Asthma is not so much "treated" as it is "controlled". As a chronic, long-term disease, there is no cure. However, there are tools and medicines to help you control asthma as well as benchmarks to gauge your progress.
The Peak Flow Meter
A peak flow meter is a simple, small, hand-held tool that can help you maintain control of asthma by providing a measurement of how well air moves out of the lungs.
After blowing into the device, the meter reveals your peak flow number. A physician will indicate how often to test as well as how to interpret the result to determine the amount of medication to take. Some people record scores every morning while others use the peak flow meter intermittently.
Often, each test with the peak flow meter will be judged against your "personal best" peak flow number (found during 2 to 3 weeks of good asthma control). If peak flow tests begin to decline - even before other symptoms are present - it may indicate a looming asthma attack. After taking asthma medication, the peak flow meter can be used to test the effectiveness of drug therapy.
Asthma is considered "well-controlled" if:
- Chronic and troublesome symptoms (coughing and shortness of breath) are prevented and occur no more than 2 days per week.
- There is little need for quick-relief medicines or they are needed less than 2 days per week.
- You maintain good lung function.
- Your activity level remains normal.
- Your sleep level remains normal and symptoms do not wake you from sleep more than 1 to 2 nights per month.
- You do not need emergency medical treatment.
- You have no more than one asthma attack each year that requires inhalation of corticosteroids.
- Your peak flow stays above 80% of your personal best number.
These benchmarks can be obtained by working with a doctor and avoiding factors that can make your asthma flare up. Also be sure to treat other conditions that may interfere with asthma management.
Good control also means avoiding things that trigger asthma or asthma symptoms such as allergens. This may mean limiting time spent outdoors when pollen levels or air pollution levels are highest and limiting contact with animals. Asthma linked to allergies can also be suppressed by getting the necessary allergy shots.
Part of good asthma control is seeing a doctor every 2 to 6 weeks for regular checkups until it is under control. Then checkups may be reduced to once a month or twice a year.
It is a good habit to keep track of asthma symptoms and attacks and diagnostic numbers such as the peak flow measurement. Doctors and nurses will ask about these and about daily activities in order to gauge the status of your asthma control.
Medication for asthma is broadly categorized as either quick-relief medicine or long-term control medicine. Reducing airway inflammation and preventing asthma symptoms is the goal of long-term control medicines, where as immediate relief of asthma symptoms is the goal of quick-relief or "rescue" medicines.
Medications can be ingested in pill form, but most are powders or mists taken orally using a device known as an inhaler. Inhalers permit medicines to travel efficiently through the airways to the lungs.
Medication may also be administered using a nebulizer, providing a larger, continuous dose. Nebulizers vaporize a dose of medication in a saline solution into a steady stream of foggy vapor that is inhaled by the patient.
SMART (Single Inhaler Maintenance and Reliever Therapy), is better for the relief and preventive treatment of asthma symptoms in adults compared to standard therapy, researchers reported in The Lancet Respiratory Medicine (March 2013 issue). SMART refers to using ICS (corticosteroid) plus LABA (long-acting β2 agonist) in one inhaler.
Long-term control medicines are taken every day and are designed to prevent asthma symptom such as airway inflammation. Inhaled corticosteroids are the most effective long-term control medicine - the best at relieving airway inflammation and swelling. They are usually taken daily to greatly reduce the inflammation that initiates the chain reaction of the asthma attack.
Even if taken every day, inhaled corticosteroids are not habit-forming. However, the medicines do have side effects such as the mouth infection known as "thrush". Thrush occurs when the corticosteroids land in your throat or mouth. Spacers or holding chambers have been developed to help avoid this. Thrush can also be avoided by rinsing the mouth out after inhalation.
Inhaled corticosteroids also increase the risk of cataracts (clouding of the eye's lens) and osteoporosis (weakening of the bones) if taken for long periods of time.
There are other long-term control medicines available that doctors may prescribe. Most of them are taken by mouth and are designed to open the airways and prevent airway inflammation. Examples include inhaled long-acting B2-agonists (used with low-dose inhaled corticosteroids), leukotriene modifiers, cromolyn and nedocromil, and theophylline.
