Asthma is a chronic lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing, chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.
Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma. About 7 million of these people are children.
To understand asthma, it helps to know how the airways work. The airways are tubes that carry air into and out of your lungs. People who have asthma have inflamed airways. The inflammation makes the airways swollen and very sensitive. The airways tend to react strongly to certain inhaled substances.
When the airways react, the muscles around them tighten. This narrows the airways, causing less air to flow into the lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways might make more mucus than usual. Mucus is a sticky, thick liquid that can further narrow the airways.
This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are inflamed.
Sometimes asthma symptoms are mild and go away on their own or after minimal treatment with asthma medicine. Other times, symptoms continue to get worse.
When symptoms get more intense and/or more symptoms occur, you're having an asthma attack. Asthma attacks also are called flare-ups or exacerbations.
Treating symptoms when you first notice them is important. This will help prevent the symptoms from worsening and causing a severe asthma attack. Severe asthma attacks may require emergency care, and they can be fatal.
Asthma has no cure. Even when you feel fine, you still have the disease and it can flare up at any time.
However, with today's knowledge and treatments, most people who have asthma are able to manage the disease. They have few, if any, symptoms. They can live normal, active lives and sleep through the night without interruption from asthma.
If you have asthma, you can take an active role in managing the disease. For successful, thorough, and ongoing treatment, build strong partnerships with your doctor and other health care providers.
The exact cause of asthma isn't known. Researchers think some genetic and environmental factors interact to cause asthma, most often early in life. These factors include:
• An inherited tendency to develop allergies, called atopy (AT-o-pe)
• Parents who have asthma
• Certain respiratory infections during childhood
• Contact with some airborne allergens or exposure to some viral infections in infancy or in early childhood when the immune system is developing
If asthma or atopy runs in your family, exposure to irritants (for example, tobacco smoke) may make your airways more reactive to substances in the air.
Some factors may be more likely to cause asthma in some people than in others. Researchers continue to explore what causes asthma.
The "Hygiene Hypothesis"
One theory researchers have for what causes asthma is the "hygiene hypothesis." They believe that our Western lifestyle—with its emphasis on hygiene and sanitation—has resulted in changes in our living conditions and an overall decline in infections in early childhood.
Many young children no longer have the same types of environmental exposures and infections as children did in the past. This affects the way that young children's immune systems develop during very early childhood, and it may increase their risk for atopy and asthma. This is especially true for children who have close family members with one or both of these conditions.
Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 22 million people are known to have asthma. Nearly 6 million of these people are children.
Young children who often wheeze and have respiratory infections—as well as certain other risk factors—are at highest risk of developing asthma that continues beyond 6 years of age. The other risk factors include having allergies, eczema (an allergic skin condition), or parents who have asthma.
Among children, more boys have asthma than girls. But among adults, more women have the disease than men. It's not clear whether or how sex and sex hormones play a role in causing asthma.
Most, but not all, people who have asthma have allergies.
African Americans and Puerto Ricans are at higher risk for asthma than those of other racial and ethnic groups.
Some people develop asthma because of contact with certain chemical irritants or industrial dusts in the workplace. This type of asthma is called occupational asthma.
You can’t prevent asthma. However, you can take steps to control the disease and prevent its symptoms. For example:
• Learn about your asthma and ways to control it.
• Follow your written asthma action plan. (For a sample plan, go to the National Heart, Lung, and Blood Institute's "Asthma Action Plan.")
• Use medicines as your doctor prescribes.
• Identify and try to avoid things that make your asthma worse (asthma triggers). However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.
• Keep track of your asthma symptoms and level of control.
• Get regular checkups for your asthma.
Common signs and symptoms of asthma include:
• Coughing. Coughing from asthma often is worse at night or early in the morning, making it hard to sleep.
• Wheezing. Wheezing is a whistling or squeaky sound that occurs when you breathe.
• Chest tightness. This may feel like something is squeezing or sitting on your chest.
• Shortness of breath. Some people who have asthma say they can't catch their breath or they feel out of breath. You may feel like you can't get air out of your lungs.
Not all people who have asthma have these symptoms. Likewise, having these symptoms doesn't always mean that you have asthma. The best way to diagnose asthma for certain is to use a lung function test, a medical history (including type and frequency of symptoms), and a physical exam.
The types of asthma symptoms you have, how often they occur, and how severe they are may vary over time. Sometimes your symptoms may just annoy you. Other times, they may be troublesome enough to limit your daily routine.
Severe symptoms can be fatal. It's important to treat symptoms when you first notice them so they don't become severe.
With proper treatment, most people who have asthma can expect to have few, if any, symptoms either during the day or at night.
