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How Is Severe Asthma Treated

How Do Asthma Treatments Work

Treating severe asthma

Asthma treatments work in these ways:

  • They relax the muscles that tighten around the airways. They relieve the squeeze. They can be short- or long-acting. By opening the airways, they help remove and reduce mucus. These medicines are bronchodilators or beta agonists.
  • They reduce the swelling and mucus inside the airways. These medicines are anti-inflammatories .
  • Bronchodilators

    Bronchodilators can be short- or long-acting. If you use short-acting bronchodilators more than two days a week, talk with your doctor about your asthma control. You may need to make changes to your treatment plan to better control your asthma.

    Anti-Inflammatories

    Anti-inflammatories come in many different forms. They are also called controllers because they help to control or prevent asthma symptoms. They reduce swelling and extra mucus inside the airways. They will not relieve sudden symptoms.

    Other Types of Medicines and Treatments

    Single Maintenance and Reliever Therapy

    The 2020 Focused Updates to the Asthma Management Guidelines recommends single maintenance and reliever therapy, also known as SMART. SMART uses one inhaler that has two medicines as a quick-relief and controller medicine. When on SMART, you can either take your medicine only as needed to relieve sudden symptoms, or you can take it daily as a controller and as needed for quick relief. This is based on your age and the severity of your asthma.

    How Is Severe Asthma Treated

    Asthma is one of the respiratory disorders of the lungs and has a periodic aggravation. Very quick acting medicines are needed to control these episodes and provide relief to the patient. These are called rescue medication. This group contains quick, short acting bronchodilators called short-term beta agonists. Another group of medicines used for asthma treatments give relief within minutes. These are is normally used to treat acute emphysema but has been found to be useful to control severe symptoms of asthma like tightness in chest, wheezing, cough etc.

    Oral and intravenous medications are used for short spells and they have side effects on long, continuous use. The use of emergency medication becomes very rare when long term medicines work well. It is important to keep a record of the number puffs and times one uses these drugs and inform the doctor. In allergic asthma, one can get relief from the use of desensitizing medicines. One needs to take a shot every two to four weeks. As the sensitivity of the immune system reduces, these shots are lessened. Another specialized treatment is bronchial thermoplasty. This is no more widely available and is not useful to all. In the course of three or four sessions in the outpatient setting, the insides of the air passage are heated up using an electrode. This reduces the smooth muscle inside the bronchi. This limits the ability of the bronchi to contract keeping them open. This reduces the asthma symptoms.

    Personal Asthma Action Plan

    As part of your initial assessment, you should be encouraged to draw up a personal asthma action plan with your GP or asthma nurse.

    If you’ve been admitted to hospital because of an asthma attack, you should be offered an action plan before you go home.

    The action plan should include information about your asthma medicines, and will help you recognise when your symptoms are getting worse and what steps to take. You should also be given information about what to do if you have an asthma attack.

    Your personal asthma action plan should be reviewed with your GP or asthma nurse at least once a year, or more frequently if your symptoms are severe.

    As part of your asthma plan, you may be given a peak flow meter. This will give you another way of monitoring your asthma, rather than relying only on symptoms, so you can recognise deterioration earlier and take appropriate steps.

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    Clinical Assessment And Re

    The assessment of both severity and control are very important. The National Asthma Education and Prevention Program guidelines base the assessment of control on two sets of parameters, those assessing impairment or disability and those assessing future risk for the patient . Patients with continuous symptoms, frequent night awakenings, frequent use of reliever medications and reduced lung function are impaired in their daily activities and their QoL. Moreover, patients with frequent exacerbations, progressive loss of lung function, comorbidities and treatment-related side-effects are at increased risk of future exacerbations and poor disease outcome.

    Types Of Severe Asthma

    Asthma Treatment in Annapolis, MD

    There are two main categories of severe asthma Type-2 inflammation and Non-Type-2 inflammation. These categories are based on a persons response to treatment. Type-2 inflammation includes allergic asthma and eosinophilic asthma and Non-Type-2 inflammation includes non-eosinophilic asthma. For example, allergic asthma and e-asthma respond to treatment with inhaled corticosteroids and IgE -directed therapy or other biologics listed in the above table. Patients with Non-Type-2 inflammation, including non-eosinophilic asthma, generally do not respond well to inhaled corticosteroids. Allergic asthma and e-asthma have distinct biomarkers and treatment options available today. Treatments for non-eosinophilic asthma are currently being development.

    Allergic asthma is caused by exposure to allergens such as pollen, pet dander, molds, etc. Most people diagnosed with allergic asthma will also have a diagnosis of hay fever or rhinitis. For these patients, exposure to allergens causes the bodys immune system to produce immunoglobulin E, an antibody that attaches to certain cells and causes them to release chemicals creating an allergic reaction. When this happens, common symptoms are sneezing, itchy/watery eyes, severe allergic reactions , and increased airway sensitivity.

    Non-eosinophilic asthma includes neutrophilic, smooth-muscle mediated and mixed cells. People in this subgroup have few to no eosinophils in test results, and do not respond well to inhaled corticosteroids.

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    What Is An Asthma Action Plan

    Your healthcare provider will work with you to develop an asthma action plan. This plan tells you how and when to use your medicines. It also tells you what to do if your asthma gets worse and when to seek emergency care. Understand the plan and ask your healthcare provider about anything you dont understand.

    What Types Of Asthma Are There

    Healthcare providers identify asthma as intermittent or persistent . Persistent asthma can be mild, moderate or severe. Healthcare providers base asthma severity on how often you have attacks. They also consider how well you can do things during an attack.

    Asthma can be:

    • Allergic: Some peoples allergies can cause an asthma attack. Molds, pollens and other allergens can cause an attack.
    • Non-allergic: Outside factors can cause asthma to flare up. Exercise, stress, illness and weather may cause a flare.

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    Taking Steroids Long Term

    Taking steroids long term can cause side effects and many people have concerns about them. Your healthcare professional will keep the steroid dose as low as possible, but without them people with severe asthma risk having a life-threatening asthma attack.

    Many people may be concerned about the potential side effects of these higher doses of steroids long term, says Dr Andy. Steroid tablets are an essential option at times for most people with severe asthma. Your healthcare professional will make sure you are on the lowest possible dose, this is to keep your asthma symptoms as well controlled as possible but keep your risk of side effects as low as possible too.

    In order to do this, theyll keep prescribing your other preventer medication at high doses and they may also give you other treatments to help reduce the need for the steroid tablets. All medicines prescribed to reduce the need for steroid tablets are known as steroid-sparing treatments.

    Taking high doses of inhaled corticosteroids can temporarily affect your bodys ability to produce its own corticosteroids. These natural chemicals help our bodies deal with illness or infection, or cope with the stress of surgery.

    When You Go Home

    Treating Severe Asthma

    When the doctors at the hospital decide that youâre well enough to go home, theyâll make sure that you have:

    • Medicines to keep your asthma under control
    • An asthma action plan that lets you know how to prevent asthma attacks and manage your condition. You should already have one of these, but if you donât, you will when you leave the hospital.
    • Instructions for follow-up care

    If your child has asthma, make sure that their school, babysitters, day care, and anyone else who takes care of them knows about their asthma action plan so that they know what to do in case of an attack.

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    How Can Immunotherapy Help Severe Allergic Asthma

    If you have allergic asthma, you should consider talking with your doctor about allergen immunotherapy. Immunotherapy can reduce some underlying triggers of asthma such as pollen, mold, house dust mites and pet dander. It may also decrease the severity of your symptoms over time.

    Its important to have a discussion with a board-certified allergist who can evaluate your symptoms and help you determine the best immunotherapy option for you.

    Clinical Functional And Laboratory Data Of Patients At Baseline

    Clinical, functional, and laboratory characteristics of the study population at baseline are shown in Table .

    Table 1 Baseline patient characteristics

    A total of 27 severe asthma patients were evaluated, 88.9% had eosinophilic asthma and 11.1% also had atopic features. Mean time since diagnosis was 19.2 years. At baseline, mean blood eosinophil count was 371.9 cells/L and 55.6% had300 cells/L mean ACT score was 14 with a total of 21 patients with uncontrolled asthma .

    All patients were treated with high-dose ICS plus LABA and 24 had been treated with OCS as maintenance treatment prior to benralizumab initiation. Oral prednisone mean dose was 20.3 mg/day. All patients had insufficient response or were intolerant to prior treatment with anti-IL5 or anti-IgE treatment: 24 had been previously treated with mepolizumab, 3 with reslizumab and 2 even received omalizumab before the anti-IL5 treatments.

    Most of the patients had1 asthma-related comorbidity . The most frequent were allergic rhinitis , nasal polyps , gastroesophageal reflux disease , and chronic rhinosinusitis .

    Table 2 Baseline patient comorbidities

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    Epidemiology And Risk Factors

    It is estimated that 510% of asthmatics suffer from severe asthma. However, there is a scarcity of epidemiological studies assessing severity and an urgent need for more studies to define the true prevalence of severe refractory asthma. High healthcare costs are associated with severe asthma. Godardet al. showed that direct costs for goods and services, numbers of consultations, supplementary examinations and medications, as well as indirect costs parameters), all increase significantly with increasing severity. More recently, data from the North American cohort of severe asthma enrolled in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study were analysed. The investigators examined the cost of severe controlled and severe uncontrolled asthma and reported that controlled patients experienced fewer work or school absences and less healthcare resource use than uncontrolled patients at all study time-points . Using the multilevel Asthma Therapy Assessment Questionnaire control score, asthma costs increased directly with the number of asthma control problems. Costs for uncontrolled patients were more than double those of controlled patients throughout the study . This study demonstrated that the economic consequence of uncontrolled disease is substantial .

    TENOR risk score for severe asthma exacerbations

    Confirmation Of The Diagnosis

    How To Treat Severe Asthma

    If severe asthma is suspected, differential diagnoses that may mimic asthma should first be ruled out. This requires a detailed clinical history . Because up to 40% of asthma patients in Europe smoke , subacute reversibility testing using systemic steroid therapy should be performed in addition to acute reversibility testing to rule out chronic obstructive pulmonary disease . If prednisolone therapy largely or completely restores lung function, COPD is unlikely.

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    What Are The Different Types Of Asthma Medicines And Treatments

    There are four types of asthma medicines and treatments:

  • Quick-relief medicines These medicines work quickly to relieve sudden symptoms. You take them as needed and at the first sign of symptoms.
  • Controller medicines These medicines 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.
  • Combination of quick-relief and controller medicines These medicines are used for both short-term relief and control.
  • Biologics This type of treatment targets a cell or protein to prevent swelling inside the airways. They are for people with certain types of persistent asthma and are given by injection or infusion.
  • The difference between these asthma treatments can be confusing. It is important to understand what each treatment does and how they help your asthma. Learning how to use each correctly can you help keep your asthma well-controlled. Always take your medicines as directed by your doctor and follow your Asthma Action Plan.

    Management Of Acute Asthma Exacerbations

    SUSAN M. POLLART, MD, MS REBEKAH M. COMPTON, MSN, FNP-C and KURTIS S. ELWARD, MD, MPH, University of Virginia Health System, Charlottesville, Virginia

    Am Fam Physician. 2011 Jul 1 84:40-47.

    Patient information: See related handout on how to treat an asthma attack, written by the authors of this article.

    In 2005, the prevalence of asthma in the United States was nearly 8 percent , and approximately 4 percent of Americans experienced an asthma attack.1,2 There have been many advances in medical therapy to prevent the worsening of asthma symptoms, including an improved understanding of asthma etiology, identification of risk factors for asthma exacerbations, and evidence supporting the benefits of written asthma action plans.