Quick-relief medicines relieve asthma symptoms when they occur. The most common of these are inhaled short-acting B2-agonists - bronchodilators that quickly relax tight muscles around the airways, allowing air to flow through them.
The quick-relief inhaler should be used when asthma symptoms are first noticed, but should not be used more than 2 days a week. Most people carry the quick-relief inhaler with them at all times. Quick-relief medicines usually do not reduce inflammation and therefore should not be used as a replacement for long-term control medicines.
If your medicines do not relieve an asthma attack or your peak flow is less than half of what it normally is, emergency medicine may be necessary. Call 911 or have someone take you to the emergency room if you cannot walk because you are out of breath or if you have blue lips or fingernails.
Lifesaving treatments at the hospital will consist of direct oxygen (to alleviate hypoxia) and higher doses of medicines. Emergency personnel will likely administer a cocktail of short-acting B-2 agonists, systemic oral or intravenous steroids, other bronchodilators, nonspecific injected or inhaled B-2 agonists, anticholinergics, inhalation anesthetics, the dissociative anesthetic ketamine, and intravenous magnesium sulfate.
Intubation (a breathing tube down one's throat) and mechanical ventilation may also be used in patients undergoing respiratory arrest.
Although quick-relief medicines can relieve wheezing in young children, long-term control medicines will be used to treat infants and young children if symptoms are likely to persist after 6 years of age.
Like adults, children are treated with inhaled corticosteroids, montelukast, or cromolyn. Often, treatments will be tried for 4 to 6 weeks and stopped if the desired outcome is not seen. Inhaled corticosteroids carry the side-effect of slowed growth, but the effect is generally small and is only apparent for the first few months of treatment.
Elderly asthma care may require adjustments to prevent interactions between medicines. Beta blockers, aspirin, pain relievers, and anti-inflammatory medicines can prevent asthma medicines from working correctly and may worsen symptoms. In addition, it may be difficult for older persons to hold their breath for 10 seconds after inhalation of medicines, but spacers have been developed to help this issue.
The increased osteoporosis risk brought on by inhaled corticosteroids may be magnified in older adults with weak bones. It is common to take calcium and vitamin D pills, among other therapies, to keep bones healthy.
Proper asthma control is necessary for pregnant women in order to ensure a good supply of oxygen to the fetus. Babies born of asthmatic mothers have a higher chance of premature birth and lower birth weight. For pregnant women, the risks associated with having an asthma attack outweigh any risks associated with asthma medicines.
Vitamin D May Reduce Asthma Symptoms
Researchers from King’s College London have discovered how vitamin D can reduce asthma symptoms. Catherine Hawrylowicz and team explained in the Journal of Allergy and Clinical Immunology (May 2013 issue) that their findings may offer a new way of treating the debilitating and usually chronic condition.
Asthma patients are currently prescribed steroid tablets, which may have harmful side effects. There is a type of asthma, however, that is resistant to steroid therapy. Patients with this type are susceptible to severe and often life-threatening asthma attacks.
The scientists found that people with asthma have higher levels of IL-17A (interleukin-17A). IL-17A is part of the immune system that protects the body against infection. However, this natural compound also worsens asthma symptoms. Large amounts of IL-17A can reduce the clinical effects of steroids.
The team found that asthma patients who were on steroids had the highest levels of IL-17A. They also found that vitamin D significantly lowers IL-17A production in cells. Hawrylowicz believes vitamin D could be a safe and useful add-on treatment.
Some people treat asthma using unconventional alternative therapies, but there is little formal data to support the effectiveness of these methods. There is research, however, that has found acupuncture, air ionizers, and dust mite control measures, to have little or no effect on asthma symptoms or lung function. Evidence is inconclusive to support or reject osteopathic, chiropractic, physiotherapeutic, and respiratory therapeutic techniques. Homeopathy may mildly reduce the intensity of symptoms, but this finding is not robust.