Many things can trigger or worsen asthma symptoms. Your doctor will help you find out which things (sometimes called triggers) may cause your asthma to flare up if you come in contact with them. Triggers may include:
• Allergens from dust, animal fur, cockroaches, mold, and pollens from trees, grasses, and flowers
• Irritants such as cigarette smoke, air pollution, chemicals or dust in the workplace, compounds in home décor products, and sprays (such as hairspray)
• Medicines such as aspirin or other nonsteroidal anti-inflammatory drugs and nonselective beta-blockers
• Sulfites in foods and drinks
• Viral upper respiratory infections, such as colds
• Physical activity, including exercise
Other health conditions can make asthma harder to manage. Examples of these conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. These conditions need treatment as part of an overall asthma care plan.
Asthma is different for each person. Some of the triggers listed above may not affect you. Other triggers that do affect you may not be on the list. Talk with your doctor about the things that seem to make your asthma worse.
Your primary care doctor will diagnose asthma based on your medical and family histories, a physical exam, and test results.
Your doctor also will figure out the severity of your asthma—that is, whether it's intermittent, mild, moderate, or severe. The level of severity will determine what treatment you'll start on.
You may need to see an asthma specialist if:
• You need special tests to help diagnose asthma
• You've had a life-threatening asthma attack
• You need more than one kind of medicine or higher doses of medicine to control your asthma, or if you have overall problems getting your asthma well controlled
• You're thinking about getting allergy treatments
Medical and Family Histories
Your doctor may ask about your family history of asthma and allergies. He or she also may ask whether you have asthma symptoms and when and how often they occur.
Let your doctor know whether your symptoms seem to happen only during certain times of the year or in certain places, or if they get worse at night.
Your doctor also may want to know what factors seem to trigger your symptoms or worsen them. For more information about possible asthma triggers, go to "What Are the Signs and Symptoms of Asthma?"
Your doctor may ask you about related health conditions that can interfere with asthma management. These conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea.
Physical Exam
Your doctor will listen to your breathing and look for signs of asthma or allergies. These signs include wheezing, a runny nose or swollen nasal passages, and allergic skin conditions, such as eczema.
Keep in mind that you can still have asthma even if you don't have these signs on the day that your doctor examines you.
Diagnostic Tests
■ PULMONARY FUNCTION TESTS
Your doctor will use pulmonary function tests to check how your lungs are working.
• Spirometry measures how much air you can breathe in and out. It also measures how fast you can blow air out.
• Bronchoprovocation tests measure how your airways react to specific exposures. Using spirometry, this test repeatedly measures your lung function during physical activity or after you receive increasing doses of cold air or a special chemical to breathe in. Fractional concentration of exhaled nitric oxide tests measure how much nitric oxide is in the air you exhale. This test can be helpful to diagnose or guide asthma treatment in some patients.
Your doctor also may give you medicine and then test you again to see whether the results have improved.
If the starting results are lower than normal and improve with the medicine, and if your medical history shows a pattern of asthma symptoms, your diagnosis will likely be asthma.
■ OTHER TESTS
Your doctor may recommend other tests if he or she needs more information to make a diagnosis. Other tests may include:
• Allergy testing to find out which allergens affect you, if any.
• A test to measure how sensitive your airways are. This is called a bronchoprovocation (brong-KO-prav-eh-KA-shun) test. Using spirometry, this test repeatedly measures your lung function during physical activity or after you receive increasing doses of cold air or a special chemical to breathe in.
• A test to show whether you have another condition with the same symptoms as asthma, such as reflux disease, vocal cord dysfunction, or sleep apnea.
• A chest X-ray or an EKG (electrocardiogram). These tests will help find out whether a foreign object or other disease may be causing your symptoms.
Diagnosing Asthma in Young Children
Most children who have asthma develop their first symptoms before 5 years of age. However, asthma in young children (aged 0 to 5 years) can be hard to diagnose.
Sometimes it's hard to tell whether a child has asthma or another childhood condition. This is because the symptoms of asthma also occur with other conditions.
Also, many young children who wheeze when they get colds or respiratory infections don't go on to have asthma after they're 6 years old.
A child may wheeze because he or she has small airways that become even narrower during colds or respiratory infections. The airways grow as the child grows older, so wheezing no longer occurs when the child gets colds.
A young child who has frequent wheezing with colds or respiratory infections is more likely to have asthma if:
• One or both parents have asthma
• The child has signs of allergies, including the allergic skin condition eczema
• The child has allergic reactions to pollens or other airborne allergens
• The child wheezes even when he or she doesn't have a cold or other infection
The most certain way to diagnose asthma is with a pulmonary function test (spirometry), a medical history, and a physical exam. However, it's hard to do pulmonary function tests in children younger than 5 years. Thus, doctors must rely on children's medical histories, signs and symptoms, and physical exams to make a diagnosis.
Doctors also may use a four- to six-week trial of asthma medicines to see how well a child responds.
