How is asthma treated?
Asthma medications play a central role in a treatment plan. Some medications prevent or reduce airway inflammation; others interrupt the allergic reaction that triggers symptoms; others relieve coughing and wheezing, making it easier to breathe.
Your doctor will work with you to find the right combination of medicines to manage your asthma and adjust the type and amount based on your symptoms and the type of asthma that you have. The goal of asthma treatment is to have you feel your best with the least amount of medicine.
Get to know your medications. Understand how and why they treat and soothe your lungs and airways. If you’re prescribed an inhaler, ask for one with a dose counter. Learn when and how you’re supposed to use your inhaler and follow your plan to better breathing.
When you hear the term “steroids” in asthma care, they are referring to corticosteroids – NOT the anabolic steroids used illegally in body building.
What are common types of asthma medications?
There are four basic types of asthma medications that each treat a different part of your asthma:
- bronchodilators relax and open the airways to relieve asthma symptoms such as coughing, wheezing, chest tightness and shortness of breath
- anti-inflammatory medications reduce and prevent lung inflammation
- combination medications combine a bronchodilator and anti-inflammatory in one device
- leukotriene modifiers block the action of leukotrienes, chemicals involved in immune system responses
- biologics are medications that target the specific cells and pathways that cause inflammation related to severe asthma.
Bronchodilators
Bronchodilators relax and open the airways to relieve asthma symptoms such as coughing, wheezing, chest tightness and shortness of breath.
Quick-relief (short-acting) bronchodilators
Quick-relief bronchodilators (albuterol, levalbuterol) are beta2-agonist medications that make it easier to breathe within minutes, lasting 3-6 hours. In addition, doctors prescribe quick-relief bronchodilators to prevent exercise-induced bronchospasm (EIB).
Long-acting bronchodilators
Long-acting bronchodilators (indacaterol, olodaterol, salmeterol) are beta2-agonist medications that relieve symptoms for up to 12 hours. They should not be used more than once every 12 hours or to treat sudden-onset asthma symptoms
Anti-inflammatory asthma medications
Anti-inflammatory medications treat and prevent airway inflammation and swelling, and also decrease mucus. These medications usually need to be taken every day to prevent asthma symptoms from occurring.
After using an anti-inflammatory medication, you won’t feel different and you won’t see any immediate changes. That’s because it takes time for airway swelling to subside and the mucus and excess fluid to clear out of the airways. Keep using it as directed even if you don’t feel anything happening right away.
When you hear the term “steroids” in asthma care, they are referring to corticosteroids – NOT the anabolic steroids used illegally in body building.
- Inhaled corticosteroids (beclomethasone, budesonide, ciclesonide, fluticasone, mometasone) are the most effective long-term therapy available for asthma. Taken as prescribed, they reduce and prevent fluid and excess mucus and swelling in the airways. Because it is inhaled, the medicine goes directly to the inflamed airways.
Note: Always use inhaled corticosteroids as prescribed; do not stop using them even when you are symptom-free and appear to be well.
- Oral corticosteroids are used to treat acute asthma flares or severe asthma. They are usually prescribed only for short periods of time (5-7 days). Taken as prescribed, they gradually reduce asthma symptoms and open up the airways.
- Because the dose of oral corticosteroids are 10 times the dose of inhaled corticosteroids, there is an increased risk of side effects, including behavioral problems, moodiness and depression, weight gain, headaches and easy bruising of the skin. When taking long-term, side effects can include eye problems, diabetes symptoms, increased risk of infections and thinning bones. Patients should talk with their doctor about whether the benefits of taking oral corticosteroids outweigh the side effects.
Combination medications
Combination medications combine into one device an anti-inflammatory corticosteroid and a long-acting beta2-agonist bronchodilator. They are prescribed as daily medications and should be taken no more than once every 12 hours. They should not be used to treat sudden or severe asthma symptoms.
Leukotriene modifiers
Leukotriene modifiers (montelukast, zafirlukast, zileuton) are oral medications that block the action of leukotrienes, chemicals involved in immune system responses that cause inflammation, swelling and tightening of the airways. They are available as granules, chewable or tablets. Leukotriene modifiers should not be used to treat sudden-onset asthma symptoms.
Montelukast may cause behavioral side effects including sleep disturbances, anxiety, depression, confusion, sudden mood changes and suicidal thoughts or actions. Patients should talk with their doctor about these potential side effects before taking montelukast and/or monitor side effects during treatment.
Biologics
Biologics target cells and pathways that cause allergic inflammation and bronchoconstriction – treating the source of symptoms rather than the symptoms themselves. Biologics are prescribed as an add-on therapy for severe asthma. They are usually administered as an injection or infusion every 2-4 weeks in a doctor’s office.
When biologics are effective, they help patients gain long-term control of asthma and reduce the risk of an asthma flare. The most serious side effect is anaphylaxis, a life-threatening allergic reaction; your doctor will have epinephrine readily available for treatment after administering the biologic.
How are inhalers used to treat asthma?
Many asthma medications are delivered using an inhaler or a nebulizer. Inhalers and nebulizers are devices that allow the asthma medications to be breathed in and go straight to the airways. There are four types of delivery devices:
- metered-dose inhaler (MDI): a pressurized device that releases medication in a fine spray for you to inhale
- slow-moving mist inhaler: similar to an MDI, with a slower-moving mist
- dry powder inhaler (DPI): releases medication as a fine powder for inhaling
Improving asthma with tools and devices
Asthma is a cyclical disease, with episodes that come and go. Flares don’t just “happen” however. Subtle warning signs are there if you know where and how to look. By the time you begin coughing or wheezing, your lungs are already congested and compromised. That’s why you need to pay close attention to the subtle signs and follow the treatment plan prescribed by your doctor.
The following management tools have proven to be excellent for anticipating, treating and shortening an asthma flare. Always keep in mind that the real goal is to prevent or minimize asthma symptoms.
Asthma holding chamber or spacer
A valved holding chamber is a handheld device that attaches to a metered-dose inhaler (MDI) and captures the medicated mist as it sprays out. The medication is trapped long enough inside the holding chamber to be inhaled at your own speed. It also pulls out large particles of medication and prevents them from settling in your mouth or throat.
A spacer is similar to a valved holding chamber, but it does not suspend the medication, so when using it you must coordinate your breath to begin slightly before actuating the MDI.
Holding chambers are available for use with and without masks. Masks are often essential for children, the elderly or disabled people who cannot close their lips securely around the mouthpiece or who need to take several breaths to inhale the medication fully.
Nebulizers
Nebulizers turn liquid asthma medicine into a fine aerosol that can be inhaled deep into the airways. They are powered by a compressed air machine and can be battery operated or plugged into an electrical outlet.
Although studies show nebulizers are no more effective than MDIs, they offer an alternative for patients who have difficulty with MDI coordination or who prefer a slower delivery of medication. Some say they benefit from taking extra time during an asthma flare for a nebulizer treatment, giving them a chance to sit down, relax and breathe normally, while relieving inflammation and bronchospasm.
Discuss with your doctor or pharmacist if a nebulizer is right for your family.
What is bronchial thermoplasty?
Bronchial thermoplasty is an outpatient surgical procedure for adults ages 18 and older whose asthma is not adequately controlled using standard therapy of a combination of inhaled corticosteroids and a long-acting bronchodilator.
The procedure is performed in three outpatient visits under moderate or general anesthesia. A pulmonologist or other qualified physician inserts a long, slender tube called a bronchoscope into the lungs and surrounding airways to heat and shrink the size of muscle tissue, thereby allowing more air to pass through and make breathing easier.
Side effects may include a short-term worsening of asthma symptoms, but these usually resolve within a week.
If you have severe, difficult-to-control asthma, talk with an allergist or pulmonologist to determine if bronchial thermoplasty is right for you. Be sure to check your health insurance to confirm if the procedure is covered.
How do you decide what treatment is right for your asthma?
Patients want to have a say in their care and treatment choices. We call it Shared Decision Making – where your physician, nurse or healthcare professional discusses with you the pros and cons of a specific test or treatment, and then you come together to decide what is best for you.
Studies show when patients and families work closely with doctors and make healthcare decisions together, their health improves. Their knowledge of the condition is greater and they are more likely to adhere to treatment plans and go to follow-up appointments.
How do I reduce the need for medications?
Sometimes asthma symptoms seem to come out of nowhere. Other times, you can predict them. You can make sense of the asthma rollercoaster by tracking when and how symptoms happen.
Learn the early warning signs of asthma. If you know what to look for, you will notice when an asthma flare is developing. These will vary from one person to another but can be as simple as a tickle in the throat or chest, a sharp or sudden cough, or a feeling of extreme tiredness.
This is important because it takes less medication to stop symptoms from worsening than it does to treat a full-blown flare. By the time you begin to cough or wheeze, your lungs are already congested and compromised.
When you learn what makes your symptoms worse, you’ll find ways to reduce your need for asthma medications. Notice your triggers in your home, work or school that bring on your symptoms and try your best to avoid contact with them when possible.
What if I can’t afford asthma medication?
Go to Asthma Medication Assistance Programs
Patient education resources from Allergy & Asthma Network
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Last updated : 3/10/2022