If you have asthma, this page has good news for you. Asthma treatment guidelines issued by the National Heart, Lung and Blood Institute's National Asthma Education and Prevention Program can help you live life to the fullest by showing you how to work with your doctor in order to take an active role in your treatment.
Understand Your Condition
If you have asthma, you may experience wheezing, shortness of breath, a feeling of tightness in your chest or a persistent cough, especially late at night or early in the morning. Medical problems other than asthma can also cause similar symptoms.
When caused by asthma, these breathing problems are the result of conditions in the airways of your lungs:
- An inflamed and swollen airway lining, producing thick mucus that may clog the airways
- Airway muscle spasm that constricts and narrows the airways
- Sensitivity to common allergens like pollen, dust mites, cockroaches, molds, animal dander
- Irritation of the airways by asthma triggers such as tobacco smoke, air pollution, the common cold, sinus infections and cold air
- Exercise
When asthma gets worse, inflamed airways become increasingly constricted, making it difficult to breathe. The information on this page can help you breathe easier and live a fuller, more symptom-free life by showing you how to work with your doctor to control your asthma and the inflammation of your airways.
Early Diagnosis, Proper Treatment, Ongoing Monitoring and Self-Management
Many of the 14 million to 15 million Americans who suffer from asthma make unnecessary lifestyle compromises to accommodate their disease. Asthma also can be deadly: an estimated 5,000 people die each year. Under diagnosis and improper treatment are major contributors to these alarming statistics.
While there is yet no cure for asthma, it can be controlled with an accurate diagnosis, the right treatment and ongoing monitoring by you and your physician.
Early Diagnosis
Your asthma may be diagnosed by your personal or family physician or by an asthma specialist such as an allergist. The important thing is that the symptoms of asthma be recognized early and dealt with effectively. The longer you wait, the more permanent the damage to your lungs may be.
Because symptoms vary widely from patient to patient, it is essential that you and your doctor determine the severity of your asthma to develop the best plan to treat it. The new guidelines classify asthma into four categories: mild intermittent, mild persistent, moderate persistent and severe persistent.
Proper Treatment
Once asthma is diagnosed, aggressive treatment is recommended to gain quick control of your asthma. Regardless of the severity of your condition, the goals of asthma treatment are the same: control of your symptoms and a normal lifestyle. You and your doctor will work together to develop a treatment plan that can:
- End the coughing, wheezing and breathlessness, especially at night and in the morning;
- Enable you to participate in all normal activities including exercise;
- Avoid emergency room visits or hospitalizations;
- Avoid the possible side effects of asthma medications; and
- Meet your goals for a good quality of life.
Often the most effective and fastest way to bring asthma under control is to reduce your exposure to whatever is triggering the asthma. Avoidance and environmental control should be the first consideration in an overall treatment plan.
When allergy triggers cannot be avoided, immunotherapy ("allergy shots") may be considered. Immunotherapy is especially helpful when symptoms occur year-round or during a majority of the year, or when it is difficult to control symptoms with medication.
Asthma medications also play an important role in asthma therapy. No matter how severe your asthma, a quick-relief medication must be readily available for treatment of acute symptoms. If your asthma is more than mild and intermittent, a preventive "controller" anti-inflammatory medication should be used on a regular basis.
Ongoing Monitoring
Regular visits with your doctor to monitor your condition will help you meet your treatment goals. During your visits, the doctor will review your asthma symptoms, activities, peak flow records and medications.
Between visits you'll likely be using a peak flow meter and keep a diary to monitor the health of your lungs. Close monitoring of your condition will help you and your doctor determine if any changes in your treatment are necessary.
Education and Self-Management
The more you learn and know about your asthma and medications to treat it, the better you'll be able to work with your doctor to control your asthma.
How severe are your asthma symptoms?
The frequency and intensity of your asthma symptoms will help you and your doctor determine the treatment that's right for you. The Guidelines discuss how severity can be categorized, although most people with asthma don't fit perfectly into one category or another. In order to make an initial assessment of asthma severity, take a moment to describe your asthma as it would be without treatment or medication by answering these questions.
Mild Intermittent
Do you ...
- Have symptoms twice a week or less, and nighttime symptoms twice a month or less?
- Have symptoms that are brief, lasting from a few hours to a few days with the intensity of the attack varying?
