Treatments for Asthma

The goals of treatment focuses primarily on:

  • Reducing the frequency and severity of symptoms
  • Limiting the impact asthma has on normal activities
  • Reducing the risk of future asthma attacks
  • Preventing progressive lung function impairment
  • Reducing the risk of side effects of asthma medication
  • Minimizing the need for hospitalization or emergency care.

The patient and the health professional need to work together to determine an asthma management plan which is the most effective for the individual in their current circumstances. Management plans need to be monitored regularly and changes are often made as the need arises.

Medication

In order to achieve a good level of asthma control, treatment will require several elements to be addressed. Usually, medication is required but the type and quantity needs to be carefully determined and evaluated in follow-up visits.

Environmental Factors

Environmental factors that can trigger or exacerbate asthma symptoms will also need to be discussed. Simple measures can often be implemented to help the sufferer avoid exposure to substances or conditions that negatively affect their asthma. Allergen immunotherapy may be considered for patients who have persistent asthma that is consistently linked to exposure to an allergen.

Doctors will strongly advise that all asthma patients avoid exposure to tobacco smoke as it is so irritating to the already sensitive airways that asthmatics have.

Comorbid Conditions

The presence of other coexisting conditions that may be contributing to the asthma symptoms should be looked into as treatment of these conditions may improve the patientís ability to control their asthma. Potentially problematic coexisting conditions include:

Patient Education

Patient education is very important, as it is nearly impossible to have good control of asthma without the patient fully understanding their condition and knowing how to implement their asthma management pan. In order to treat asthma effectively, you need to understand the difference between long-term control and quick-relief medications and under what circumstances each should be used.

  • Long-term control medications such as inhaled corticosteroids (ICSs) prevent symptoms by reducing inflammation. They need to be taken every day as a standard preventative measure but they wonít provide rapid relief in the event of a flare-up of symptoms.
  • Quick-relief medications include short-acting beta2-agonists (SABAs) allow the muscles along the airway to relax which relieves symptoms. This type of medication does not provide long-term control but is meant to be used for rapid relief when symptoms occur. Generally, if SABAs are used more than twice a week (unless if needed for exercise-induced asthma) then long-term control medications need to be started or increased.

Patients also need to be educated on how best to avoid environmental factors that may affect their asthma.

Long-Term Monitoring

The doctor will need to monitor your symptoms over the long term in order to evaluate how well the asthma is being controlled. Treatment may need to be adjusted if asthma symptoms are still problematic despite adherence to the management plan. During the review, the doctor will also want to know if you are suffering any side effects or having problems with adhering to the treatment plan.

During follow-up visits the doctor will ensure that you are taking your medication in the correct manner. The doctor will also make sure that you are not having difficulty using the correct technique in administering the medication as poor technique can limit the benefits of the medications.

Asthma Action Plan

A written asthma action plan is an essential part of the treatment. The doctor will work with you to determine agreed treatment goals. You will be instructed on how to use the asthma action plan to maintain control of your asthma on a day-to-day plan as well as how to adjust the medication if symptoms become worse. The plan will also outline when to seek further urgent medical care.

A good relationship with your healthcare provider is essential as working together ensures the patient has a better chance of adhering to the treatment plan and hence, better long-term outcomes. A treatment plan needs to be tailored to and individualís preference with regards to ability to stick to the plan and desired outcomes. Encouragement from the healthcare provider and family involvement builds patient confidence and provides them with the necessary support.

Managing Asthma during Pregnancy

While pregnant, a personís asthma may improve or worsen and hence, their medication may need to be adjusted. It is safe for a pregnant woman to take inhaled corticosteroid (ICS) medication. Ultimately, it is safer for the mother and the unborn infant to use medication to properly control the asthma than to have poorly controlled asthma. Good lung function is essential as it allows adequate oxygen supply to the developing fetus. Inhaled corticosteroid medications are the recommended form of long-term control medication. Again, it is essential that exposure to tobacco smoke is avoided.

Physical Activity

Physical activity should not be avoided just because you have asthma and there is generally no limit to the level of participation. Short acting beta-agonists (SABAs) taken before exercising will prevent exercise-induced asthma in most patients. Leukotriene receptor antagonists (LTRAs), cromolyn or long acting beta-agonists (LABAs) may also be useful.

It is advisable to avoid using LABAs regularly to manage exercise-induced asthma as this is usually a sign that that the individualís asthma is not properly controlled. In this situation, it is better to consider using long-term control medication where regular medication reduces overall airway inflammation.

Before performing any physical activity, it is a good idea to warm-up properly or even to wear a mask over your mouth if cold air tends to make you asthma symptoms worse.