Asthma is a long-term disease that has no cure. The goal of asthma treatment is to control the disease. Good asthma control will:
• Prevent chronic and troublesome symptoms, such as coughing and shortness of breath
• Reduce your need for quick-relief medicines (see below)
• Help you maintain good lung function
• Let you maintain your normal activity level and sleep through the night
• Prevent asthma attacks that could result in an emergency room visit or hospital stay
To control asthma, partner with your doctor to manage your asthma or your child's asthma. Children aged 10 or older—and younger children who are able—should take an active role in their asthma care.
Taking an active role to control your asthma involves:
• Working with your doctor to treat other conditions that can interfere with asthma management.
• Avoiding things that worsen your asthma (asthma triggers). However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.
• Working with your doctor and other health care providers to create and follow an asthma action plan. An asthma action plan gives guidance on taking your medicines properly; avoiding asthma triggers, except physical activity; tracking your level of asthma control; responding to worsening symptoms; and seeking emergency care when needed. See the Follow an Asthma Action Plan section below.
Asthma is treated with two types of medicines: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or "rescue," medicines relieve asthma symptoms that may flare up.
Your initial treatment will depend on the severity of your asthma. Followup asthma treatment will depend on how well your asthma action plan is controlling your symptoms and preventing asthma attacks.
Your level of asthma control can vary over time and with changes in your home, school, or work environments. These changes can alter how often you're exposed to the factors that can worsen your asthma.
Your doctor may need to increase your medicine if your asthma doesn't stay under control. On the other hand, if your asthma is well controlled for several months, your doctor may decrease your medicine. These adjustments to your medicine will help you maintain the best control possible with the least amount of medicine necessary.
Asthma treatment for certain groups of people—such as children, pregnant women, or those for whom exercise brings on asthma symptoms—will be adjusted to meet their special needs.
Follow an Asthma Action Plan
You can work with your doctor to create a personal asthma action plan. The plan will describe your daily treatments, such as which medicines to take and when to take them. The plan also will explain when to call your doctor or go to the emergency room.
If your child has asthma, all of the people who care for him or her should know about the child's asthma action plan. This includes babysitters and workers at daycare centers, schools, and camps. These caretakers can help your child follow his or her action plan.
Go to the National Heart, Lung, and Blood Institute's (NHLBI's) "Asthma Action Plan" for a sample plan.
Avoid Things That Can Worsen Your Asthma
Many common things (called asthma triggers) can set off or worsen your asthma symptoms. Once you know what these things are, you can take steps to control many of them. (For more information about asthma triggers, go to "What Are the Signs and Symptoms of Asthma?")
For example, exposure to pollens or air pollution might make your asthma worse. If so, try to limit time outdoors when the levels of these substances in the outdoor air are high. If animal fur triggers your asthma symptoms, keep pets with fur out of your home or bedroom.
One possible asthma trigger you shouldn’t avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.
The NHLBI offers many useful tips for controlling asthma triggers. For more information, go to page 2 of NHLBI's "Asthma Action Plan."
If your asthma symptoms are clearly related to allergens, and you can't avoid exposure to those allergens, your doctor may advise you to get allergy shots.
You may need to see a specialist if you're thinking about getting allergy shots. These shots can lessen or prevent your asthma symptoms, but they can't cure your asthma.
Several health conditions can make asthma harder to manage. These conditions include runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. Your doctor will treat these conditions as well.
Medicines
Your doctor will consider many things when deciding which asthma medicines are best for you. He or she will check to see how well a medicine works for you. Then, he or she will adjust the dose or medicine as needed.
Asthma medicines can be taken in pill form, but most are taken using a device called an inhaler. An inhaler allows the medicine to go directly to your lungs.
Not all inhalers are used the same way. Ask your doctor or another health care provider to show you the right way to use your inhaler. Review the way you use your inhaler at every medical visit.
Long-Term Control Medicines
Most people who have asthma need to take long-term control medicines daily to help prevent symptoms. The most effective long-term medicines reduce airway inflammation, which helps prevent symptoms from starting. These medicines don't give you quick relief from symptoms.
■ Inhaled corticosteroids.
Inhaled corticosteroids are the preferred medicine for long-term control of asthma. They're the most effective option for long-term relief of the inflammation and swelling that makes your airways sensitive to certain inhaled substances.
Reducing inflammation helps prevent the chain reaction that causes asthma symptoms. Most people who take these medicines daily find they greatly reduce the severity of symptoms and how often they occur.
Your doctor may prescribe low-dose inhaled corticosteroids that you will need to take each day. If your symptoms get worse, your doctor may prescribe higher doses to prevent severe flare-ups. however, one study of children between the ages of 5 and 11 found that children given the higher doses when their symptoms worsened did not experience fewer severe flare-ups. More frequent or prolonged high-dose inhaled corticosteroids in children in this age group may also affect growth.
Your doctor may have you add another long-term asthma control medicine so he or she can lower your dose of corticosteroids.
