Asthma treatment primarily involves three main components:
- Monitoring of peak expiratory flow and asthma symptoms
- Avoidance of triggers
- Treatment with medications
Asthma Treatment: Monitoring of Your Peak Expiratory Flow and Asthma Symptoms
Monitoring symptoms is an essential part of your asthma treatment to gain control of your asthma. In order to do this, you and your doctor need to develop an asthma action plan as part of your asthma treatment. The plan will allow you to determine how well your asthma is controlled and what actions need to be taken.
You will monitor your asthma using a peak flow meter, a handheld device allowing you to determine the airflow in your lungs. The peak expiratory flow rate (PEFR) measures how fast air is moving out of the lungs. As asthma worsens PEFR decreases.
Your doctor will specify three zones related to your PEFR: Green, yellow, and red-- just like a traffic light. After determining your goal PEFR, your actions will depend upon the zone.
Green: A green zone PEFR indicates your asthma and lungs are doing well. You feel well and do not have coughing or wheezing. Your PEFR is 80% or more of your best peak flow. You can continue routine daily medications and asthma treatment without altering activities.
Yellow: With a yellow zone PEFR, you may begin to notice an increase in both frequency and severity of symptoms and a drop in PEFR to between 50-80% of best peak flow. You may notice increased cough, waking up at night, and not be able to do all normal activities. Based on your asthma treatment care plan, you will make changes to your medication usage-- possibly increasing the dose and/ or frequency.
Red: A red zone PEFR indicates a more significant airway obstruction and requires your immediate attention. Generally, patients are short of breath, actively wheezing, and cannot complete normal activities. You will again change your routine medication based on your asthma treatment care plan.
In addition to recording PEFR, your healthcare provider may also ask you to keep a record of how often you need to use rescue, or fast-acting relief medication, and symptoms of nighttime cough as part of the asthma treatment plan. He or she may use this diary to adjust your medication, either increase or decrease, depending on the symptoms.
Learn more: Example asthma care plan
Asthma Treatment: Asthma Triggers
Things that set off or worsen your asthma are called triggers. Identifying and avoiding triggers is an important part of asthma treatment and can lead to significant improvements in your asthma. Triggers can include:
- Allergens such as dust and molds
- Cold air
- Respiratory infections
- Exercise
- Irritants such as tobacco smoke
- Medications like aspirin
- Emotional stress
Once you've identified your asthma triggers, there are several options:
- Avoid the trigger entirely -- a great thought and goal, but not always achievable.
- If avoiding the trigger completely is not possible (like your favorite furry pet), limit your exposure (keep your pet outside).
- If exposure to the trigger can be predicted (like exercise), talk with your healthcare provider about treatments that might be taken before exposure to the trigger.
- Immunotherapy or allergy shots -- If you live in a community with high pollen counts, all of the above may be extremely difficult and allergy shots may significantly decrease your response to the trigger.
Asthma Treatment: Medications
Your asthma treatment will be based on how frequently you experience symptoms. Most physicians follow guidelines from the National Heart, Blood, and Lung Institute.
Generally, asthma medications either provide quick relief and long-term control.
Bronchodilators: Short-acting bronchodilators (SABA) like Albuterol provide quick relief by relaxing the smooth muscles in the narrowed airways. SABAs are generally inhaled using a device called a metered dose inhaler. In patients who require SABA use only once or twice per week, this may be the only medication needed. Side affects that you may notice after using a SABA include:
- Feeling shaky
- Rapid heart rate
- Anxiousness after use
Long Term Control Medications
Controller medications need to be taken daily, even when your child feels good and their PEFR is in the green zone.
Inhaled Steroids Inhaled steroids decrease inflammation, or swelling, and irritation in the airways of your lungs. With treatment, decreased sensitivity to triggers may also occur. The most common side effects are:
- Thrush- preventable by using a spacer, a small tube attached to your metered dose inhaler, and rinsing after use.
- Hoarse voice and sore throat- may require changing medications.
Long-Acting Bronchodilators: Long-acting bronchodilators, similar to the quick-relief medications but last for 12 or more hours, may be combined with inhaled steroids in patients with persistent asthma symptoms not responding to inhaled steroids alone. Patients will still need to use their quick-relief inhaler.
Cromolyn: Cromolyn works by decreasing the activity of certain allergy cells that cause inflammation in the airways, but is less effective than inhaled steroids as a single treatment. As opposed to the inhaled steroids that are taken once or twice daily, cromolyn needs to be taken 3 to 4 times daily via a metered dose inhaler to be effective.
Leukotriene Inhibitors: Many children and parents would prefer treatment with leukotriene inhibitors because it is delivered as a pill. Leukotriene inhibitors work by decreasing inflammation, constriction of the airways, and mucus production. While there are very few side effects, as a single therapy for asthma, leukotriene inhibitors are less effective than inhaled steroids.
Oral Steroids: A short course of oral steroids, 5 to 7 days, may be needed when asthma symptoms are poorly controlled.
Monitoring your asthma and avoiding asthma triggers will allow you to be more active and feel better. Understanding the purpose of each asthma medication and the common side effects can facilitate a more informed discussion with your health care provider at your next visit.
Source:
National Heart, Lung, and Blood Institute. Accessed: January 1, 2009. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma
