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Intermittent inflammation in the airways is known as asthma, which causes chest tightness, shortness of breath, wheezing, and coughing. There is no “cure” for asthma yet but current treatments can provide relief to a satisfactory level in most patients.
Treatment methods include identifying and avoiding triggers, monitoring using a peak flow meter, and managing the respiratory symptoms with bronchodilators and anti-inflammatory medications.
Medical Treatment for Asthma
Asthma is incurable but it can be managed through medications and preventive measures. The doctor will take into account all the relevant factors and customize the treatment plan to meet the needs of each individual patient. (1)
Asthma drugs (2) are broadly classified into the following two types:
a. Long-term control medicines
Long-term control medicines prevent the occurrence of future attacks by curbing airway inflammation, but they are useless for stopping an ongoing attack. These include:
- Inhaled corticosteroids are the first class of drugs prescribed to patients with asthma. (3)
- Cromolyn inhibits the action of mast cells, which are involved in allergic reactions.
- Inhaled long-acting beta-2 agonists (LABAs) are used as an adjunct to inhaled corticosteroids.
- Leukotriene modifiers are oral drugs that block the action of inflammation-causing molecules and thus help prevent the contraction of airways.
- Biologics such as omalizumab, benralizumab, reslizumab, and mepolizumab are prescribed to people with severe asthma who are unresponsive to other treatments or need high doses of corticosteroids. They are administered through subcutaneous or intravenous injections and work to attack IgE antibodies that play a primary role in allergic responses.
- Immunotherapy may be beneficial in preventing allergic responses that can trigger an asthma attack. (4) The drugs and methods vary for children (5–16 years) and adults (above 18 years).
Note: According to a drug safety review conducted by the US Food and Drug Administration (FDA), the asthma drug Xolair (omalizumab) is associated with an increased risk of cardiovascular problems that can affect the brain.
b. Rescue or quick-relief medicines
Rescue or quick-relief medicines such as inhaled beta-agonists (e.g., albuterol), intravenous or oral corticosteroids, and anticholinergics help to subside ongoing attacks within a few minutes by relaxing the contracted bronchial muscles to open up the airways and restore normal breathing.
These fast-acting drugs known as bronchodilators act like first aid in the case of an asthma attack and can even be taken right before any heavy exercise to prevent a flare-up. Go for regular follow-ups so that your doctor can track your progress and taper down or increase your dosage accordingly.
c. Medical tools for administering asthma medications
While some asthma medicines are available in the form of a pill, a majority of them require the use of specialized devices that enable the drug to enter your lungs directly. These include:
1. Inhaler (puffer)
Inhalers are of two types:
- Metered-dose inhalers (MDI) – deliver a short bust of medicine through a plastic mouthpiece with an aerosol canister
- Dry powder inhalers (DPI) – administer the drugs in powder form
A nebulizer dispenses the drug in the form of a fine mist through masks or mouthpieces. Since it does not require any specialized technique but only simple breathing, nebulizers are generally used for young children or people with severe asthma who are not comfortable with using inhalers.
A spacer is recommended if an individual is unable to use an MDI properly. The medication is sprayed into a chamber and then inhaled by the patient.
The foremost step for asthma diagnosis is reviewing the symptoms and obtaining a complete medical history of the patient, including any previous allergies or asthma cases among close relatives. (5)
Further diagnostic procedures include but are not limited to, the following tests:
- Physical exam is performed, which involves listening to your breath and examining you for signs of asthma or atopy, including swollen nasal passages, wheezing, and allergic skin conditions such as eczema.
- Pulmonary function tests or spirometry is done to obtain a baseline for comparison during flare-ups and to rule out other conditions.
- Bronchoprovocation tests are performed when asthma is suspected but the diagnostics elements (symptoms, history, baseline tests, etc.) are not conclusive. Additional tests such as blood sampling, allergy testing, and chest X-rays may be performed to gain further clarity.
Note: Children under 6 years of age may be given asthma medicines based only on their medical history and symptoms, as these tests cannot be performed on them. Further diagnosis is made on the child’s response to the drugs after a few months of use.
Expert Answers (Q&A)
Answered by Dr. Maeve O’ Connor, MD (Allergist/Immunologist)
If no quick-relief or rescue inhaler is available (having a rescue inhaler on hand is VERY IMPORTANT), the best way to manage an asthma attack is to CALL 911.
While waiting for the ambulance, staying calm is one of the most important things you can do, which can help your respiratory muscles become less constricted.
Sit in an upright position to stop breathing constriction. Take slow, deep, and long breaths to prevent hyperventilation.
Use the “relaxing breath” technique – breathe in through the nose for a count of 4, hold the breath for 1 second, and then slowly exhale for a count of 4. Never delay seeking emergency care when needed.
Asthma is a chronic condition and unfortunately cannot be cured. It can be managed effectively by avoiding known triggers and taking controlling medications as prescribed.
If asthma is limiting your daily activities or waking you up at night, it is important to talk to your doctor about your asthma action plan.
Coughing at night is a hallmark sign of poorly controlled asthma. If you are waking up more than two nights per month with coughing, wheezing, or shortness of breath, you should talk to your doctor to better understand your type of asthma and be given proper treatment to manage the symptoms.
Hot caffeinated drinks such as coffee can help to open up the airways slightly, providing symptomatic relief for an hour or two. However, this is not a long-term solution to asthma symptoms.
Each individual patient has unique triggers for his/her asthma. Some patients may have food allergies that can worsen asthma or cause symptoms that can be confused with asthma.
If you are experiencing a severe allergic reaction and an asthma flare-up, it is important to err on the side of caution and treat with epinephrine for anaphylaxis first. Time is of the utmost importance, and epinephrine should be administered quickly.
Nasal saline rinses may help to clear mucus in the upper airway, which often impacts the lower airways.
It is also important to stay well hydrated by drinking at least 2 liters of water per day unless you have kidney or heart issues.
Asthma treatment is of two types: for immediate relief or long-term control. However, you must always be ready with an emergency action plan to handle extreme attacks that can prove life-threatening if treatment is delayed. Living with asthma has become relatively easy with the availability of new and improved medicinal interventions, but it still requires a support system.
Although asthma patients can lead independent, fulfilling lives with the right kind of treatment, there can be instances when you find yourself breathless, helpless and anxious in the throes of a severe attack. In such cases, it comes down to the people around you to calm you down and offer you the help you need.
Thus, the people you share your life with, such as your family and friends, should be educated about this condition to provide emergency care when you need it.