Treatment Of Severe Asthma
There is no single treatment or medication solution. Everyone is affected differently and what works well for one person may have no effect on another. The same medications may be prescribed as someone who has a milder asthma, but at a much higher dose.
Treatment of severe asthma focuses on trying to control the symptoms. Youll be prescribed medication and treatment to manage the inflammation in your airways and prevent lung damage. Youll also be advised to reduce the risk of coming into contact with asthma triggers as much as possible, as this will reduce your risk of having a severe asthma attack.
As a starting point, everyone with asthma is prescribed:
- A reliever inhaler usually blue, this inhaler is used to provide relief when you need it and should be carried with you at all times.
- A preventer inhaler often brown, contains corticosteroids that help to reduce swelling and inflammation in the airways. This needs to be taken every day, as prescribed by your doctor.
If youre diagnosed with severe asthma, you should speak to your doctor about a referral to a specialist clinic. While some primary care surgeries have dedicated asthma nurses that can offer specialist support.
Therapy For Acute Asthma
The rapidity of response to initial therapy, as defined by changes in symptoms, signs and FEV1 or peak expiratory flow, may be a more useful measure of severity and the need for more aggressive therapy than the clinical status at presentation.2,3 Definitions of the terms status asthmaticus,life-threatening or near fatal, and a severe episode of asthma are imprecise and should not be used to determine the level of therapy for acute asthma. Here, we use the term moderate to severe asthma, by which we mean patients who have no clinical improvement with initial standard therapy and those whose presenting FEV1 or peak expiratory flow is less than 25%30% of predicted.
Treatment Options For Severe Asthma
Your asthma treatment depends on how severe your symptoms are on a regular basis. If you have severe asthma, its likely that you already take long-term control medications. You may also have a rescue inhaler on hand just in case an asthma attack occurs.
Severe asthma attacks dont respond to regular asthma treatment, so you need emergency medical treatment if your rescue medications arent working. At the emergency room, your medical team may:
- use a test called pulse oximetry to tell how much oxygen is in your blood
- measure your PEF to determine how much and how fast you exhale
- take a nitric oxide measurement to determine bronchial tube inflammation
- measure your forced expiratory volume with a spirometry test
- perform a chest X-ray
Once your doctor confirms that youre having a severe asthma attack, they may administer one or more of the following:
- albuterol, an inhaled aerosol or powder
- ipratropium , a type of inhaled bronchodilator used when rescue inhalers alone are not enough
- oral or intravenous corticosteroids to control inflammation
- practicing breathing techniques
- eating anti-inflammatory foods
First, its important to get lots of rest post-attack. Your body needs to recover from the stress of an asthma attack, and you may also feel emotionally drained. Take time off work if needed and put chores on the back burner while you recover. Ask for help from friends and family for anything that cant wait.
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Talk To Your Asthma Specialist
If youâve been diagnosed with asthma but your treatment doesnât seem to work anymore, itâs time to see your doctor again. Likewise, if youâre having to use your rescue inhaler too often, see your doctor. You may need to change your asthma treatment for better control.
Though asthma is common, itâs a serious condition that needs a diagnosis and treatment. Talk to your doctor for asthma support, and find the medications that work best for you.
What Would Be The Treatment For An Acute Episode Of Asthma
Inhaled short-acting beta2 agonists are the cornerstones of treatment for acute asthma. An inhaler with a spacer is equivalent to nebulized short-acting beta2 agonist therapy in children and adults. Continuous beta2 agonist administration reduces hospital admissions in patients with severe acute asthma.
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When To See An Allergist
An allergist can help you learn more about your asthma and develop a treatment plan that works for you. You should see an allergist if:
- Your asthma symptoms occur every day and often at night, limiting your activity.
- Youve had a life-threatening asthma attack.
- Your goals for asthma treatment havent been met after three to six months, or your doctor believes that you arent responding to current treatment.