Inhaled corticosteroids generally are safe when taken as prescribed. These medicines are different from the illegal anabolic steroids taken by some athletes. Inhaled corticosteroids aren't habit-forming, even if you take them every day for many years.
Like many other medicines, though, inhaled corticosteroids can have side effects. Most doctors agree that the benefits of taking inhaled corticosteroids and preventing asthma attacks far outweigh the risk of side effects.
One common side effect from inhaled corticosteroids is a mouth infection called thrush. You might be able to use a spacer or holding chamber on your inhaler to avoid thrush. These devices attach to your inhaler. They help prevent the medicine from landing in your mouth or on the back of your throat.
Check with your doctor to see whether a spacer or holding chamber should be used with the inhaler you have. Also, work with your health care team if you have any questions about how to use a spacer or holding chamber. Rinsing your mouth out with water after taking inhaled corticosteroids also can lower your risk for thrush.
If you have severe asthma, you may have to take corticosteroid pills or liquid for short periods to get your asthma under control.
If taken for long periods, these medicines raise your risk for cataracts and osteoporosis. A cataract is the clouding of the lens in your eye. Osteoporosis is a disorder that makes your bones weak and more likely to break. Your doctor may suggest you take calcium and vitamin D pills to protect your bones. High doses of these medicines over time may have other side effects that your doctor will monitor.
Inhaled corticosteroids may affect the growth rate in children, with effects that persist through adulthood.
■ Other long-term control medicines.
Other long-term control medicines include:
• Anti-inflammatory medicine, such as cromolyn. This medicine is taken using a device called a nebulizer. As you breathe in, the nebulizer sends a fine mist of medicine to your lungs. Cromolyn helps prevent airway inflammation.
• Immunomodulators, such as omalizumab (anti-IgE). This medicine is given as a shot (injection) one or two times a month. It helps prevent your body from reacting to asthma triggers, such as pollen and dust mites. Anti-IgE might be used if other asthma medicines have not worked well. A rare, but possibly life-threatening allergic reaction called anaphylaxis might occur when the Omalizumab injection is given. If you take this medication, work with your doctor to make sure you understand the signs and symptoms of anaphylaxis and what actions you should take.
• Inhaled long-acting beta2-agonists. These medicines open the airways. They might be added to inhaled corticosteroids to improve asthma control. Inhaled long-acting beta2-agonists should never be used on their own for long-term asthma control. They must used with inhaled corticosteroids.
• Leukotriene modifiers. These medicines are taken by mouth. They help block the chain reaction that increases inflammation in your airways.
• Theophylline. This medicine is taken by mouth. Theophylline helps open the airways.
If your doctor prescribes a long-term control medicine, take it every day to control your asthma. Your asthma symptoms will likely return or get worse if you stop taking your medicine.
Long-term control medicines can have side effects. Talk with your doctor about these side effects and ways to reduce or avoid them.
With some medicines, like theophylline, your doctor will check the level of medicine in your blood. This helps ensure that you’re getting enough medicine to relieve your asthma symptoms, but not so much that it causes dangerous side effects.
Quick-Relief Medicines
All people who have asthma need quick-relief medicines to help relieve asthma symptoms that may flare up. Inhaled short-acting beta2-agonists are the first choice for quick relief.
These medicines act quickly to relax tight muscles around your airways when you're having a flareup. This allows the airways to open up so air can flow through them.
You should take your quick-relief medicine when you first notice asthma symptoms. If you use this medicine more than 2 days a week, talk with your doctor about your asthma control. You may need to make changes to your asthma action plan.
Carry your quick-relief inhaler with you at all times in case you need it. If your child has asthma, make sure that anyone caring for him or her has the child's quick-relief medicines, including staff at the child's school. They should understand when and how to use these medicines and when to seek medical care for your child.
You shouldn't use quick-relief medicines in place of prescribed long-term control medicines. Quick-relief medicines don't reduce inflammation.
Track Your Asthma
To track your asthma, keep records of your symptoms, check your peak flow number using a peak flow meter, and get regular asthma checkups.
■ Record Your Symptoms
You can record your asthma symptoms in a diary to see how well your treatments are controlling your asthma.
Asthma is well controlled if:
• You have symptoms no more than 2 days a week, and these symptoms don't wake you from sleep more than 1 or 2 nights a month.
• You can do all your normal activities.
• You take quick-relief medicines no more than 2 days a week.
• You have no more than one asthma attack a year that requires you to take corticosteroids by mouth.
• Your peak flow doesn't drop below 80 percent of your personal best number.
If your asthma isn't well controlled, contact your doctor. He or she may need to change your asthma action plan.
■ Use a Peak Flow Meter
This small, hand-held device shows how well air moves out of your lungs. You blow into the device and it gives you a score, or peak flow number. Your score shows how well your lungs are working at the time of the test.
Your doctor will tell you how and when to use your peak flow meter. He or she also will teach you how to take your medicines based on your score.
