Asthma treatment consists of two parts:
- Addressing flare ups, also called exacerbations
- Daily maintenance medications
Treatment of Asthma Flare-Ups
If you have one, review your Asthma Action Plan. A flare-up of asthma is common and can be triggered by many things. It is important to discuss how to treat flare-ups with your doctor. Your doctor may have you follow his or her Asthma Action Plan, or one of the many Asthma Action Plans available on the Internet. If chest tightness, coughing, or wheezing occurs, albuterol or one of the other bronchodilators should be used. You can use it safely 3-4 times consecutively with 20-minute intervals between each treatment. If there is no improvement, an oral steroid may then be used. The oral steroid will help recruit beta receptors (which bronchodilate) and reduce inflammation in the bronchials. This means that the receptors in the lungs responsible for opening the bronchials will increase in number, resulting in stronger bronchodilation (opening of the bronchials). The inflammation in the lungs will also resolve sooner.
Once the oral steroid is used, albuterol can be used with increased frequency, but efforts to reduce the frequency and increase the amount of time between treatments should be made. The bronchodilators can make your heart race or cause you to feel shaky or hyper, so frequent use of a bronchodilator needs to be discussed with a doctor. Oral steroids may be needed for several days once started, so your physician will prescribe the appropriate amount for you. If you require the bronchodilator more than 4 to 6 times in a day, you may be suffering an asthma flare-up, which should be discussed with your physician.
Bronchodilators can also be used for activity that will cause chest tightness or wheezing. Typically, athletes will use the bronchodilator before working out or before a game. The bronchodilator can be used again during the sporting activity if needed.
Asthma Maintenance Medications
Daily medications are important to stop the inflammation of asthma. Asthma is a chronic disease that if not controlled can lead to permanent scarring and decrease lung function. Poorly controlled asthma can lead to COPD (chronic emphysema and bronchitis). Inhaled steroids are the only medications that have been shown to control inflammation. The inhaled steroids are safe, and stay where you inhale them, they are not like oral steroids that can affect growth rate and bones. The inhaled steroids sold in the United States include: Flovent®, Qvar HFA®, Asmanex®, Alvesco®, Pulmicort®. Inhaled steroids combined with a LABA (long acting beta agonist) are Advair disc®, Advair HFA®, Symbicort® and Dulera®. A LABA is either Serevent® (Salmeterol) or Foradil® (Formoterol), these medications act like an albuterol that lasts for 12 hours.
The National Institute of Health (NIH) published The NIH 2007 guidelines for the treatment and management of asthma. These guidelines outline in a clear format how asthma should be treated. Unfortunately, too many physicians do not diagnose or treat asthma correctly. Inhaled steroids are the first line of therapy to treat persistent asthma. Too many patients are prescribed Singulair®. This medication does not stop inflammation and the scarring of asthma. Singulair® has been associated with suicide and increase risk of behavioral problems. The guidelines recommend inhaled steroids as first line therapy. If the asthma is not well controlled then increasing the strength of the inhaled steroid or using a combination of an inhaled steroid and LABA is recommended. Singulair® is only recommended to be used in combination with an inhaled steroid in children under 5 years of age, or the same patient could be treated with an inhaled steroid and LABA combination. After 5 years of age Singulair® is not recommended as first line therapy.
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