Asthma Part 4: Treatment and Control

There is no cure for asthma. The goal of management is to achieve control of the disease. This includes the following:

  • It prevents chronic and recurrent symptoms such as night cough.

  • Reduce the use of medications

  • Maintenance of lung function

  • Maintenance of regular activities

  • Prevention of severe asthmatic attacks that require hospitalizations or visits to the emergency room

Practical tips for managing asthma:

  • Control other conditions that can make asthma worse.

  • Avoid known allergens

  • Maintain an active lifestyle

  • Have an action plan in case of asthma attacks.

Your asthma action plan should include medication regimen, avoiding triggers, keeping track of asthma attacks, and actions to take if asthma symptoms flare despite treatment. For example, when to go to the hospital emergency room for treatment

Asthma medications

Asthma medications can be broadly divided into medications that exert long-term control and medications that provide quick relief from asthma symptoms.

Both types of medications aim to reduce inflammation in the airways to control asthma.

Initial treatment depends on the severity of your asthma. Follow-up treatment depends on how well the patient follows the asthma action plan and how effective the action plan is.

However, keep in mind that your asthma action plan will vary with changes in your lifestyle and social environment because different social exposures result in exposure to different allergens in your environment.

The dose adjustment of the medicine should be left to the discretion of your GP. If you have adjusted the dose of the medicine on your own, you should inform your GP immediately to facilitate proper titration of the medicine dose at each doctor visit.

Your doctor will always try to use the least amount of medication necessary to achieve control of your asthma, so it is imperative that your doctor knows how many medications you have been using.

Certain patient groups require more intensive titration regimens, including pregnant women, young children, or patients with special needs.

Asthma Action Plan

Each asthma action plan should be designed for each patient. The plan should include medication regimen, avoidance of triggers, monitoring of asthma attacks, and actions to take in case asthma symptoms become progressively severe.

It is best to work with your GP to write your asthma action plan. The plan should describe all of the above in detail.

For children, parents and caregivers need to know the child’s asthma action plan. This should include babysitters, daycare workers, parents, schools, and organizers of children’s outdoor activities.

Trigger avoidance

A large number of allergens have been documented to be related to asthma. For the individual patient, the most important thing is to know what triggers your asthma. After that, know what steps to take when asthma is triggered.

Simple common sense is essential. For example, if you have a known allergy or sensitivity to pollen, limit your exposure to pollen and stay indoors if necessary. If you are sensitive to pets or pet fur, do not leave them at home or allow them into your bedroom.

It is noteworthy that physical activity can also trigger asthma attacks. However, it is recommended that asthmatics exercise regularly because, in the long run, exercise will help them control their asthma. Talk to your GP if you experience asthma attacks while doing physical activities. Medications are available to control asthma during exercise.

In the event that your asthma is strongly correlated with allergens that cannot be avoided (eg dust), your GP may recommend the use of allergy medications.

Asthma medications

Consult with your GP about the appropriate medications to control your asthma. Your GP will adjust the dose of your medications as needed. If you have self-adjusted the dose, you should inform your GP at your next visit.

Generally speaking, asthma medications can be in pill form, injectable, or as nebulized medication taken through the use of an inhaler. Nebulized medications are inhaled directly into the lungs where they work.

Please note that the use of inhalers will require a certain technique and should be taught by a physician or trained healthcare provider.

Drugs aimed at long-term control

Chronic asthmatics will need medications to achieve long-term control of their asthma. These drugs work slowly and reduce inflammation in the airways.

Inhaled corticosteroids

Inhaled corticosteroids are most often used for long-term control of asthma. They work by reducing inflammation in the airways of the lungs. Daily use of inhaled corticosteroids will greatly reduce the severity and frequency of symptoms.

The most common side effect of inhaled corticosteroids is oral candidiasis. The use of a spacer when using inhaled corticosteroid can reduce the incidence of oral yeast infection. Check with your GP if you are not sure how to use a spacer. Simply rinsing your mouth after using inhaled corticosteroids can also reduce the incidence of oral yeast infection.

Patients who have severe asthma may need to take oral corticosteroids instead of inhaled corticosteroids to achieve sufficient control of their asthma. Unlike inhaled corticosteroids, which can be taken for years, oral corticosteroids will have significant side effects if used for long periods.

