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Asthma Treatment

An estimated 26 million Americans have asthma, according to the Centers for Disease Control. That’s one in 12 people or over seven percent of adults and more than eight percent of children. Asthma is a chronic condition, which means it cannot be cured. However, asthma can be controlled with the right medications, the right precautions and the right lifestyle. The asthma specialists at the Allergy & Asthma Center will develop a custom Asthma Action Plan so you can live life with asthma to the fullest.

What is asthma?

Asthma is a chronic disease involving the airways in the lungs. These airways, or bronchial tubes, allow air to come in and out of the lungs.

If you have asthma, your airways are always inflamed. The inflammation worsens, they become even more swollen and the muscles around the airways can tighten when something triggers your symptoms. This obstruction makes it difficult for air to move in and out of the lungs, causing signs/symptoms such as coughing, wheezing, shortness of breath or chest tightness.
For many people with asthma, the timing of these symptoms is closely related to physical activity. In addition, some otherwise healthy people can develop asthma symptoms only when exercising. This is called exercise-induced bronchoconstriction (EIB), or exercise-induced asthma (EIA). Staying active is an important way to stay healthy, so asthma shouldn't keep you on the sidelines. Your asthma specialist can develop a management plan to keep your symptoms under control before, during and after physical activity.

People with a family history of allergies or asthma are more prone to developing asthma. Many people with asthma also have allergies. This is called allergic asthma. Non-allergic asthma can affect people who do not have allergies. Occupational asthma is caused by inhaling fumes, gases, dust or other potentially harmful substances while on the job.

What are common triggers of asthma?

A trigger is something that provokes an asthmatic response from your body. When you have asthma, your body sees these triggers as a threat and releases chemicals to combat them – and these chemicals, in turn, can cause an asthma attack.
Different people can have different triggers, but common asthma triggers include allergens, emotions, exercise, infections/illness, irritants and weather. Triggers can also come from certain medications and for some people foods.

  • Allergens: A variety of allergens can make asthma symptoms worse, but it is important to note that not all people with asthma have allergies. Common allergens include animal dander, saliva and urine from feathered or furry animals, dust mites, cockroaches, mold and pollen.
  • Emotions: Emotions do not cause asthma, but can make asthma worse because strong feelings can lead to changes in breathing patterns. Times of "good" stress and "bad" stress can cause problems for people with asthma. However, it is important to express your emotions, and having well-controlled asthma can minimize the effect of stress.
  • Infections: Infections are perhaps the most common trigger for asthma symptoms. Common cold viruses, respiratory infections, sinusitis, and influenza frequently cause an increase of asthma symptoms. We recommend an annual flu vaccination.
  • Irritants: Many substances found in the environment can irritate sensitive airways and cause asthma symptoms. Common irritants include smoke (such as tobacco smoke and smoke from wood-burning or kerosene stoves and fireplaces), aerosol sprays, strong odors (like perfumes, cologne and gasoline fumes), dust, and air pollution. Cigarette smoke is a particularly serious asthma trigger.
  • Weather: Certain types of weather that may cause problems for some people with asthma. Some weather conditions that may make asthma symptoms worse include extremely hot or cold temperatures, windy conditions, thunderstorms and changes in humidity or barometric pressure.

No matter the cause, asthma is a serious condition, but it responds well to treatment.

Symptoms/Signs

Asthma symptoms can best be described as how asthma makes a person feel. Signs are the outward manifestations of an asthma episode. 

Symptoms of asthma may include:

  • Chest tightness or pain
  • Chest heaviness 
  • Shortness of breath
  • Difficulty breathing – inhaling or exhaling
  • Decreased exercise tolerance and fatigue

The most common signs of asthma are:

  • Coughing, especially at night, with exercise or when laughing/crying
  • Wheezing (a whistling or squeaky sound in your chest when breathing, especially when exhaling)
  • Fast breathing
  • In small children and infants, grunting and nasal flaring can be seen
  • Difficulty talking

Asthma makes breathing difficult. Asthma symptoms may be mild or life-threatening. If you suspect you have asthma, you should come to the Allergy & Asthma Center for a complete evaluation. If you have asthma, you will need to follow a long-term and short-term treatment plan to keep your asthma under control, so you live life to its fullest.

Diagnosis

A diagnosis of asthma is made based upon your history and symptoms, as well as physical examination. Specific personal medical history points that are important include a history of environmental allergy, food allergy and eczema. Family history is also considered, as a positive family history increases a person's chances of developing asthma.

Lung function testing and exhaled nitric oxide testing can be performed in our offices in just a few short minutes. These tests show how well your lungs are functioning and help to determine if airways are constricted or inflamed. In addition, you may need to undergo allergy testing or an exercise provocation challenge to help aid in making the diagnosis and to determine the triggers of your asthma. This information is critical to developing an effective treatment plan.

Treatment

Asthma is a chronic condition and cannot be cured. Symptoms can be controlled with effective asthma treatment and management. This involves taking your medications as directed and learning to avoid triggers that cause your asthma symptoms. Your allergist at the Allergy and Asthma Center will prescribe the best medications for your condition and provide you with specific instructions for their use.

Asthma medications fall into two categories: long-term controller medications and short-term, quick-relief medications.
Long-term control medications are used daily to maintain control of asthma symptoms and prevent asthma exacerbations. These medications are in different categories and can be used alone or in combination with others. They are to be taken every day, even when you are doing well, to prevent episodes.

  • Inhaled corticosteroids fluticasone, budesonide, mometasone, ciclesonide, flunisolide, beclomethasone and others are very effective anti-inflammatory medications. They are available in a variety of strengths and dosing regimens that can be tailored based on an individuals specific asthma needs.
  • Combination inhalers contain an inhaled corticosteroid plus a long-acting beta-agonist (LABA). LABAs are symptom-controllers that are helpful in opening your airways. They provide bronchodilation (opening of the tightened airways) and bronchoprotection (some degree of protection against triggers). However, in certain people they may carry some risks.
    • LABAs should never be prescribed as the sole therapy for asthma. Current recommendations are for them to be used only along with inhaled corticosteroids. Combination medications include fluticasone and salmeterol, fluticasone and vilanterol, budesonide and formoterol, and mometasone and formoterol.
  • Anticholinergics are inhaled medications that also help in opening the airways. The medication tiotropium can be used as maintenance therapy in asthma.
  • Leukotriene modifiers are oral medications that include montelukast, zafirlukast and zileuton.
  • Biologics are a new class of medication for the treatment of moderate to severe asthma. These unique medications target very specific points in the pathways of allergic inflammation and have been shown to be highly effective in treating allergic asthma with a low incidence of side-effects and adverse effects. All are given in injectable forms; some require administration in the office, some may be given at home. Biologics for asthma include anti-IgE therapy (omalizumab), anti-IL-5 therapies (benralizumab and mepolizumab) and anti-IL-4 receptor alpha therapy (dupilumab). 

Short-term, quick-relief medications are used to quickly relax and open the airways and relieve symptoms during an asthma flare-up, and can be taken before exercising if prescribed. These include: short-acting beta-agonists. These inhaled bronchodilator medications include albuterol, levalbuterol and pirbuterol. Quick-relief medications do not replace controller medications. If you rely on rescue relief more than twice a week, it is time to see your allergist.

In addition to medications, critical features of asthma management include the identification and avoidance of asthma triggers. Asthma monitoring is essential and includes regular lung function readings and routine follow up visits with your asthma specialist at the Allergy and Asthma Center. Taking asthma medications as they are prescribed and following your individualized Asthma Action Plan will allow you to live life to the fullest.