Your doctor and other health care providers may ask you to use your peak flow meter each morning and keep a record of your results. You may find it very useful to record peak flow scores for a couple of weeks before each medical visit and take the results with you.
When you're first diagnosed with asthma, it's important to find your "personal best" peak flow number. To do this, you record your score each day for a 2- to 3-week period when your asthma is well-controlled. The highest number you get during that time is your personal best. You can compare this number to future numbers to make sure your asthma is controlled.
Your peak flow meter can help warn you of an asthma attack, even before you notice symptoms. If your score shows that your breathing is getting worse, you should take your quick-relief medicines the way your asthma action plan directs. Then you can use the peak flow meter to check how well the medicine worked.
■ Get Asthma Checkups
When you first begin treatment, you'll see your doctor about every 2 to 6 weeks. Once your asthma is controlled, your doctor may want to see you from once a month to twice a year.
During these checkups, your doctor may ask whether you've had an asthma attack since the last visit or any changes in symptoms or peak flow measurements. He or she also may ask about your daily activities. This information will help your doctor assess your level of asthma control.
Your doctor also may ask whether you have any problems or concerns with taking your medicines or following your asthma action plan. Based on your answers to these questions, your doctor may change the dose of your medicine or give you a new medicine.
If your control is very good, you might be able to take less medicine. The goal is to use the least amount of medicine needed to control your asthma.
Emergency Care
Most people who have asthma, including many children, can safely manage their symptoms by following their asthma action plans. However, you might need medical attention at times.
Call your doctor for advice if:
• Your medicines don't relieve an asthma attack.
• Your peak flow is less than half of your personal best peak flow number.
Call 9–1–1 for emergency care if:
• You have trouble walking and talking because you're out of breath.
• You have blue lips or fingernails.
At the hospital, you'll be closely watched and given oxygen and more medicines, as well as medicines at higher doses than you take at home. Such treatment can save your life.
The treatments described above generally apply to all people who have asthma. However, some aspects of treatment differ for people in certain age groups and those who have special needs.
Children
It's hard to diagnose asthma in children younger than 5 years. Thus, it's hard to know whether young children who wheeze or have other asthma symptoms will benefit from long-term control medicines. (Quick-relief medicines tend to relieve wheezing in young children whether they have asthma or not.)
Doctors will treat infants and young children who have asthma symptoms with long-term control medicines if, after assessing a child, they feel that the symptoms are persistent and likely to continue after 6 years of age. (For more information, go to "How Is Asthma Diagnosed?")
Inhaled corticosteroids are the preferred treatment for young children. Montelukast and cromolyn are other options. Treatment might be given for a trial period of 1 month to 6 weeks. Treatment usually is stopped if benefits aren't seen during that time and the doctor and parents are confident the medicine was used properly.
Inhaled corticosteroids can possibly slow the growth of children of all ages. Slowed growth usually is apparent in the first several months of treatment, is generally small, and doesn't get worse over time. Poorly controlled asthma also may reduce a child's growth rate.
Many experts think the benefits of inhaled corticosteroids for children who need them to control their asthma far outweigh the risk of slowed growth.
Older Adults
Doctors may need to adjust asthma treatment for older adults who take certain other medicines, such as beta blockers, aspirin and other pain relievers, and anti-inflammatory medicines. These medicines can prevent asthma medicines from working well and may worsen asthma symptoms.
Be sure to tell your doctor about all of the medicines you take, including over-the-counter medicines.
Older adults may develop weak bones from using inhaled corticosteroids, especially at high doses. Talk with your doctor about taking calcium and vitamin D pills, as well as other ways to help keep your bones strong.
Pregnant Women
Pregnant women who have asthma need to control the disease to ensure a good supply of oxygen to their babies. Poor asthma control increases the risk of preeclampsia, a condition in which a pregnant woman develops high blood pressure and protein in the urine. Poor asthma control also increases the risk that a baby will be born early and have a low birth weight.
Studies show that it's safer to take asthma medicines while pregnant than to risk having an asthma attack.
Talk with your doctor if you have asthma and are pregnant or planning a pregnancy. Your level of asthma control may get better or it may get worse while you're pregnant. Your health care team will check your asthma control often and adjust your treatment as needed.
People Whose Asthma Symptoms Occur With Physical Activity
Physical activity is an important part of a healthy lifestyle. Adults need physical activity to maintain good health. Children need it for growth and development.
In some people, however, physical activity can trigger asthma symptoms. If this happens to you or your child, talk with your doctor about the best ways to control asthma so you can stay active.
The following medicines may help prevent asthma symptoms caused by physical activity:
• Short-acting beta2-agonists (quick-relief medicine) taken shortly before physical activity can last 2 to 3 hours and prevent exercise-related symptoms in most people who take them.
• Long-acting beta2-agonists can be protective for up to 12 hours. However, with daily use, they'll no longer give up to 12 hours of protection. Also, frequent use of these medicines for physical activity might be a sign that asthma is poorly controlled.
• Leukotriene modifiers. These pills are taken several hours before physical activity. They can help relieve asthma symptoms brought on by physical activity.
• Long-term control medicines. Frequent or severe symptoms due to physical activity may suggest poorly controlled asthma and the need to either start or increase long-term control medicines that reduce inflammation. This will help prevent exercise-related symptoms.
Easing into physical activity with a warmup period may be helpful. You also may want to wear a mask or scarf over your mouth when exercising in cold weather.
If you use your asthma medicines as your doctor directs, you should be able to take part in any physical activity or sport you choose.
People Having Surgery
Asthma may add to the risk of having problems during and after surgery. For instance, having a tube put into your throat may cause an asthma attack.
Tell your surgeon about your asthma when you first talk with him or her. The surgeon can take steps to lower your risk, such as giving you asthma medicines before or during surgery.
If you have asthma, you’ll need long-term care. Successful asthma treatment requires that you take an active role in your care and follow your asthma action plan.
Learn How To Manage Your Asthma
Partner with your doctor to develop an asthma action plan. This plan will help you know when and how to take your medicines. The plan also will help you identify your asthma triggers and manage your disease if asthma symptoms worsen.
Children aged 10 or older—and younger children who can handle it—should be involved in creating and following their asthma action plans. For a sample plan, go to the National Heart, Lung, and Blood Institute's "Asthma Action Plan."
Most people who have asthma can successfully manage their symptoms by following their asthma action plans and having regular checkups. However, knowing when to seek emergency medical care is important.
Learn how to use your medicines correctly. If you take inhaled medicines, you should practice using your inhaler at your doctor's office. If you take long-term control medicines, take them daily as your doctor prescribes.
Record your asthma symptoms as a way to track how well your asthma is controlled. Also, your doctor may advise you to use a peak flow meter to measure and record how well your lungs are working.
Your doctor may ask you to keep records of your symptoms or peak flow results daily for a couple of weeks before an office visit. You'll bring these records with you to the visit. (For more information about using a peak flow meter, go to "How Is Asthma Treated and Controlled?")
These steps will help you keep track of how well you're controlling your asthma over time. This will help you spot problems early and prevent or relieve asthma attacks. Recording your symptoms and peak flow results to share with your doctor also will help him or her decide whether to adjust your treatment.
Ongoing Care
Have regular asthma checkups with your doctor so he or she can assess your level of asthma control and adjust your treatment as needed. Remember, the main goal of asthma treatment is to achieve the best control of your asthma using the least amount of medicine. This may require frequent adjustments to your treatments.
If you find it hard to follow your asthma action plan or the plan isn't working well, let your health care team know right away. They will work with you to adjust your plan to better suit your needs.
Get treatment for any other conditions that can interfere with your asthma management.
Watch for Signs That Your Asthma Is Getting Worse
Your asthma might be getting worse if:
• Your symptoms start to occur more often, are more severe, or bother you at night and cause you to lose sleep.
• You're limiting your normal activities and missing school or work because of your asthma.
• Your peak flow number is low compared to your personal best or varies a lot from day to day.
• Your asthma medicines don't seem to work well anymore.
• You have to use your quick-relief inhaler more often. If you're using quick-relief medicine more than 2 days a week, your asthma isn't well controlled.
• You have to go to the emergency room or doctor because of an asthma attack.
If you have any of these signs, see your doctor. He or she might need to change your medicines or take other steps to control your asthma.
Partner with your health care team and take an active role in your care. This can help you better control your asthma so it doesn't interfere with your activities and disrupt your life.
Asthma is a lung disease that makes it harder to move air in and out of your lungs.
• Asthma is chronic. In other words, you live with it every day.
• It can be serious, even life-threatening.
• There is no cure for asthma, but it can be managed so you live a normal, healthy life.
More than 26 million Americans have asthma, including 6.1 million children.
It causes millions of lost school and work days every year and is the third leading cause of hospitalization among children.
There is no cure for asthma, but the good news is that it can be managed and treated, allowing you to live a normal, healthy life.
With asthma, the airways in your lungs are often swollen or inflamed. This makes them extra sensitive to things that you are exposed to in the environment every day, or asthma "triggers." A trigger could be a cold or the weather, or things in the environment, such as dust, chemicals, smoke and pet dander.
When you breathe in a trigger, the insides of your airways swell even more. This narrows the space for the air to move in and out of the lungs. The muscles that wrap around your airways also can tighten, making breathing even harder. When that happens, it's called an asthma flare-up, asthma episode or asthma "attack."
Asthma can start at any age. Sometimes, people have asthma when they are very young and as their lungs develop, the symptoms go away, but it's possible that it will come back later in life. Sometimes people get asthma for the first time when they are older.
