Adult Asthma

General Approach for Treating and Managing Asthma

While medications play an essential role in the management of asthma, appropriate management of asthma also involves:

  • Identifying and avoiding allergens and other asthma triggers
  • Following appropriate drug treatments
  • Home monitoring performed by either patient or family
  • Good communication between the doctor and patient
  • Needed psychosocial support
  • Treatment of asthma in all environments (school, work, exercise)

The severity of asthma is classified into four groups: Intermittent, Mild Persistent, Moderate Persistent, and Severe Persistent. Six specific components of severity are used to classify patients. These components are:

  • Symptom frequency, ranging from fewer than 2 days per week to throughout the day
  • Nighttime awakenings, ranging from none to nightly
  • Short-acting beta2-agonist use for symptom control, ranging from 2 or fewer days per week to several times per day
  • Interference with normal activity, ranging from none to extremely limited
  • Lung function as measured by FEV1 and FEV1/FVC, measured with pulmonary function testing at the doctor's office
  • Number of exacerbations (sudden worsening) requiring oral corticosteroids, ranging from none to two or more in the last 6 months

Treating Symptoms Versus Controlling the Disease

Patients can greatly reduce the frequency and severity of asthma attacks by understanding the difference between coping with asthma attacks and controlling the disease over time.

Medications for asthma fall into two categories:

  • Rescue (Quick-Relief) Medication. Medications that open the airways (bronchodilators, or inhalers) are used to quickly relieve any moderate or severe asthma attack. These drugs are usually short-acting beta-adrenergic agonists (beta2-agonists). Other drugs used in special cases include corticosteroids taken by mouth and anticholinergic drugs. Beta2-agonists and anticholinergics do not have any effect on the disease process itself. They are only useful for treating symptoms.
  • Long-Term Control (Maintenance) Medication. It is very important to control the damaging inflammatory response associated with asthma and not simply treat symptoms. For adults and children over age 5 with moderate-to-severe persistent asthma, doctors recommend inhaled corticosteroids, which are sometimes accompanied by long-acting beta2-agonists when corticosteroids alone fail to control the disease.

Patients can greatly reduce the frequency and severity of asthma attacks by understanding the difference between coping with asthma attacks and controlling the disease over time. Unfortunately, many patients do not understand the difference between medications that provide rapid short-term relief and those that are used for long-term symptom control. Many patients with moderate or severe asthma overuse their short-term bronchodilator medications and underuse their long-term corticosteroid medications. The overuse of bronchodilators can have serious consequences; not using steroids can lead to permanent lung damage.

These are the signs of well-controlled asthma:

  • Asthma symptoms occur twice a week or less
  • Rescue bronchodilator medication is used twice a week or less
  • Symptoms do not cause nighttime or early morning awakening
  • Symptoms do not limit work, school, or exercise activities
  • Peak flow meter readings are normal or the patient’s personal best
  • Both the doctor and the patient consider the asthma to be well controlled

Steps for Treating Asthma

A stepwise approach is recommended for treating asthma. Medications and dosages are increased when needed, and decreased when possible. Based on a patient’s age and asthma severity, there are specific recommendations regarding whether to use long-term control medications and which ones to use. Patient education, environmental control measures, and management of any other conditions are also needed. Doctors may always adjust these recommendations based on a specific patient.

In choosing therapy, doctors must also consider the risk an individual patient has for more severe exacerbations. Factors that may contribute to this include parental history of asthma, atopic dermatitis, and known sensitivity to different allergens or foods. Patients should be reevaluated within 2 - 6 weeks of starting therapy to assess response.

Key points regarding recommendations for adults include:

  • Inhaled corticosteroids are the preferred long-term control therapy. Long-acting beta2-agonists and leukotriene antagonists are additional therapies usually used in addition to inhaled corticosteroids.
  • Avoiding or managing environmental triggers is always important.