma leads to excess mucus production and constriction of airways due to inflammation, it’s important to build a relationship with a practitioner who can help manage the condition. 

Treating asthma depends on the severity of symptoms and what triggers the breathing difficulties. 

Quick-relief inhalers are used to treat acute asthma attacks and symptoms, and sometimes the medicines are delivered via a nebulizer, which changes it into a mist that is inhaled. 

The treatment plan may include subcutaneous immunotherapy to address the root cause of allergy-triggered asthma. Immunotherapy exposes the body to small amounts of allergen through a series of injections over a period of time. This repeated exposure reduces the body’s overreaction to a specific allergen, providing long-term relief of allergy symptoms, including asthma-related breathing difficulties among other symptoms.

Sublingual (under the tongue) tablets and drops are another option.

Steroid inhalers and combo inhalers may be used daily for improved long-term control of symptoms. Certain combo inhalers can also be used for acute symptoms. Other inhalers such as Spiriva can be added to a regimen for more control.

Other medications such as montelukast can help as well.

Another option for treating moderate-to-severe asthma is the use of biologics, medications made of natural substances rather than chemicals. These medications are given through injections on a bi-weekly or monthly basis, and they disrupt the pathways that lead to inflammation in the airways that can lead to asthma. Examples of biologics include: Xolair, Dupixent, Nucala, Fasenra, and Cinqair and Tespire.

Many of these treatments are used in combination, and each combination is specific to the patient. 

Find out all factors contributing to poor control and discuss them with patient in detail, revisit this issue during every visit and make sure all factors contributing to poor control have been addressed, discussed with patient. Understanding how the medications work, the technique of proper breathing for inhalers is key to patient improvement, we make every effort to make sure the patient do it the right way

Asthma is a common lung disorder which can present with episodes of cough, wheeze, tightness in the chest and shortness of breath. Asthma is caused by inflammation of the lining of the airways in the lungs which leads to limitation of airflows from and to these tubes. Asthma may develop at any age.

Common causes and triggers include:

• environmental allergens such as pollens, dust, mold, and danders
• irritants such as cigarettes smoke, solvents.
• emotional stresses
• exercise
• respiratory infections.

Our medical practice is solely dedicated to practice of allergy and asthma, providing you with expertise firstly to determine if you indeed have asthma or not, and then identify and treat the underlying triggers so asthma can be better controlled with hopefully less amount of medications. We can also provide immunotherapy either in injectable or sublingual forms, reducing the sensitivities to airborne allergens contributing to inflammation in asthma, as well as reducing inflammation in the sinus and nasal passages which in turn improve the health of the lower respiratory tracts.

Depending on the severity of your asthma, we will devise individualized asthma treatment plan.

Treatment will vary depending on the severity of your asthma. Generally, treating asthma requires you to avoid the source(s) that trigger your asthma, especially if you have “allergic asthma,” as well as taking medication. There are two general types of medications prescribed to treat asthma: quick relief medications and controller medications. Quick relief medications are used to relieve the symptoms of an asthma attack and controller medications are generally used for long-term asthma control to treat the underlying inflammation of the lungs. Your allergist explains what is needed during your visit.

Studies show that people with asthma who see an allergist have better controlled asthma resulting in fewer visits to the doctor and emergency room as well as an overall reduction in total costs.

With the right inhalers and proper technique, symptoms can be controlled effectively.

Asthma is more and more recognized to be a spectrum and not a single disease.  We carefully review your history and your breathing test results, to firstly establish the severity of your asthma. With this information we can then establish the risks of future asthma attacks, and the goals of your treatment.  We custom-tailor your medication to your needs.

We also review the correct use of these medications because improper technique is a very common problem, and can lead to bad outcomes.

There are many different types and brands of asthma drugs on the market. We believe it is helpful to classify the drugs to help understand how they are used. The two main types are bronchodilators and anti-inflammatory medications (steroid/cortisone-type medications). Two other types of medications – Leukotriene modifiers (e.g., Singulair™) and phosphodiesterase inhibitors (e.g. theophylline) – are difficult to classify since they seem to have properties of both bronchodilators and anti-inflammatory medications.

“Reliever” medications, which are fast-acting bronchodilators, open up the lungs immediately. They are used “as needed,” when symptoms occur. Examples would include forms of albuterol (Ventolin™, Proventil™, and Pro-Air™), xopenex™, and Maxair™. These are sometimes referred to as “rescue” or “emergency inhalers,” but we believe these are misleading terms. It doesn’t have to be an emergency for you to use these drugs. Simply take them when you are uncomfortable with your breathing. All asthma patients must have a reliever medication prescribed to them. They come as inhalers, or in liquid form to be used in a nebulizer machine.