- Your symptoms are unusual or hard to diagnose.
- You have conditions such as severe hay fever or sinusitis that complicate your asthma or your diagnosis.
- Additional tests are needed to find the causes of your symptoms.
- You need more help and instruction on your treatment plan, medicines or asthma triggers.
- Allergy shots might help you.
- You need oral corticosteroid therapy or high-dose inhaled corticosteroids.
- Youve taken oral corticosteroids more than twice in one year.
- You have been hospitalized because of your asthma.
- You need help to identify your asthma triggers.
Consultation with an asthma specialist is recommended if your child is 4 years old or younger and has asthma symptoms every day and three to four nights or more a month. It should be considered if your child has symptoms three days or more a week and one to two nights a month. Find out more about whats involved in asthma screening.
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Confirmation Of The Diagnosis
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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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.
Care Advice For Asthma Attack
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How Do Healthcare Providers Diagnose Asthma
Your healthcare provider will review your medical history, including information about your parents and siblings. Your provider will also ask you about your symptoms. Your provider will need to know any history of allergies, eczema and other lung diseases.
Your provider may order spirometry. This test measures airflow through your lungs and is used to diagnose and monitor your progress with treatment. Your healthcare provider may order a chest X-ray, blood test or skin test.
Other Drugs Used To Prevent And Treat Asthma
Other drugs are occasionally used in asthma treatment. These drugs may be used in specific circumstances. Magnesium is often given by vein in the emergency department for acute attacks.
Other drugs that may be given for chronic asthma include lidocaine or heparin given with a nebulizer, colchicine, and intravenous immune globulin. Evidence supporting the use of any of these therapies is limited, so these drugs are used much less often.
, such as older age, family members with osteoporosis, a diet that is low in calcium and vitamin D, or thin build, may need to take calcium and vitamin D supplements and bisphosphonates to try to preserve bone density.
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Will Medicine Help Me Breathe Better When I Exercise
Yes. Exercising, particularly in cold air, may cause airway swelling or exercise-induced bronchoconstriction . Quick-relief asthma medicines, taken before exercise, usually control this. If you need repeated doses of quick-relief medicine during and after exercise talk with your doctor. Your medicines may need to be adjusted. Thanks to these medicines, many Olympic and professional athletes have successful sports careers even with their asthma.
It is important for everyone, including people with asthma, to be as active as possible for good health. Talk with your doctor about how you can be physically active while keeping your asthma well-controlled.
What Are Common Asthma Attack Triggers
You can have an asthma attack if you come in contact with substances that irritate you. Healthcare providers call these substances triggers. Knowing what triggers your asthma makes it easier to avoid asthma attacks.
For some people, a trigger can bring on an attack right away. For other people, or at other times, an attack may start hours or days later.
Triggers can be different for each person. But some common triggers include:
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Signs And Symptoms Of Flare Up
Mild to Moderate
What can you do to prevent this happening again?
If you have had an asthma attack or ended up in a hospital or an emergency department, it means that your asthma is not under your control.
When youve had an asthma flare-up you need to see your doctor within 3 days to review your asthma and update your Asthma Action Plan to discuss:
- What is your current level of asthma control how do we improve it?
- How well are your asthma medicines working can we improve their use?
- What triggered your asthma attack can you avoid the trigger, or how to respond better to the trigger next time to avoid an asthma attack?
- Are there any other factors that might be affecting your asthma control how do we reduce their impact on your asthma?
For more support about managing asthma, talk to us. 1800 ASTHMA is a no-charge service open Monday-Friday, 9am-5pm. You can get in touch with us through phone, or by booking in a call-back.
To help get back on track after your visit to the emergency department or hospital after an asthma attack visit our after hospital page.
How To Use A Metered
A nebulizer can be used to deliver beta-adrenergic drugs directly to the lungs. A nebulizer uses pressurized air or ultrasonic sound waves to create a continuous mist of drug that is inhaled without having to coordinate dosing with breathing. Nebulizers are often portable, and some units can even be plugged into a power outlet in a car. Nebulizers and metered-dose inhalers often deliver different amounts of drug with a single dose, but both are capable of delivering sufficient amounts of drug to the lungs. Nebulizer therapy is less likely to reach the more distant airways in people who are breathing comfortably and not taking deep breaths, making nebulized therapy less effective than a correctly used metered-dose inhaler or a dry powder formulation.
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Anyone Having Difficulty Using An Inhaler Can Try A Nebulizer
While not technically an inhaler, theres yet another option for inhaling medicine.
Nebulizer If you have severe asthma and are unable to use a regular inhaler, a nebulizer may be a better option.
This machine turns liquid medicine into a fine mist that you inhale through a mouthpiece, a mask that fits over your nose and mouth, or into your mouth alone.
Caffeine May Also Trigger Symptoms Of Asthma In Some People
Try to stay away from coffee, tea, and chocolate. If you drink coffee, switch to decaffeinated or drink it in the morning only. Caffeine triggers your breathing muscles so if your body doesnt get it during the day, youll likely suffer more with chronic asthma symptoms than you would with the caffeine alone.
You can also use a peak flow meter to check for your level of respiratory resistance. It has been shown to be a great tool when you go to your doctor to get your annual physical.
You can either buy one of these meters or have one professionally installed in your home. They measure your peak flow or amount of air you take in and push a button to mark your progress on a graph. Your doctor will be able to customize your asthma plan around this data.
The breathing muscles are not the only part of your respiratory system that need to work at their most efficient level. You also need to make sure your heart is pumping correctly. You can do this by using a heart monitor. A lot of hospitals have machines that can determine your heart rate and help you keep it in good shape during an asthma attack.
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Asthma Lifestyle Home Remedies
In addition to following your treatment plan, you can try:
- Breathing exercises. These can lower the amount of medication you need to control your symptoms.
- Herbal and natural remedies. Things that may help improve asthma symptoms include:
- Black seed oil . Some studies have shown that it can help open airways.
- Caffeine. Itâs a mild bronchodilator, meaning it can open your airways, but it doesnât work as fast as medications. Avoid caffeine for several hours before any medical appointment that might include a lung function test.
- Choline. This helps your body work the way it should. You can get it in meat, liver, eggs, poultry, fish, shellfish, peanuts, and cauliflower, or from a supplement.
- Pycnogenol. You can get this pine bark extract as a supplement.
Asthma Symptoms Bothering You It Might Be Your Inhaler Technique Here Are Some Common Inhaler Mistakes And How To Avoid Them
If your asthma symptoms are flaring up, poor inhaler technique could be at the root of the problem. Its easy to slip into mistakes, especially if youve had inhalers for a long time, but you can break those bad habits. Here are some common inhaler mistakes and simple tips for avoiding them.
Not breathing in the right way for your type of inhaler
There are two main types of inhaler dry powder inhalers and pressurised Metered Dose Inhalers . Wondering what type of inhaler you have? Find out here
- If you have a pMDI, you need to breathe in slow and steady. At the same time, press the canister on the inhaler once. Continue to breathe in slowly over 3 to 4 seconds, until your lungs feel full.
- If you have a dry powder inhaler you need to breathe in quickly and deeply until your lungs feel full, to be sure you inhale all the medicine
Forgetting to shake your inhaler first
Some inhalers need shaking before you take them, and some dont. Weve made videos about every kind of inhaler find yours to find out whether yours needs shaking, or not.
Not waiting between puffs
With some inhalers, you need to wait least 30 to 60 seconds before taking the next puff. This gives the medicine and propellant enough time to mix together.
Not breathing out before using your inhaler
Not having a tight lip seal
When you breathe in, making sure your lips are tightly clamped round your inhaler will make sure the whole dose of medicine goes where its needed most.
Not using a spacer
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