Most people with asthma experience a tight feeling in the chest, shortness of breath, coughing or wheezing at some point in their life.
Asthma is a life-threatening disease, but it can be managed to minimize symptoms so people living with asthma can be active and healthy. Working in partnership with a healthcare provider is key to successfully managing asthma.
Together, you can find out the experiences or exposures, called "asthma triggers," that put you at the greatest risk for an asthma flare-up, the steps to take when you experience symptoms, and knowing when to see the doctor or seek immediate help.
Asthma Symptoms
Common asthma symptoms when your asthma is not well-controlled include a tight feeling in the chest, shortness of breath, coughing and wheezing.
It's important to recognize these signs and talk to your doctor so you can be symptom-free, active and healthy. Learn more about asthma symptoms.
Asthma Causes
Understanding the experiences or exposures that make your asthma flare-up is a key step to better managing your asthma.
Making a plan to avoid or limit your exposure to your asthma triggers can eliminate asthma symptoms and put you on the right track to better control your asthma.
These factors play an important role in the development of asthma.
Asthma Risk Factors
A combination of genetics and exposures to certain elements in the environment put people at the greatest risk of developing asthma for the first time.
Understand if you are at risk for developing asthma and get tips to protect your lungs.
Asthma is a disease that requires a diagnosis by a healthcare professional and ongoing assessments and monitoring throughout your lifetime.
At the initial visit, your asthma care provider will determine your level of severity and create a treatment plan.
At each follow-up visit, they will assess your asthma control and adjust your treatment plan as needed.
How Is Asthma Diagnosed?
To diagnose asthma, your doctor will evaluate your symptoms, ask for your complete health history, conduct a physical exam and look at test results.
Here's what to expect.
http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/diagnosing-treating-asthma/how-is-asthma-diagnosed.html
How Is Asthma Treated?
A variety of medicines can help control asthma, but regular healthcare and an action plan are important parts of your treatment.
Learn about ways to treat asthma.
http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/diagnosing-treating-asthma/how-is-asthma-treated.html
There are a variety of medicines available to treat asthma, but there is no "best" medicine for all people. Each person's asthma is different and your healthcare provider and healthcare team can work with you to set up the best plan for you based on your symptoms and needs.
By taking the right medicine at the right time, you can:
• Breathe better
• Do more of the things you want to do
• Have fewer asthma symptoms
There are many good treatments for asthma available today.
Some asthma medicines relax your airways and help you breathe easier, while other treatments reduce the swelling and inflammation in your airways, and some medicines help prevent asthma symptoms.
It's important to follow your healthcare provider's advice about your treatment and take your medicines as directed.
Other medicines may be needed if your asthma starts to get worse.
If your asthma is getting worse, visit your doctor, discuss what is new in asthma treatment and start treatment as soon as your symptoms begin.
Types of Medicines Usually Prescribed for Asthma
■ Bronchodilators
Bronchodilators relax the muscles around the airways (breathing tubes). When the airways are more open, it is easier to breathe.
There are two general types of bronchodilators, and you may be prescribed one or both types:
• Short-Acting bronchodilators work quickly after you take them so that you feel relief from symptoms quickly.
• Long-Acting bronchodilators have effects that last a long time. They should not be used for quick relief.
These medications are only recommended for use when combined with an anti-inflammatory asthma medicine (see below).
■ Anti-Inflammatories
Anti-inflammatory medicines reduce the swelling and mucus production inside the airways. When that inflammation is reduced, it is easier to breathe. These medicines also are called corticosteroids or steroids.
Most often, these are inhaled medications and it is important to rinse out your mouth with water immediately after using them to avoid getting thrush, a yeast infection in your throat.
Some corticosteroids come in pill form and usually are used for short periods of time in special circumstances, such as when your symptoms are getting worse.
■ Combination Medicines
There are a few medicines that combine inhaled bronchodilators and inhaled corticosteroids.
■ Anticholinergics
Anticholinergics (an-ti-cho-lin-er-gics) are a class of medicines that prevent muscle bands from tightening around the airways.
The medicine can be inhaled using a metered-dose inhaler or nebulized from a solution.
This type of medicine is typically used in combination with an inhaled corticosteroid and should be taken daily for long-term control.
They are often added on to treatment to relieve cough, mucus production, wheeze or chest tightness.
■ Severe Asthma Treatments
For more severe forms of asthma that are not well-controlled with standard therapy, there are several approved medicines now available.
Research has helped to identify different types of airway inflammation in asthma such as allergic (atopic) and eosinophilic asthma (eosinophils are a type of while blood cell associated with allergies).
Studies have found targeted therapies for each of these subgroups (or phenotypes) in asthma. These medicines are administered in your doctor’s office once a month by either a shot or IV.