Asthma and Surgery

It is important that you ensure that your doctor is aware of your asthma before you have surgery as asthma does increase the risk of having problems during or after surgery. The surgeon can help manage this risk by administering asthma medication before or during surgery to prevent symptoms developing.

Drugs

There are two main types of medications for treating asthma:

  • Control medications - used to prevent attacks
  • Quick-relief, or rescue, medicines - used during an asthma attack.

Long-Term Control Medicines

Long-term control medicines are also known as maintenance or controller medicines. This kind of medicine is most often prescribed for moderate to severe cases of asthma. Control medicines are the primary part of asthma treatment and are meant to be taken every day in order for them to be effective. Even if you feel well, it is still important to keep taking the medicine so that they will prevent symptoms or attacks from developing.

Long-term control medicines are generally anti-inflammatories that prevent asthma from occurring by keeping the airways free of swelling. This type of medication is not helpful in a situation where symptoms flare-up suddenly or an asthma attack develops - this is when rescue or quick-relief medicines are needed.

Long-term medicines come in different forms. Some are breathed in through an inhaling device, such as long-acting beta-agonists and steroids. Others are taken orally (by mouth). Your doctor will help you determine which is the most appropriate for you.

Quick-Relief Medicines

Quick-relief medicines are also known as rescue medicines and are generally taken when symptoms have already started or are about to start. When taken, they can provide temporary relief of symptoms by quickly opening swollen airways. For example, they can be taken if symptoms such as wheezing, coughing, breathing problems or even an asthma attack occur. They may also be used as a preventer for people affected by exercise-induced asthma by taking them before exercising.

Keep in mind that this type of medicine is only meant to be used occasionally when symptoms develop. If you find that you are using rescue medicines more than twice a week then it may be a good idea to talk to your doctor as your asthma may not be under control. If this is the case, it may be simply a matter of adjusting your daily dose of control medication.

Quick-relief medicines include inhaled short-acting bronchodilators that relax muscles around the airways causing them to open up and allow more air to flow through. They may also help clear mucus from the lungs by allowing it to more easily and be coughed up. Oral corticosteroids can also provide rapid relief and are generally used when symptoms of an asthma attack persist or when severe symptoms develop.

Are Steroid Medications Bad For You?

It is a commonly held perception that steroid medications are bad for you. However, inhaled corticosteroids (ICS) are the most effect type of medication for long-term control of persistent asthma. As the medication is inhaled, it goes straight to the lungs where it reduces inflammation. They usually need to be taken every day in order to achieve good control of symptoms and avoid asthma attacks.

Although corticosteroids may carry some risks, the benefits greatly outweigh these. By working closely with your doctor you can ensure that you are taking your medication correctly and using the lowest possible dose that will still give you adequate asthma control.

High doses of ICSs may be associated with an increased risk of mouth irritation and thrush that can be avoided by rinsing your mouth and spitting after using ICSs. Using a valved holding chamber or spacer if applicable for your inhaler device can also minimise this risk.

There is also a perception that ICSs will slow a childís growth but this link is yet to be clearly determined. Growth rates in children are highly variable so it is unwise to assume that slowed growth is necessarily associated with ICS use, especially when doses are not particularly high. Furthermore, poorly controlled asthma can slow the growth rate in children.

Some patients fear that ICSs are addictive - this is not true. Similarly, there is no link between this form of medication and the anabolic steroids that some athletes controversially use to improve the performance.

Long-Acting Beta2-Agonists (LABAs)

Long-acting beta2-agonists, or LABAs, are usually used in addition to inhaled corticosteroids (ICSs) as it tends to be more effective than doubling the dose of ICSs. LABAs are not to be used as the only form of treatment to achieve long-term control and should be used in conjunction with ICSs.

A large clinical trial has shown that LABAs may carry a slightly increased of death when used in conjunction with ICSs compared to using a placebo in conjunction with ICSs. There is also a slightly increased risk of more sever exacerbations associated with use of LABA. This has resulted in the Food and Drug Administration placing a Black Box warning on all drugs containing LABA. Despite this, it is still considered more beneficial to the majority of patients to use LABAís in conjunction with ICSs than to use higher doses of ICSs alone.

Which drugs are used to treat Asthma?

Various drugs are available for the treatment of asthma. E.g. Serevent is a prescription drug that is used to treat asthma symptoms.

