How Asthma Is Treated
While there is no cure for asthma, there are a number of treatments that can help control the condition.
Treatment is based on two important goals, which are:
- relieving symptoms
- preventing future symptoms and attacks
For most people, this will involve the occasional or, more commonly, daily use of medications, usually taken using an inhaler. However, identifying and avoiding possible triggers is also important.
You should have a personal asthma action plan agreed with your doctor or nurse that includes information about the medicines you need to take, how to recognise when your symptoms are getting worse, and what steps to take when they do so.
These symptoms are often worse at night and early in the morning, particularly if the condition is not well controlled. They may also develop or become worse in response to a certain trigger, such as exercise or exposure to an allergen.
Read our page on the causes of asthma for more information about potential triggers.
Speak to your GP if you think you or your child may have asthma. You should also talk to your doctor or asthma nurse if you have been diagnosed with asthma and you are finding it difficult to control the symptoms.
When To See A Gp
See a GP if you think you or your child may have asthma.
Several conditions can cause similar symptoms, so it’s important to get a proper diagnosis and correct treatment.
The GP will usually be able to diagnose asthma by asking about symptoms and carrying out some simple tests.
Find out more about how asthma is diagnosed.
What Are Common Side Effects With Asthma Medications
Inhaled asthma medications are usually well-tolerated with few side effects when used as prescribed however, there are a few precautions.
- Inhaled corticosteroids can cause oral thrush, a fungal infection of the mouth.
- Rinsing your mouth with water after using the inhaler or using a spacer device might help prevent thrush.
- Contact your doctor if you notice white patches in your mouth, which could be the beginning of a thrush infection.
Inhaled quick-acting medicines like albuterol can also cause side effects like: shakiness, nervousness, difficulty sleeping or a fast heartbeat, among others.
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Four Components Of Asthma Treatment
The use of objective measures of lung functionspirometry, peak flow expiratory flow rateto access the severity of asthma, and to monitor the course of treatment.
The use of medication therapy designed to reverse and prevent the airway inflammation component of asthma, as well as to treat the narrowing airways.
The use of environmental control measures to avoid or eliminate factors that induce or trigger asthma flare-ups, including the consideration of immunotherapy.
Patient education that includes a partnership among the patient, family members, and the doctor.
How The Treatment Goals Are Attained
Unfortunately, there is no magic bullet for asthma. While treatment can control symptoms safely and effectively for most patients most of the time, it is not a simple matter of the doctor writing a prescription and the patient taking the medication. Successful treatment of asthma is likely to require several steps on the part of physician. These include:
- Confirmation of the diagnosis
- Characterization of the asthma with regard to:
- Identification of triggers
- Identification of the components of airway obstruction
The diagnosis of asthma is suspected when a patient has a history of recurrent or chronic shortness of breath, labored breathing, or cough in the absence of any other obvious reason. The diagnosis is confirmed by obtaining evidence that there is airway obstruction that reverses either spontaneously or as a result of treatment with anti-asthmatic measures. The procedures used to make the diagnosis include a careful history, measurement of pulmonary function , and therapeutic trials of medication.
Triggers of asthma, those identifiable factors that commonly worsen symptoms include:
- Viral respiratory infections
- Airborne allergens
- Inhaled irritants
- Cold air
Patients with an intermittent pattern of asthma require only intervention measures.
Read Also: Severe Eosinophilic Asthma
Viral Exposure In Children
Evidence suggests that rhinovirus illness during infancy is a significant risk factor for the development of wheezing in preschool children and a frequent trigger of wheezing illnesses in children with asthma. Human rhinovirus C is a newly identified genotype of HRV found in patients with respiratory tract infections. A study of children with acute asthma who presented to the emergency department found HRVC present in the majority of patients. The presence of HRVC was also associated with more severe asthma.
Approximately 80-85% of childhood asthma episodes are associated with prior viral exposure. Prior childhood pneumonia due to infection by respiratory syncytial virus, Mycoplasma pneumoniae, and/or Chlamydia species was found in more than 50% of a small sample of children aged 7-9 years who later had asthma. Treatment with antibiotics appropriate for these organisms improves the clinical signs and symptoms of asthma.
How Do You Monitor Asthma Symptoms
Monitoring your asthma symptoms is an essential piece of managing the disease. Your healthcare provider may have you use a peak flow meter. This device measures how fast you can blow air out of your lungs. It can help your provider make adjustments to your medication. It also tells you if your symptoms are getting worse.
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Type 2 Inflammation Is A Disease Modifier
Inhibiting triggers and mediators of type 2 inflammation such as IgE, IL-5 and IL-13 has very limited effects on baseline asthma indices such as measures of airflow limitation or BHR. Indeed, in steroid-naive patients, IL-13-directed therapy has little effect on FEV1, even in individuals with asthma who have high serum periostin levels. Similarly, a recent meta-analysis of seven clinical trials of mepolizumab showed that it has no significant effect on lung function. This lack of effect of lebrikizumab and mepolizumab on FEV1 and BHR is in contrast to the robust effects of these drugs on asthma exacerbation rates and asthma control, as measured by the asthma control questionnaire. This should be compared with the effects of corticosteroids on both baseline measures of asthma and asthma exacerbations. The data showing that many individuals with asthma have no evidence of active type 2 inflammation in their airways, despite evidence of active smooth muscle dysfunction, indicate that the core physiological abnormalities of excessive smooth muscle tone and BHR in asthma are not driven by type 2 inflammation. Rather, the effect of type 2 inflammation might be to modify asthma to worsen asthma control and increase susceptibility to exacerbation .
Asthma as a core disease of smooth muscle that is modified by inflammation
How Is Asthma Connected To The Immune System
Scientists are still studying exactly how asthma is connected to the immune system. They think the immune system has a role in the asthma response and the development of asthma.1
Scientists do not know exactly why some people develop asthma. Some think asthma could be caused by an immune response to viruses. They believe standard viruses could cause the immune system to develop the behavior that leads to asthma in some people.5,6
The causes of intrinsic asthma are not well understood. This is because it can be triggered by so many things. But some scientists also think an autoimmune response may have a role in causing it. This potential link could help people with intrinsic asthma, who are sometimes more difficult to treat. It is possible that intrinsic asthma could respond to treatment with medicine used for autoimmune conditions.1
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Evaluating An Asthma Attack
Because people who are having a severe asthma attack commonly have low blood oxygen levels, doctors may check the level of oxygen by using a sensing monitor on a finger or ear . In severe attacks, doctors also need to measure levels of carbon dioxide in the blood, and this test typically requires obtaining a sample of blood from an artery or, occasionally, a vein. However, carbon dioxide levels can sometimes be monitored in the person’s breath using a sensor placed in front of the nose or mouth.
Doctors may also check lung function, usually with a spirometer or with a peak flow meter. Usually, a chest x-ray is needed only when asthma attacks are severe, in order to rule out other serious conditions .
Asthma Approvals: Cinqair And Nucala
- Cinqair reduces eosinophils, a type of white blood cell that contributes to asthma development.
- It is classified as an interleukin 5 antagonist monoclonal antibody .
- Cinqair is given once every four weeks by intravenous infusion in your doctor’s office. It take about 20 to 50 minutes to receive the infusion.
- Common side effects included anaphylaxis , cancer, and muscle pain.
- Nucala blocks interleukin-5 and reduces inflammatory-producing white blood cell accumulation in the lungs.
- Nucala is given by subcutaneous injection every 4 weeks. Nucala can be given at home by self-injection using a prefilled syringe or autoinjector if approved by your doctor. It is given into the upper arm, thigh, or abdomen.
- Common side effects may include headache, injection site reactions, back pain, and weakness.
Recommended Reading: Do Allergies Cause Asthma
Health Conditions That May Mimic Asthma
A variety of illnesses can cause some of the same symptoms as asthma. For example, cardiac asthma is a form of heart failure in which the symptoms mimic some of the symptoms of regular asthma.
Vocal cord dysfunction is another asthma mimic. Many recent reports have drawn attention to a peculiar syndrome in which abnormal vocal cords cause wheezing that is frequently misdiagnosed as asthma. This is most common in girls and young women who have loud and dramatic episodes of wheezing that do not respond to medications that open the airways.
Smolley, L. Breathe Right Now, Dell, 1999.
Bruce, D. The Sinus Cure, Ballantine, 2007.
Schachter, N. Life and Breath, Broadway Books, 2003.
American Academy of Allergy, Asthma & Immunology: “Distinguishing Between Asthma and Heart Disease,” “Vocal Cord Dysfunction in Children,” “Occupational Asthma: Tips to Remember.”
American Lung Association: “Facts About Hay Fever.”
American College of Allergy, Asthma and Immunology: âAsthma Attack.â
Asthma and Allergy Foundation of America: âAsthma,â âAsthma Action Plan,â âThunderstorms and Asthma: An Unexpected Connection.â
National Asthma Council Australia: âThunderstorm Asthma,â âThunderstorm Asthma Advice — Those Who âWheeze and Sneezeâ Urged to Take Extra Care.â
Asthma Australia: âThunderstorm Asthma.â
Victoria State Government, Better Health Channel: âEpidemic Thunderstorm Asthma.â
National Asthma Council Australia: âBe Prepared For Thunderstorm Asthma.â
How Do My Airways React To Triggers
If you have asthma you have sensitive airways that are inflamed and ready to react when they come into contact with something they don’t like.
If you come into contact with one of your asthma triggers it causes your airways to react in three ways:
These reactions in the airways make it difficult to breathe and lead to asthma symptoms, such as chest tightness, wheezing, or coughing. It can also lead to an asthma attack.
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Is Asthma Curable
No, this disease cannot be cured. Some children with Asthma will relinquish it by adulthood. However, for many, it is a permanent condition. It is essential to living a healthful life. More current treatments are highly efficient. You can additionally overcome your risk of attacks with lifestyle alterations.