Long-term use of oral corticosteroids increases the risk of diabetes, osteoporosis, cataracts, and abnormal metabolic activity.

Consult with your GP to weigh the risks and benefits before taking oral corticosteroids.

Other long-term medications:

These include:

  • Cromolyn: This medicine prevents inflammation of the airways and is used as a nebulized medicine given through an inhaler.

  • Omalizumab: This medicine is a form of immunotherapy and works against immunoglobulin E (anti-IgE) that triggers the narrowing of the airways. This medicine is usually given as an injection once or twice a month and prevents the immune system from reacting to asthma triggers. However, it is not a first-line treatment for asthma and your GP may not offer it in advance.

  • Long-Acting Inhaled Beta2 Agonists: These drugs are usually taken together with inhaled corticosteroids to achieve a synergistic effect on the expansion of the lumen of the lung airways.

  • Leukotriene modifiers: These are oral medications that reduce inflammation of the airways.

  • Theophylline: Theophylline can be taken orally or by injection and works to open the lung airways.

Be aware that there is a chance that symptoms will rebound if long-term medications are suddenly stopped. Also, all long-term medications will have side effects. Talk to your GP before starting long-term treatment regimens.

Quick-acting medications

Short-Acting Beta 2: Agonists are often the first-line drugs in this group. They are often given in a nebulized form through an inhaler. They work by relaxing the muscles of the airways, allowing a greater passage of air.

Quick-acting medications should be taken as soon as symptoms appear.

If the medicine is needed for more than 2 days a week, you should inform your doctor to formulate more strategies for your asthma action plan.

Asthmatics are advised to carry their quick-relief inhaler with them at all times.

It is noteworthy that these drugs do not reduce airway inflammation and therefore cannot replace long-acting drugs.

Documentation of asthma progression

Regular use of peak flow and regular visits to your GP will be the primary means of documenting asthma progression.

As a general rule, asthma is well controlled if:

  • Symptoms do not occur more than 2 days a week.

  • The symptoms do not disturb sleep more than twice a month.

  • There are no limitations to your daily activities.

  • Quick-relief medications are required less than 2 days a week.

  • Less than one severe asthma attack per year requiring oral steroids

  • Peak flow meter readings remain at 80% of the reference level

Peak flow meter

Your primary care physician will instruct you on the use of the peak flow meter.

When used, the peak flow meter measures the maximum rate of air flow leaving the lungs during exhalation. Regular measurements will allow the progression of asthma to be documented and it is recommended that the patient record their peak flow each morning.

During the initial phase after diagnosis, it is important to determine the basal peak flow. This is often touted as the patient’s “Personal Best” peak flow reading. Future asthma control is based on this baseline. Good asthma control is maintaining peak flow at least 80% of baseline.

Regular peak flow readings also help predict impending asthma attacks. Progressively deteriorating peak flow readings often indicate an imminent attack and should be incorporated into your asthma action plan.

Medical reviews

Frequent medical check-ups with your primary care physician every fortnight are the norm during the initial phase of treatment. Once your asthma is under control, your GP may choose to care for you for a longer period.

During checkups, important information required by your primary care physician includes:

  • Asthma attack frequency

  • Changes in symptoms

  • Changes in peak flow readings

  • Changes in daily activities such as exercise tolerance.

  • Difficulty complying with the asthma action plan

  • Problems with current medications

Emergency situations

Seek medical advice if:

  • Common medicines cannot treat an asthma attack.

  • Peak flow readings drop below 50% of baseline

Go to the nearest hospital emergency room right away if:

  • You experience severe shortness of breath to the point where walking becomes difficult

  • Your lips and your tongue turn blue

Asthma: a lifelong problem

There is no cure for asthma. Successful asthma management requires that the patient take an active role in asthma control by following an asthma action plan.

Your GP is your best partner in developing your asthma action plan. The action plan will remind you of your medication regimen, triggers, and protocols to follow when asthma symptoms develop or worsen. Even children should be involved in creating their action plan because it is individual effort that counts in long-term asthma care.

Asthma will not go away. But it can be controlled.

Written by Tzun Hon Lau

September 6, 2020
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