Asthma, Part 3: Treatment

The goals of asthma treatment are to prevent troublesome symptoms (wheezing, cough, breathlessness), keep lung function and activity as close to normal as possible, and prevent exacerbations and hospitalizations, while using the least amount of medication possible, and with minimal side effects. Sounds tricky? It can be. People with mild asthma can probably be managed by their family health care providers, but those with severe or frequent symptoms would do well to see an asthma specialist.

Asthma medications fall into two categories: short-acting or “rescue” medications, and long-acting or “controller” medications. These come in inhalers, nebulizers (for those unable to use an inhaler), pills or liquids. Medication choice depends on the frequency and severity of symptoms. Treatment may need to be “stepped-up” if symptoms worsen or increase in frequency, or “stepped-down” if symptoms lessen. All persons with asthma should have a short-acting aka rescue inhaler available, and follow preventive guidelines (see part 2) regardless of other treatment.

For mild, intermittent asthma (daytime symptoms not more than twice a week and nighttime symptoms not more than twice a month) rescue inhalers are usually enough. If the person finds they need rescue inhalers more than twice a week, it may be time to step-up treatment. Rescue inhalers contain short-acting bronchodilator (opens up the breathing passages) medicine. The most commonly used are albuterol or terbutaline.

For mild, persistent asthma (daytime symptoms more than twice a week but less than once a day, and nighttime symptoms more than twice a month), add a daily anti-inflammatory inhaler (such as low dose prednisone or cromolyn).

For moderate persistent asthma (daytime symptoms daily and nighttime symptoms more than once a week) add a medium-dose prednisone inhaler and long-acting inhaled bronchodilator, and possibly additional oral bronchodilator if needed.

For severe persistent asthma (continual symptoms, limited physical activity, frequent exacerbations and frequent nighttime symptoms) use high dose inhaled prednisone, long-acting bronchodilator, and add oral prednisone tablets.

Some health care providers ask patients to monitor their asthma by using a home peak flow meter. This is a device that measures the amount of air in a forced exhalation. A baseline “normal” number is established, and if patients notice their numbers decreasing, they may be instructed to step-up their treatment or come for an office visit. This home monitoring can help stave off worsening exacerbations by catching them early.

These guidelines are just the basics for asthma treatment. Individuals would do well to meet with their health care providers to establish their own treatment plan, work on preventive behaviors, and have a plan on what to do when symptoms worsen.


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