    In persons older than two years with asthma, neither the injectable nor the intranasal influenza vaccine increases the likelihood of an asthma exacerbation in the period immediately following vaccination. However, one study of infants found an increase in wheezing and hospital admissions after intranasal influenza vaccination.7 Seasonal influenza vaccine does not reduce the risk of developing an asthma exacerbation. Influenza vaccination appears to improve asthma-related quality-of-life in children during influenza season.7

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    Staying In The Hospital

    The amount of time you spend in the hospital will depend on how your symptoms respond to emergency treatments.

    Once your symptoms improve, your doctor will likely monitor you for a few hours to make sure you dont experience another attack. Once your symptoms are under control, they can send you home.

    But if your symptoms dont improve after emergency treatment, you may be admitted to the hospital and stay overnight, or for a few days.

    In severe, life threatening cases, a person with asthma may need to stay in the intensive care unit .

    Your doctors will continuously monitor your progress, giving you medications and checking your peak flow levels as needed. Doctors may also perform blood tests and X-rays to check your lungs.

    How Is A Severe Asthma Attack Treated At The Hospital

    Why is severe asthma so hard to treat?

    If you experience difficulty breathing that does not improve with at-home treatment, seek medical attention.

    Asthma treatment at the hospital could include typical at-home asthma medications combined with additional treatments such as supplemental oxygen, bronchodilators, and corticosteroids.

    Some cases of asthma are so severe that a healthcare provider could recommend a procedure called bronchial thermoplastythat uses heat to soften the airways that constrict during an asthma attack.

    The length of hospitalization can vary from person to person. Some people with severe asthma are treated in the emergency room but never admitted to the hospital. Regardless of admission, anyone who is treated at a hospital will be sent home with instructions on how to treat their asthma at home.

    Discharge instructions following an asthma attack will advise the patient to avoid allergy triggers and follow up with their provider to adjust the asthma plan as needed. The instructions could also include additional medications, such as oral corticosteroids, to treat and prevent future attacks.

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    How Can Severe Asthma Be Treated

    It can cause symptoms that are hard to manage, because they may not respond very well to typical asthma medicines. To treat and manage this asthma subtype, patients will often need more complex treatments that involve higher doses of several different medicines every day.1,4 For example, patients might take a combination of:

    • Long-term maintenance medicines to reduce inflammation in the airways
    • Long-acting and short-acting bronchodilators to relieve symptoms that suddenly get worse
    • Anti-inflammatory medicines called leukotriene modifiers

    Sometimes, patients may need to take their medications using a special device called a nebulizer.Physiotherapy can be very helpful for patients living with severe asthma. Specialists called physiotherapists can perform special types of therapies to clear the patients airways and coach patients about how to develop good breathing patterns. They can also provide guidance about ways patients can carry out regular exercise routines, even when their physical abilities are limited by their asthma.

    Is There A Difference Between Severe Asthma And Uncontrolled Asthma

    Not all uncontrolled asthma is severe and not all severe asthma is uncontrolled. A person with mild or moderate asthma can have uncontrolled asthma. Lack of control is defined using Baylor Universitys Rules of Two ®. Your asthma is considered uncontrolled if you experience any or all of the following:

    • You use your quick relief inhaler each week
    • You need oral steroids
    • You have asthma symptoms at night
    • You have to refill your quick-relief inhaler often

    Severe asthma is not always uncontrolled. Severe asthma is asthma that requires a higher level of daily treatment. The measure of severe asthma is based upon:

    • How often you need your controller medication
    • The frequency and duration of your asthma symptoms
    • The impact of asthma on your daily life

    Do you or your teenage child have asthma? We are recruiting patients for the PRECISION asthma study. By participating in the study, you’ll attend 6 virtual asthma coaching sessions for free and help advance asthma care.

    There are several asthma assessment tools you can use to determine if your asthma is in control or not:

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