Asthma Treatments

THE MAIN GOAL OF TREATMENT IS THE CONTROL OF ASTHMA

What does control of asthma mean?

1. The ability to deal with sudden asthma attacks in order to prevent the need for urgent health care.
2. Avoid hospital stays, Emergency Room visits, or unscheduled visits to the doctor’s office.
3. To be able to take part in all normal activities, including sports.
4. Avoid symptoms that create problems with sleep.

These goals should be reached safely and they should get in the way of a normal life-style as little as possible. The risks and problems of treatment must be carefully weighed against the risk and problems of asthma.

The benefit obtained from the treatment must be worth any trouble and possible health risks carried by the treatment. Any medication has the possible risk of side effects regardless of how small the risk. In other words, the goal of treatment is to find the simplest and safest way that minimizes problems, avoiding the need for sudden medical care of asthma and permits a normal life.

HOW THE TREATMENT GOALS ARE ATTAINED

Unfortunately, there is no magic bullet for asthma. While treatment can control symptoms safely and effectively for most patients most of the time, it is not as simple as receiving a prescription and taking the medication.

Successful treatment of asthma is likely to require several steps. The physician, with your help will need to:

1. Confirm the diagnosis. Make sure it’s asthma and only asthma.
2. Categorize the asthma, including:

3. • Type, such as Intermittent or Persistent
   • Severity, both during routine time and during exacerbations (attacks).
   • Identify triggers –viral infections, allergies, irritants, exercise
   • Identify the components of airway obstruction –bronchospasm, inflammation or both?

4. Develop a plan to include:
   • The lowest dose of effective medication, which is both safe and effective.
   • Modifications in the environment, if needed.
   • How to treat asthma exacerbations.
5. Provide education how to accomplish the plan at home.

Confirm the Diagnosis

The diagnosis of asthma is suspected when a patient has a history of recurrent or persisting cough, shortness of breath, labored breathing in the absence of any other obvious reason. The diagnosis is confirmed by obtaining evidence that there is airway obstruction that reverses either spontaneously or as a result of treatment with anti-asthma medication.

The procedures used to make the diagnosis include a careful history, pulmonary functions (if possible) and often, trials of medication. To categorize the pattern of asthma, it will be critical to determine the frequency and severity of symptoms.

Some patients only have episodes associated with viral illnesses, with long periods of being symptom-free even without medication. This type is Intermittent asthma. Others have some degree of routine symptoms, which occur either seasonally or year-round, Seasonal allergic or Persistent asthma. Assessment of severity is another important part of classifying.

Categorize the Asthma

To determine severity for acute asthma, an important question to answer is “how bad does the asthma get, when it gets bad?” For any type of asthma, symptoms during an asthma exacerbation may range from trivial to life threatening. Asthma symptoms that have resulted in loss of consciousness or admission to an intensive care unit identify a particularly dangerous degree of severity.

Another aspect is severity of regular symptoms. Some patients will have routine symptoms that disrupt activity daily. They may already be limiting their exercise or activity, knowing it will cause them discomfort. Others though have daily symptoms with minimal interference. These patients tolerate activity and sleep undisturbed by their asthma. Assessing severity of both routine symptoms and exacerbations are necessary to a meaningful categorization.

Triggers of asthma, include those things known to worsen symptoms.

• Viral respiratory infections or common colds
• Airborne allergens (pollens, molds spores, animal danders, dust mites)
• Inhaled irritants (cigarette smoke, chemical fumes, strong odors-perfumes, air pollution, etc.)
• Exercise

Other factors can also worsen asthma on occasion. Cold air may trigger asthma. Hyperventilation, excessively rapid and deep breathing, can worsen asthma. This occurs from anxiety in some patients, particularly when asthma symptoms have begun for some other reason.

A vicious cycle then occurs of asthma causing anxiety, which then causing more hyperventilation, causing more asthma. Ingested substances such as aspirin, sulfite preservatives and specific foods can cause acute attacks of asthma in specific sensitive patients. The components of airway obstruction in asthma include bronchospasm and inflammation. Inflammation includes both swelling of the lining of the airway and increased mucus production.

Develop a Treatment Plan

This distinction is important because the responses of each to medical treatment are different. Bronchospasm responds to bronchodilators, medications that relax the smooth muscle lining the airway. These muscles when constricted cause narrowing. Examples of bronchodilators include albuterol (also known as Proventil or Ventolin), pirbuterol (Maxair) or levalbuterol (Xopenex). These work very rapidly to relieve bronchospasm.

On the other hand, these medications have no effect on airway swelling or mucus production. Bronchodilators are usually given as in inhaled medication, because of their fast action right at the site they are needed. Anti-inflammatory corticosteroids (not anabolic steroids used by athletes to build muscle) dramatically, but slowly reduce inflammation but have no direct action on the smooth muscle of the airways.

Anti-inflammatory corticosteroids (steroids for short) can be given as inhaled medication, oral liquid or in tablet forms, though each is not interchangeable. An organized plan will determine specific treatment needs to control the asthma.It should include medication needs, environmental alterations and consider the needs and abilities of the individual.It should address if and what medication should be taken regularly (maintenance or controller medications) as well as what to do for acute asthma (intervention or reliever medications).

Education

The treatment plan can be no more effective than how well it is used. The most important part of treatment is carried out by the patient (or family for young children). It is the physician’s job (with help from other health professionals) to teach how to carry out the treatment plan.

This is an interactive and ongoing process. Use each contact, whether in person or by phone to learn more about managing your (or your child’s) asthma.