- Have no symptoms between more severe episodes?
Mild Persistent
Do you ...
- Have symptoms more than twice a week but less than once a day, and nighttime symptoms more than twice a month?
- Have more severe episodes that sometimes affect your activity?
Moderate Persistent
Do you ...
- Have symptoms daily, and nighttime symptoms more than once a week?
- Use a quick-relief medication daily?
- Change your daily activity because of your asthma?
- Have more severe episodes that occur twice a week or more and may last days?
Severe Persistent
Do you ...
- Experience frequent severe episodes?
- Have a continual daytime symptoms and frequent nighttime symptoms?
- Have symptoms that cause you to limit your activity?
Understand How Medication Controls and Prevents Your Symptoms
Today, effective medications are available for the treatment of asthma. The new guidelines recommend a stepwise approach to using these medications with the type and amount determined by the initial assessment of the severity of your condition. When your asthma is worse, you increase or step up your medication, and when your asthma is under control, you often can decrease or step down your medication. Always consult your doctor before making any change in prescribed medications.
There are two types of asthma medications: long-term preventive "controller" and quick-relief "rescue" medications.
Long-term Controller medications are preventive, and are taken daily. They can help you achieve and maintain control of your asthma symptoms. Examples include:
- Antileukotrienes (such as Accolate®, Singulair®, Zyflo™)
- Cromolyn sodium (Intal® or generic cromolyn) and nedocromil (Tilade®)
- Inhaled corticosteroids (such as AeroBid®, Azmacort®, Beclovent®, Flovent®, Pulmicort®, Vanceril®)
- Long-acting inhaled beta2-agonists (such as Serevent®, which is commonly used along with another controller)
- Methylxanthines (such as SloBID®, TheoDur®)
- Oral corticosteroids (such as prednisone)
Quick-relief medications are used to treat asthma symptoms when they occur. They relieve symptoms rapidly and are normally taken only on an as-needed basis. Quick-relief medications include:
- Short-acting, inhaled beta2-agonists (such as Maxair®, Proventil®, Ventolin®, Xopenex®)
- Anticholinergics (Atrovent®)
Since inflammation of the lungs and airways plays a critical role in asthma, the most effective medications for long-term control have anti-inflammatory effects. Taken early and as directed by your doctor, these well-tolerated and safe medications can improve asthma control, normalize lung function, and possibly prevent irreversible injury to your lung airways.
When to See an Asthma Specialist
An allergist can diagnose asthma, help you learn more about your asthma, and help you develop a treatment plan to prevent your symptoms.
The new asthma guidelines recommend that you see an asthma specialist (such as an allergist) if you have difficulty achieving or maintaining control of your asthma. You should seek specialist care if:
- You have had a life-threatening asthma attack.
- You are not meeting the goals of your asthma therapy after three to six months of treatment, or your doctor believes you are not responding to current therapy.
- Your symptoms are unusual or difficult to diagnose.
- You have other conditions such as severe hay fever or sinusitis that complicate your asthma or your diagnosis.
- You need additional diagnostic tests to determine the severity of your asthma and what causes your asthma symptoms.
- You require additional education or guidance on the complications of therapy, adhering to your treatment plan, or avoiding asthma triggers.
- You are a candidate for immunotherapy.
- You have severe persistent asthma.
- You require continuous oral corticosteroid therapy or high-dose inhaled corticosteroids, or have taken more than two bursts of oral corticosteroids in one year.
Children younger than 3 years old with moderate or severe asthma, or children who are beginning daily long-term therapy, also should see an asthma specialist.
Partner With Your Doctor to Manage Your Asthma
People who participate in managing their own health tend to be healthier. This is especially true for people with asthma.
The best partnerships of patients and physicians have open and frequent communication for review and adjustment of treatment plans to fit your needs according to your individual goals and expected outcomes. The treatment plan may involve your family, employer or school, as appropriate.
Remember
- Seek an early and accurate diagnosis.
- Work with your regular physician or allergist to develop a written, daily action plan for managing asthma symptoms.
- Control your environment to the extent practical.
- Avoid your known asthma triggers.
- Adhere to the medication plan prescribed by your physician. Notify your physician if there are any problems obtaining the medications that have been prescribed.
- Monitor your response to treatment.
- Communicate with your physicians.
Updated May 2000
