Asthma - Treatment

There are three primary goals of an asthma treatment program. First, troublesome symptoms should be prevented to the greatest extent possible. Second, lung function should be kept as close to normal as possible. Third, patients should be able to carry out their normal activities, including those requiring special effort, such as vigorous exercise. Patients should be examined on a regular basis to make sure treatment goals are being met. Spirometer tests are an essential part of these examinations.

Drugs

The goal of drug therapy is to find medications that control the symptoms of asthma with few or no side effects.

METHYLXANTHINES. The most commonly used methylxanthine (pronounced meth-uhl-ZAN-theen) is theophylline (pronounced thee-OFF-uh-lin).

Theophylline is used to reduce inflammation of the airways. It is especially helpful in controlling nighttime symptoms of asthma. Blood levels of the drug must be measured on a regular basis, however. If levels get too high, they can cause an abnormal heart rhythm or convulsions.

BETA-RECEPTOR AGONISTS. Beta-receptor agonists are bronchodilators (pronounced brong-ko-die-LATE-urs), drugs that open up bronchi and bronchiole. They make it easier for air to get into and out of airways. They are best used for the relief of sudden asthma attacks and to prevent exercise-induced asthma. These drugs generally start acting within minutes and last for up to six hours. They are taken by mouth, by injection, or with an inhaler.

STEROIDS. Steroids are related to natural body hormones. They reduce or prevent inflammation and are very effective in relieving the symptoms of asthma. When taken over a long period of time by inhalation, steroids can reduce the frequency of asthma attacks. They can also make airways less sensitive to allergens. For these reasons, they are the strongest and most effective methods for treating asthma. They can control even the most severe cases of the disease and maintain good lung function.

On the other hand, steroids have a number of side effects, some of which are serious. They can cause stomach bleeding, loss of calcium from bones, cataracts in the eyes, and a diabetes-like condition. Long-term use of steroids can also result in weight gain, loss of some mental function, and problems with wound healing. In children, growth may be slowed. Steroids can be taken by mouth, by injection, or by inhalation.

LEUKOTRIENE MODIFIERS. Leukotriene (pronounced lyoo-kuh-TRI-een) modifiers are drugs that interfere with changes in the bronchi and bronchioles that occur during an asthma attack. They prevent airways from narrowing and the release of mucus. They are recommended in place of steroids for older children and adults who have mild, long-lasting cases of asthma.

OTHER DRUGS. Anti-inflammatory drugs are sometimes used to prevent asthma attacks over the long term in children. Cromolyn (pronounced KRO-muh-lun) and nedocromil are two such drugs. They can also be taken before exercise or when exposure to an allergen cannot be avoided. These drugs are safe but expensive. They must be taken on a regular basis, even if the patient has no symptoms.

A class of drugs known as anti-cholinergics (pronounced ko-luh-NER-jiks) can also be used in the case of severe asthma attacks. Atropine is an example of this class of drugs. Anti-cholinergics are usually taken in combination with beta-receptor agonists. The combination helps widen airways and reduce the production of mucus.

Immunotherapy is used when a person cannot avoid exposure to an allergen. Immunotherapy is a procedure that involves a series of injections of the allergen. The series must be continued over a very long period of time, usually three to five years. During this period, the amount of allergen given in a shot is gradually increased. As more and more allergen is given, the patient's body slowly builds up an immunity (resistance) to the allergen.

Immunotherapy also has its risks. Injecting an allergen can itself cause an asthmatic attack. Studies seem to indicate, however, that the procedure can be effective against certain types of allergens, such as house-dust mites, ragweed pollen, and cat dander.

Managing Asthma Attacks

A severe asthma attack requires immediate treatment. Patients usually require supplemental (extra) oxygen. In rare cases, a mechanical ventilator may be needed to help a patient breathe. Inhalation of a beta-receptor is often effective in treating serious asthma attacks. If the patient does not respond to a beta-receptor, an injection of steroids may be necessary. Follow-up treatments with steroids make a recurrence of the attack less likely.

Maintaining Control

Long-term control over asthma is based on the use of beta-receptor drugs. These drugs are taken with inhalers that monitor the dose. Patients are instructed how to properly use an inhaler to make sure they receive the amount of drug needed to keep their disease under control. Once that goal is achieved, the amount of beta-receptor taken can be reduced. Patients should be seen by a doctor on a regular basis, however (such as once every one to six months).

As early on as possible, asthma patients should be trained in the treatment and control of their disease. They should be taught how to monitor their symptoms so they will know when an attack is starting. Using a flow meter is essential to this process. Over-the-counter medications should be avoided. Patients should also have an action plan to follow if their symptoms become worse. This plan includes how to adjust their medication and when to seek medical help.

Calling an asthma specialist should be considered when:

• There has been a life-threatening asthma attack or the disease has become severe and persistent (long-lasting).
• Treatment for three to six months has not met its goals.
• Some other condition, such as chronic lung disease, is complicating asthma.
• Special tests, such as allergy skin testing, are needed.
• Intensive steroid therapy has been necessary.

Hospitalization can sometimes be necessary for an asthma patient. That decision depends on a number of factors, such as the past history of serious attacks, severity of symptoms, current medication, and the availability of support at home.