How is asthma treated?

Asthma is a chronic disease that can be controlled but not cured completely. In general, the aim of treatment of asthma is to manage the disease or to reduce the frequency of asthma attacks.

Achieving a good asthma control will help in:

• Avoiding chronic and bothersome symptoms, such as cough and shortness of breath.
• Decreasing the need to take reliever.
• Maintaining lung function.
• Conducting daily activities as usual as well as obtaining good night sleep.
• Lessening trips to emergency rooms or avoid hospital admission due to frequency attacks.

It is best to discuss closely with your physician on the best way to control your asthma or your child’s asthma. Children may also actively take part in controlling their asthma. The excellent way to achieve a good control is to pick up on knowledge on your asthma condition and ways to improve it.

Taking part actively in asthma management means:

• Working with your doctor to treat other conditions that can interfere with asthma management.
• Avoiding possible exposure that may trigger asthma.
• Trigger should never interfere in conducting physical activity as it is an important part of building a healthy lifestyle.
• Following the asthma action plan that has been agreed by you and your physician.

An asthma action plan provides a clear instruction on how to properly take your medicines, checking on the level of control achieved and also illustrates ways to react when emergency treatment is in need.

The treatment of asthma focuses on the:

• Relaxation of muscle lining of the respiratory tract/passage.
• Respiratory tract inflammation by treating and preventing from having attacks in future.

There are two types of asthma medications; the so called reliever and controller/preventer.

The reliever or quick relief medication should be taken in cases of acute/sudden asthma attack. It helps in dealing with sudden symptoms of asthma. On the other hand, the controller or long term control medication prevents asthma attack from happening.

Treatment indicated will be determined by the severity of the asthma condition.

The level of asthma may vary from time to time. It also depends on your surrounding environment. For example being at school, work or at home may alter the asthma control. This is due to probability of exposure towards asthma triggers such as pollen or dust. Alteration in asthma medication may be made by your physician, for example increasing the dose or adding number of medication depending on the level of control achieved. In contrast, if the asthma is well controlled and sustained for a certain period of time, the medication may be reduced depending on the necessities.

Asthma treatment may be adjusted to specific group of patients such as pregnant women, children and elderly.

Adhering to Asthma Action Plan

Doctors will usually propose the asthma action plan. The plan will help in giving a clear picture of daily activities and treatments. It gives instruction on frequency of taking the medicines. The plan also explains on how to deal with a sudden asthma attack that may need emergency care.

Avoiding Asthma Triggers

Many things may trigger asthma. These things are called asthma triggers. Asthma triggers may worsen asthma symptoms and lead to asthma attacks. You may figure them out through a thorough discussion with your doctors.

For example, exposure to dusts or furry pets might make your asthma worse. If this is the case avoid using rugs that may accumulate dusts at home or keep pets with fur out of your house or bedroom.

One possible asthma trigger you shouldn’t avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk to your doctor about medicines that can help you stay active.

Several health conditions can make asthma harder to manage. These conditions include runny nose, sinus infections, reflux disease and psychological stress. Your doctor will treat these conditions as well.

Medication for Asthma

The prescription on asthma medication will be considered by the doctor after a thorough evaluation. This also accounts for the medication that can best manage the asthma control. Hence, the medications will be adjusted according to the patients’ need. There are various forms of asthma medications that may be taken orally or by using devices. The most common forms of asthma medications are inhalers that are available in various types. Inhalers help to deliver the medication straightly into the lungs.

Refer the inhaler techniques video for more information on how to use inhalers.

Preventer or Long-Term Control Medicines

Most people who have asthma will be prescribed with medication that prevents symptoms. The best long-term medicines lessen inflammation of airway passage. This may prevent symptoms from flaring up. However, these medicines only prevent attack but will not provide relief from symptoms of asthma.

Inhaled corticosteroids

Inhaled corticosteroids are the favoured medicine for long-term control of asthma. They are efficacious in providing long-term relief of asthma symptoms. It helps in reducing inflammation of the airways. An example of inhaled corticosteroid is budesonide.

Through reducing the inflammation, the frequency of asthma attacks may be minimized. Inhaled corticosteroids are generally safe when taken as instructed by the doctors and pharmacists. Inhaled corticosteroids may cause side effects. However, it was agreed that the benefits of taking inhaled corticosteroids in reducing frequency of asthma attacks greatly outweigh the risk of the side effects.

One of the commonly experienced side effects is fungal infection in the oral cavity often called oral thrush. Oral thrush may be prevented by gargling or rinsing the oral cavity after using inhaled corticosteroid. Spacer or aerochamber may also be used with inhaler in preventing oral thrush. Long term consumption of corticosteroid may cause osteoporosis. Osteoporosis is a condition where bones become fragile and easy to break. However, often time’s doctors will advise on taking vitamin D and calcium pills to prevent such condition.