How It Is Treated
You will usually only need a rescue inhaler to treat this mild form of asthma. You dont typically need daily medication since your symptoms only occur occasionally. However, your medication needs will be assessed based on how severe your attacks are when they do occur. Your doctor may also prescribe allergy medications if your asthma is triggered by allergies.
If your asthma is exercise induced, your doctor may instruct you to use your rescue inhaler before exercise to prevent symptoms.
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Biomarkers Have The Potential To Guide Asthma Treatment
Only when clinical trials of mepolizumab used persistent eosinophilia as a biomarker was it possible to show the efficacy of targeting IL-5 in decreasing asthma exacerbation rates. Similarly, the clinical efficacy of IL-13-directed therapies has been most apparent in the subgroups of individuals with asthma who have type 2 inflammation, as indicated by eosinophilia or increased serum periostin levels. Indeed, these clinical trials have highlighted the potential for blood-based biomarkers to guide treatment for individuals with asthma. Specifically, it is now clear that the benefit of treatments targeting type 2 cytokines is restricted to patients who have biomarkers of type 2 inflammation. This is the first evidence that asthma management could progress to a phase in which treatment guidelines can move from empirical recommendations on the basis of asthma severity towards biomarker-based recommendations that promise to increase treatment precision.
What Does Asthma Feel Like
There are three major signs of asthma:
- Airway blockage. When you breathe as usual, the bands of muscle around your airways are relaxed, and air moves freely. But when you have asthma, the muscles tighten. Itâs harder for air to pass through.
- Inflammation. Asthma causes red, swollen bronchial tubes in your lungs. This inflammation can damage your lungs. Treating this is key to managing asthma in the long run.
- Airway irritability. People with asthma have sensitive airways that tend to overreact and narrow when they come into contact with even slight triggers.
These problems may cause symptoms such as:
- Coughing, especially at night or in the morning
- Wheezing, a whistling sound when you breathe
- Shortness of breath
- Trouble sleeping because of breathing problems
Not every person with asthma has the same symptoms in the same way. You may not have all of these symptoms, or you may have different symptoms at different times. Your symptoms may also vary from one asthma attack to the next, being mild during one and severe during another.
Some people with asthma may go for long periods without having any symptoms. Others might have problems every day. In addition, some people may have asthma only during exercise or with viral infections like colds.
When to see your doctor
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Is Asthma An Autoimmune Disease
Asthma is caused by an overactive immune response. But asthma is not considered an autoimmune disease. The processes that cause the asthma immune response are different from the ones that cause autoimmune diseases.3
Most people with asthma have allergic asthma. This is sometimes called extrinsic asthma. In extrinsic asthma, the immune system is triggered by allergens. This causes the immune system to overreact. The reaction causes inflammation in the lungs, which then causes trouble breathing. This immune reaction is mainly driven by an antibody called IgE.3
Some people with asthma are not triggered by allergens. Instead, things like exercise, stress, extreme hot or cold temperatures, or infections trigger their asthma. This type of asthma is called nonallergic, or intrinsic, asthma. It makes up 10 to 33 percent of all asthma cases. The immune response in intrinsic asthma is very similar to the response in extrinsic asthma. However, intrinsic asthma is more likely to cause severe asthma.4
Ige Has An Important Role In Mechanisms Of Asthma Exacerbations
Omalizumab is effective in preventing exacerbations in many individuals with asthma, particularly in those with evidence of type 2 inflammation. These data reveal an important role for IgE in the pathogenesis of asthma exacerbations. Although the clinical trials do not explain the mechanism, of which there are several possibilities, I believe that this might relate to the effects of IgE on IFN secretion by plasmacytoid dendritic cells . Specifically, IgE crosslinking impairs IFN production and hence antiviral responses by pDCs, so that omalizumab may reduce virus-induced asthma exacerbations by restoring the antiviral activity of pDCs.
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What Does Control Of Asthma Mean
- The ability to deal with acute exacerbations of asthma so that the need for urgent medical care is prevented
- Prevention of hospitalization for asthma
- Tolerating all normal activities up to and including competitive athletics if otherwise able
- The avoidance of symptoms that interfere with sleep.
- Normal pulmonary physiology .
- These goals should be reached safely and with the least interference with a normal life-style. The risks and bother of the treatment must be carefully weighed against the risk and bother of the asthma. The benefit obtained from the treatment must be worth any inconvenience and potential medication risks imposed by the treatment.
In other words, it is the goal of treatment to determine the simplest, safest therapeutic measures that minimize disability, normalize lung function, avoid the need for acute medical care of asthma, and permit a normal life.
What Are The Three Types Of Asthma
The three common types of asthma are as follows:
Other types of asthma include the following:
- Occupational asthma: This is common in carpenters, hairdressers, animal breeders, and farmers who are exposed to allergens at their workplace. Medication and counseling may be needed.
- Cough variant asthma: Severe coughing is the main feature of this asthma rather than wheezes. It may be triggered by infections or exercises.
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