Strength of Serevent: EQ 0.05MG BASE/INH

Date that Serevent was first approved by FDA: September 7, 1997

Therapeutic area that Serevent is used for: Respiratory

Ingredients of Serevent: Salmeterol Xinoate

What form is Serevent in: Powder

How is Serevent taken: Inhaled

Brand name of Salmeterol Xinafoate Powder: Serevent

Company that sells Serevent: Glaxo Group Ltd, one of largest drug companies in USA

Complete name of company that sells Serevent: GLAXO GROUP LTD DBA GLAXOSMITHKLINE

Alternative names for Serevent: Spiriva, Foradil

Conditions or diseases treated by Serevent: COPD, asthma

How much Serevent is sold worldwide? GSK sold 182 million pounds in 2011

How much Serevent is sold in the USA? GSK sold 62 million pounds in 2011

How much Serevent is sold in Europe? GSK sold 85 million pounds of Severent in 2011

How much Serevent is sold in emerging markets? GSK sold 3 million pounds of Severent in 2011 to emerging markets

How much Serevent is sold in the rest of the world? GSK sold 32 million pounds in 2011

Asthma Emergency

Sometimes your asthma symptoms will be so severe that your medicines will not help and your peak flow is less than half of what it normally is. This is when it is important to seek emergency help. It is important to not panic and to seek assistance as quickly as possible.

At the hospital, you will usually be given oxygen and high doses of medicine which may be delivered orally, through the airways or into the veins. In rare cases where breathing stops, intubation (a breathing tube placed down the throat) is required.

Asthma Treatment in the Elderly

Elderly people often take a number of medications so your doctor will need to know what medications you are on in order to avoid interaction between medicines.

Medications such as pain relievers, anti-inflammatories, aspirin and beta blockers may exacerbate asthma symptoms or affect how well asthma medications work.

Elderly asthma sufferers are often advised to take calcium and vitamin D supplements as inhaled corticosteroids can have a negative impact on bones and increase the risk of osteoporosis.

Signs That Your Asthma Symptoms Are Under Control

There are a number of things you can consider when trying to determine if your asthma is well controlled. Signs of good asthma control are:

  • Chronic asthma symptoms have improved and occur less than two days a week.
  • Good lung function is present.
  • Capable of a normal activity level.
  • Quick-relief medications are used infrequently - less than two days a week.
  • Achieving good quality sleep with asthma symptoms waking you no more than once or twice a month.
  • Emergency medical treatment has not been required.
  • One or less asthma attack each year that has required use of inhalation corticosteroids.
  • Peak flow is above 80% of your own best number.

Signs That Your Asthma Symptoms Are NOT Under Control

When evaluating the effectiveness of your asthma treatment, the following are some signs that may indicate that your asthma is poorly controlled:

  • Your symptoms are occurring more often and are increasing in severity.
  • Your symptoms are waking you up or having a negative impact on your sleep.
  • Your symptoms have caused you to miss work or school or you have had to limit you activities such as sport.
  • Your peak flow number fluctuates greatly or is notably lower than your personal best.
  • Your asthma medications do not seem to work well.
  • You are using your rescue medications too often i.e. more than twice a week.
  • You develop an asthma attack that requires emergency care.

Asthma Devices

Asthma medications can be delivered in a number of ways by using specific devices. As asthma primarily affects the airways, medications are more effective if they can be delivered directly to the lungs.

Metered-Dose Inhalers

The metered-dose inhaler is the most common way for medicine to be delivered into the lungs of an asthmatic. These devices consist of two parts - a mouthpiece and a canister that contains the medicine, stabilizers and a propellant. These inhalers are quite easy to use - simply put the mouthpiece in your mouth, press on top of the canister and inhale the released gas. The types of medicines that can be delivered in this manner include corticosteroids, bronchodilators or mast cell stabilizers.

Dry Powder Inhalers

Dry power inhalers are a non-aerosol alternative to metered-dose inhalers. They are more difficult to use as the patient is needs to inhale with considerable force in order to mobilize the powder from the device and into the lungs. If not enough force is used, sufficient amounts of powder wonít reach the lungs resulting in less effective control of asthma symptoms.

Nebulizer

A nebulizer allows for a larger, more continuous medication dose to be delivered. The medication is vaporised along with a saline solution to form a vapour that can then be breathed in. Nebulizers tend to be used in hospitals when patients are having trouble using a metered-dose inhaler.

Asthma Spacer

An asthma spacer is an additional attachment between the mouthpiece of the inhaler and the patientís mouth. It allows the medicine to be held briefly after the canister is activated. This gives the patient a little more time to coordinate the actions required to deliver a dose. It also prevents medicine touching the sides of the mouth.

Note: This site is for informational purposes only and is not medical advice. See your doctor or other qualified medical professional for all your medical needs.