Other long-term control medicines

Long-term control medicines include:

Cromolyn sodium: This medicine is taken using a device called a nebulizer. Nebulizer delivers very fine mist to the lungs when inhaled. Cromolyn avoid airway inflammation. It is beneficial in people who experience asthma attacks due exposures to allergens. Thus it is taken prior to asthma attack i.e it is not useful if taken once asthma attack takes place.

Omalizumab (anti-IgE). This medicine is given as an injection one or two times a month. It halts body responds to asthma triggers, such as pollen and dust. This agent impedes IgE from binding to cells that release chemicals that exacerbate asthma symptoms.

Inhaled long-acting beta2-agonists: These medicines open the airways. They might be added to low-dose inhaled corticosteroids to improve asthma control. Inhaled long-acting beta2-agonists should never be used for long-term asthma control unless they’re used together with inhaled corticosteroids.

Leukotriene modifiers are available as oral medication (tablets and powder). They reduce inflammations by blocking the chain reaction that causes it. Leukotriene modifiers prevent asthma attacks. Through chemicals blockade, leukotriene modifiers helps in diminishing the airways inflammation. The leukotriene modifiers are often used as second line treatment in asthma management asthma. It usually prescribed for asthma cases that are not severe enough to require oral corticosteroids. The examples of leukotriene inhibitors are montelukast and zafirlukast.

Theophylline is an asthma medication taken by mouth. Theophylline helps ease the airways passage. Theophylline belongs to the methylxanthines group which, acts similarly to long-acting bronchodilators. They were once a commonly used medication in the treatment of asthma. However, due to the significant caffeine-like side effects, it has been used less frequently in the treatment of asthma. Theophylline and aminophylline are examples of methylxanthines medications.

Certain medicines, such as theophylline, may require your doctor to check on the level of medicine in your blood known as Therapeutic Drug Monitoring (TDM). This is to confirm that sufficient medicines are given to help manage your asthma symptoms, but safe enough to not cause dangerous side effects.

Reliever or Quick-Relief Medicines

All people who have asthma need quick-relief medicines to help relieve asthma symptoms that may flare up. Inhaled short-acting beta2-agonists are the first choice for quick relief.

These medicines act rapidly to ease muscles around your airway passage when you’re having an attack. This permits the airways passage to open up so air can easily flow through.

Always take the reliever when noticing impending attack symptoms. Reliever should always be available with you in case you might need it at any time.

Children or carers should know when and how to use these medicines and when to seek medical care for your child. Relievers are not interchangeable with preventer. Reliever is taken when an asthma attack happens. However, preventer must also be taken during an asthma attack.

Short-acting beta2-agonists are commonly used as rescue medications. Inhaled short-acting beta2-agonists work quickly, to ease the airway passages. The effects may last for hours. Salbutamol is the most common type of short-acting beta2-agonists medication used in relieving asthma attacks.

Anticholinergics are also beneficial as quick relief medicines during asthma attacks. Inhaled anticholinergic has similar action to beta2-agonists however they have longer effects. An anticholinergic drug is frequently used together with a beta-agonist drug to create a superior effect than either drug can achieve by itself. Ipratropium bromide is an example of inhaled anticholinergic drug used as a quick relief asthma medication.

Keep Track on Your Asthma

Record Symptoms

Asthma symptoms may be documented in a diary to see how well you response towards treatment.

Asthma is well controlled if:

• No symptoms for more than 2 days/week and symptoms does not disrupt the quality night sleep in a frequency of once or twice per month.
• Able to conduct normal activities.
• Quick relief medicines are used not more than 2 times/week.
• Having no more than one asthma attack a year that necessitates oral corticosteroid (prednisolone).
• Your peak flow doesn’t drop below 80 percent of your personal best number.

Always contact your doctor if you are experiencing frequent asthma attack even after following asthma action plan as prescribed.

Get Asthma Checkups

Frequent asthma checkups are essential in maintaining a good control in asthma.

During these checkups, discuss with doctors and pharmacists on the knowledge you should know such as the right way on using inhaler devices, how to avoid attacks and asthma triggers. Inform your doctors and pharmacists on your daily activities and frequency of attacks to enable them to adjust the asthma action plan according to your needs. Tell the doctors if you are having difficulties in adhering to the medication plan. Changes on medication type and devices can be made to suit one’s need. A lesser medication may be taken once the asthma is well controlled. Thus, the aim of the treatment is to depend on the least amount of medicines possible to control the symptoms.

Emergency Care

At certain times emergency medical attention may be urgently needed.

Immediately seek medical attention in cases where:

• Medications taken do not relieve asthma attack.
• Your peak flow is less than half of your personal best peak flow number.

Immediately call the emergency line if:

• You have trouble walking and talking due to shortness of breath.
• You have blue lips or fingernails.

At the hospital, life-saving treatment such oxygen and medicines at higher doses will be administered.

Last Reviewed	:	06 January 2014
Writer	:	Siti Nurul Fathihah bt. Baharuddin
Accreditor	:	Munira bt. Muhammad