“Controller” medications should be prescribed when an asthma patient has symptoms occurring more than once or twice a week on average. Some doctors prefer the term “maintenance” medications. They are taken regardless of how you feel and on a routine basis to help prevent asthma attacks. There are several types including inhaled steroids (e.g. Flovent™ and Azmanex™, budesonide for nebulizer use), leukotriene modifier tablets (e.g. Singulair™ and Zyflo CR™), as well as combination inhalers containing both a steroid and a long-acting bronchodilator (e.g Symbicort™ , Dulera™ , and Advair™).

Wheezing, coughing, chest tightness and trouble breathing, especially early in the morning or at night….these are all symptoms of asthma.

Asthma is characterized by inflammation and spasm of the airways. Your airways are tubes that carry air in and out of your lungs. If you have asthma, the inside walls of your airways become sore and swollen. That makes them very sensitive, and they may react strongly to things that you are allergic to or find irritating.

Spasm (narrowing of the bronchial tubes) is caused by the inflammation of the muscles surrounding the air passageways. The inflammation makes the airways smaller makes it difficult to move air in and out of the lung. When your airways react, they narrow and your lungs get less air. This can cause wheezing, coughing, chest tightness and trouble breathing, especially early in the morning or at night.

When your asthma symptoms become worse than usual, it’s called an asthma attack. In a severe asthma attack, the airways can close so that your vital organs do not get enough oxygen. In some cases, people die from severe asthma attacks.

Of the 20 million asthmatics, 10 million – including 3 million children – suffer specifically from allergic asthma. Research shows that many people with asthma could better control their disease by controlling their allergies. Allergic asthma is the most common form of asthma.  Allergic asthma is triggered by inhaling allergens such as dust mites, pet dander, pollens, mold, etc.  These allergens cause inflammation and swelling of the airways. This results in coughing, wheezing and chest tightness.

Allergens are the key cause of allergic asthma and they can’t be completely avoided. But the real culprit is the IgE antibody that is produced by the body in response to allergen exposure. The combination of the IgE antibody with allergens results in the release of potent chemicals.  Thus, IgE is the root cause of allergic asthma.  A new and exciting way to control allergic asthma is to take a medication that binds IgE and prevents it from setting off the inflammatory response.  Only allergists or pulmonologists can prescribe and administer this medication.

Asthma is treated with two kinds of medicines: quick-relief medicines to stop asthma symptoms and long-term control medicines to prevent symptoms.   Allergic asthma is treated with avoidance of allergens, anti-allergy medication and allergy shots.

There is a lot of exciting new research regarding asthma and genetics, nutrition, and alternative therapies.  Your allergist can provide you with more information on the treatment options that are best for you.

What is asthma?

Asthma is a chronic inflammatory disease of the airways characterized by swelling and mucus production. It can present at any age but typically occurs in childhood. Symptoms can include recurrent wheeze, breathlessness, cough, and chest tightness.

Is there a connection between allergies and asthma?

Yes, up to 80% of children with asthma may be allergic, and up to 40% of children with allergies may have asthma. Adults with asthma also are more likely to be allergic and vice versa.

Will allergy shots help my asthma?

If you are allergic (based on testing), then allergy shots can help reduce symptoms of asthma. In children specifically, allergy shots can also reduce the chance of developing asthma in the future.

There are two general classifications of asthma medications including long-term control medications and quick-relief medications.

Quick-acting bronchodilators are used for symptom relief and as a pre-treatment for exercise-induced asthma.

Anti-inflammatory agents play an essential role as controller medicines, taken even when symptoms are not present. Inhaled corticosteroids are commonly used anti-inflammatory medicines.They prevent and decrease inflammation and reduce the need for quick-relief medications. Short-courses of oral corticosteroids sometimes are added. An inhaled beta2-agonist bronchodilator for quick-relief can be more effective when oral corticosteroids are added in hard to control asthma episodes.

The first line of asthma treatment is to reduce exposure to your asthma triggers. A majority of patients with the disease are also living with allergies, which trigger their asthma. Avoiding known asthma triggers, when possible, is important in helping prevent asthma attacks. 

For those experiencing asthma symptoms without a full understanding of what their triggers are, allergy testing is a recommended next step. Allergy testing can not only determine the cause of allergic reactions but also makes it possible for a board-certified allergist to provide a custom-tailored treatment plan made just for you.

Your treatment plan may include a combination of allergy shots, maintenance prescriptions and quick relief medications. Allergy immunotherapy (allergy shots) is the one treatment that has the potential to provide a long-term cure for patients for their allergies and asthma. Patients with asthma need regular follow up with their physician to have pulmonary function testing done periodically and to monitor their level of control. Patients need to work with their allergist to find the right combination of therapy that keeps their asthma controlled.