Treatment: What will help?

In this post I am going to briefly talk about treatments for managing the symptoms of asthma. Remember, asthma is not curable, but the symptoms can be significantly reduced with the appropriate medications and environmental changes. Firstly, it is important to remove allergens from environments you are around a lot. Sometimes this is not possible, but it is important to do the best you can, as this will help reduce flare-ups. For example, if you are allergic to dust, try keeping your home clean and dust-free. Or if you are allergic to cats and your best friend has one (or ten, you never know with some people), try to find other meeting places so that you don't have to be around them.

Now let's talk meds. The medications you will be put on depend on how severe your asthma is and how well-controlled it has been (or has not been). I will put up another post soon about how asthma is staged. But for now, just know that there are many different medication options available, and if something is not working for you, your doctor will work with you to find something that does.

I found an article from the NIH about how to diagnose asthma and which medications to give for different severities. The basic principal is that we will start with a medication regime that the doctor thinks will work, then we will be monitored to see if it is working. I found an article that does a thorough job of laying out how treatment decisions are made, and here is one of their charts in particular. You can look at the website for more details. (National Heart, Lung and Blood Institute; US Department of Health and Human Services. Pg 7).

(Note: SABA=short-acting beta-2 agonist. It is a bronchodilator and thus opens up tight airways. It is used for quick symptom relief. ICS means inhaled corticosteroid, and this medication prevents airway inflammation/swelling. LABA means long-acting beta-2 agonist. It also is a bronchodilator, but it works over time to open up the airways longer, and can't be used in an emergency attack since it takes awhile to work.)


This is definitely a lot to take in, but the main idea is to keep trying until something works.

         There are 2 main categories of asthma medications: Those that dilate the airways by reducing the airway constriction ("bronchodilators") and those that reduce the airway inflammation that also happens in asthma ("anti-inflammatory") :

1) Bronchodilators can be used in emergency attacks (this kind will work immediately but for a short time) or they can be used to manage airway constriction for a longer period of time (but this kind won't act right away and thus can't be used in a sudden attack).

   Bronchodilator Example:
   SABA: "Short-acting beta2 agonist"- a medication used for immediate relief of symptoms, like in a    sudden attack. A common drug of this kind is Albuterol, which is often used in a metered-dose           inhaler, such as this:

While each bronchodilator medication is a bit different, side effects can commonly include feeling jittery/shakey and having a fast heart rate. There is not too much one can do for this except to reduce the dose of the medication they are on, but it usually isn't too bothersome for people.

2) Anti-Inflammatory drugs are used for long-term control of asthma, or are used in higher doses during times when asthma is severe and not getting better with the regular treatment regime. There are different types of anti-inflammatory drugs, each of which works in a different way.

   Anti-inflammatory drug example: 

Glucocorticoids: These are steroid drugs and can be inhaled or taken in pill form at home. The       inhaled, low dose form works long-term to reduce inflammation. This type of steroid is NOT the   same as the steroids people sometimes abuse to increase their muscle mass and strength, so do not worry! Daily inhaled glucocoriticoids do an amazing and safe job at managing asthma and preventing sudden attacks. There are rarely any significant side effects with them. They are used for prevention and do not help with sudden attacks.

        When people are going through a period of time where their asthma medications are not working and their asthma is severe, they may go on oral corticosteroids. These are dosed much higher and are used short-term to reduce the inflammation. Side effects might include weight gain (since larger doses of glucocorticoids make you keep more water in your body), suppression of your adrenal gland (the adrenal gland naturally makes glucocorticoids in your body), and growth suppression in kids, to name a few. These symptoms are not common though if the treatment is short (such as for a week or so). We cannot avoid all of the symptoms, but the main thing the doctor will focus on is weaning someone off of the drug to see if the adrenal gland is able to still produce enough glucocorticoids on its own. Symptoms like weight gain (which can manifest as a puffy, round face or a little hump on the back) will go away after the medication is finished, but this is usually a sign not seen unless the corticosteroid is taken for long-term purposes (as is sometimes the case in patients with persistent severe asthma). A very common corticosteroid prescribed is prednisone. 

        There is a lot more information out there, and I would bore you with it all if I tried to talk about every single medication and side effect. Feel free to look at the resources I did and keep researching! You can also look at this picture below for a visualization of different "relievers" (for quick relief), "controllers" that keep airways open for a longer time than relievers do, and "preventers" that help reduce inflammation/airway swelling.

 And remember:

(Picture from Francisco Q, found on http://www.who.int/respiratory/asthma/burden/en/)

Sources:

Allergy and Asthma Network: All About Asthma Medications. http://www.aanma.org/faqs/welcome-to-precious-breathers/medicationspre/

National Heart, Lung and Blood Institute; US Department of Health and Human Services. "Asthma Care Quick Reference: Diagnosing and Managing Asthma." (2012, June 1). Retrieved from http://www.nhlbi.nih.gov/files/docs/guidelines/asthma_qrg.pdf

National Heart, Lung and Blood Institute & National Asthma Education and Prevention Program. (2007, August 28). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Retrieved January 31, 2015, from http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf