Treating and Managing Asthma

It is important to appreciate why treatment plans and asthma maintenance therapies will optimize asthma management, even when asthma symptoms and triggers are controlled.¹ Make sure you understand the reasoning behind your or your child’s treatment plan, and the maintenance therapies that may be used, even when not experiencing asthma symptoms.¹ The potential negative effect of asthma on quality of life differs for every individual.¹ By discussing asthma triggers, symptoms, and maintenance therapies with your healthcare team, you will understand asthma better and acquire knowledge that can positively influence your long-term treatment outcomes.¹

There are a number of different types of medication that can be used to help you control your asthma symptoms. You can think of them in how they are used, reliever, preventer/controller and add-on therapy.

Reliever or quick-relief medicines¹

You inhale these medicines as needed, at the first sign of a symptom. Be sure and to start treatment as soon as your symptoms begin. These medicines are called, bronchodilators that relax the muscles around the airways (breathing tubes). When the airways are more open, it is easier to breathe. These are specifically short-acting bronchodilators, such as albuterol, levalbuterol, and metaproterenol.

Preventer/controller medicines³

These medicines are taken routinely to help control asthma by correcting the underlying changes in the airways, such as swelling and excess mucus. They can be one or a combination of medicines. These medicines can work in a number of different ways to relax the muscles around the airways (bronchodilators, anticholinergics, or leukotriene modifiers) or reduce the swelling and mucus production inside the airways (anti-inflammatory – corticosteroids). Add-on therapy with biologics may also be considered for asthma that is uncontrolled; these treatments work by targeting the underlying cause of inflammation in asthma, which can trigger airway swelling and symptoms.

Bronchodilators³ are long-acting and should not be used for quick-relief even though they are inhaled. Examples of some long-acting bronchodilators include salmeterol, formoterol, and olodaterol.
Anticholinergics³ are a medicine that can be inhaled using a metered-dose inhaler or nebulized from a solution. This medicine is usually used in combination with an inhaled corticosteroid and should be taken daily for long-term control. They are often added on to treatment to relieve cough, mucus production, wheeze or chest tightness; some common anticholinergics are ipratropium and tiotropium.
Leukotriene modifiers³ are medications taking in pill form that block the effect of leukotrienes or stop your body from producing them. This blocking helps your breathing tubes to relax and also make less mucus; common leukotriene modifiers include montelukast, zafirlukast and zileuton.
Corticosteroids¹ (or steroids) are most often inhaled; it is important to rinse out your mouth with water immediately after using them to avoid getting thrush, a yeast infection in your throat. Common inhaled steroids include budesonide, beclomethasone, fluticasone, and mometasone. Some corticosteroids come in pill form and are usually used for short periods of time in special circumstances, such as when your symptoms are getting worse.³ Oral corticosteroids have serious long-term side effects compared to inhaled corticosteroids, so their use is limited. Common oral steroids include prednisone, prednisolone and dexamethasone.
Add-on therapy² includes biologics which are shots or infusions given every few weeks. They work by targeting a cell or protein in your body to prevent airway swelling. They are for moderate-to-severe asthma that is hard to treat with other medicines, or people with asthma dependent on oral corticosteroids. They are for specific types of asthma and will not work for everyone. With adding a biologic, inhaled and oral steroids might be able to be reduced or discontinued over time.⁴

The Asthma Action Plan^5,6

Asthma action plans are management tools the asthma care team can create with you as part of your treatment plan. Asthma education and a management plan has the potential to reduce missed school/workdays, unscheduled clinic visits, and the likelihood of needing emergency services. This will also empower you to prevent your symptoms from getting worse and to take your prescribed controller/rescue medications as written in the plan. The 5 effective elements of asthma action plans as follows:

How to identify allergens or irritants to avoid
How to know if you are having an asthma attack and what to do
Which medicines to take, when to take them and how to adjust them
When to call your doctor or go to the emergency room
Who to contact in an emergency

References

Global Initiative for Asthma. GINA Patient Guide. ginasthma.org
Severe Asthma Toolkit. Overview. Last updated 9/19/19. https://toolkit.severeasthma.org.au/medications/overview/
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2023. Updated July, 2023. ginasthma.org
Asthma and Allergy Foundation of America. Asthma. Last reviewed 11/2023. https://aafa.org/asthma/asthma-treatment/biologics-asthma-treatment/
Rance KS. J Multidisip Healthc. 2011;4:299-309.
Asthma and Allergy Foundation of America. Asthma action plan. Last reviewed 2015. https://www.aafa.org/asthma-treatment-action-plan.
National Institutes of Health (NIH). National Heart, Lung, and Blood Institute (NHLBI). Asthma: Treatment and action plan. 3/34/22. https://www.nhlbi.nih.gov/health/asthma/treatment-action-plan

All URLs accessed 1/30/24.