■ Antibiotics
People with asthma can have flare-ups that may be caused by bacterial or viral infections. Your doctor may want you to have a prescription for an antibiotic or an anti-viral that you keep on hand. You will be instructed to have this prescription filled if you have an infection coming on.
It is important to take an antibiotic exactly as prescribed and to take it all, even if you start to feel better before it is all used up. If you do not take it all, the infection may come back and be even stronger and harder to treat.
How to Get the Most out of Your Asthma Medicine
Asthma medicines do not cure asthma, but they can help improve your symptoms. The most important thing is to take your medicine(s) exactly as your healthcare provider has instructed you to take them. That means, taking the right medicine at the right time and with the proper technique!
When using metered-dose inhalers, which can be either a quick-relief medicine or a long-term control medicine, the American Lung Association suggests that you use a valved holding chamber to get the most of your medicines. Haven't heard of this device? Learn more about valved holding chambers and spacers.
Set up a system that will work best for you and the people who help care for you:
• Make a medicine schedule showing what you take and when
• Ask a friend or family member to help you organize your "system"
• Connect taking your medicine with your routine habits, such as before or after certain meals or when you brush your teeth in the morning or evening
• Set an alarm to ring
• Use a weekly pill box that has sections for each day and different times of the day
If you are having asthma symptoms, are not sure if you are taking your medicine correctly, or if you are experiencing bothersome side effects, talk to your healthcare provider or another member of your healthcare team. They can help make sure you understand the correct way to take the medicines, or they may want to adjust the medicines you are taking.
Also, if you are denied a medicine because it is not covered by your health insurance, be sure to talk to your doctor. Sometimes they can help you get the medicines approved or put you on a different medicine that is covered by your insurance.
Never before have we had so many good, safe oral and inhaled drugs for the treatment of asthma as we do today. It is important that the drug regimen be carefully tailored to the needs of the individual. This can be achieved by working with your physician to determine the optimum medical regimen designed to achieve control over your athma. Learn about different treatment and medication options for asthma below.
Quick-Relief Medications
Quick-relief medications are used to treat lung disease symptoms or an acute episode (such as an asthma attack).
Long-Term Control Medications
Long-term control medications are used daily to maintain control of asthma symptoms.
Devices for Inhaled Medications
There are a number of devices that help deliver inhaled lung medications directly to the airways: metered-dose inhalers, dry powder inhalers and nebulizers.
Interactions and Complications
Learn about possible effects of asthma medications.
Alternative Therapies
Along with medications, additional therapies may assist in managing asthma on a daily basis.
Managing Medications
Managing your medications is also an important task. Read tips that will help you manage your medication supply.
Asthma Medications During Pregnancy
Learn about medicine safety categories and how to make decisions about medication during pregnancy.
Quick-relief medications are used to treat asthma, other lung disease symptoms or an acute episode (such as an asthma attack or COPD exacerbation). Many of these medications are inhaled and start to work within a few minutes.
Learn more about the following quick-relief asthma and other lung disease medications:
• 1. Short-Acting Beta-Agonists
Short-acting beta-agonists work quickly to relieve asthma and other lung disease symptoms. Beta-agonists relax the smooth muscles around the airways.
• 2. Anticholinergics
Anticholinergics are quick-relief asthma and lung disease medications, but slower than short-acting beta-agonists.
• 3. Oral Steroids (Steroid Pills and Syrups)
Steroid pills and syrups are often used to treat severe asthma or other lung disease episodes. They reduce swelling and help other asthma medicines work better.
(Note: An inhaled steroid is typically prescribed as a long-term control medicine. An inhaled steroid will not provide quick relief for acute attacks.)
Short-acting beta-agonists works quickly to relieve acute symptoms of shortness of breath.
Beta-agonists relax the smooth muscles around the airways. Your doctor may prescribe a beta-agonist to use as needed to relieve acute symptoms of shortness of breath.
If you use this medicine for shortness of breath more than twice a week talk with your doctor.
If you use more than one of these metered-dose inhalers in a month, also talk with your doctor.
It is a sign that your lung disease is poorly controlled and your long-term control medications may need to be adjusted.
Medicine name
• Maxair Autohaler® (pirbuterol)
• Proventil HFA®, ProAir®, and Ventolin HFA® (albuterol)
• Xopenex® (levalbuterol)
How the medicine works
• Works quickly to relieve acute attack symptoms
• Relax the smooth muscles around the airways
• Side effects may include: increased heart rate, shakiness, nervous, jittery feeling
How the medicine is used
• Available as MDI, nebulizer solution
• Usually prescribed on an as needed basis to relieve acute attack symptoms.
• May be prescribed as a "pre-treatment" before exercise to prevent symptoms of shortness of breath.
• If you use this medicine for shortness of breath more than twice a week talk with you doctor. If you use more than one metered-dose inhaler a month, also talk with your doctor or healthcare professional. This is a sign that your lung disease is not under good control and your long-term control medicine needs to be adjusted.
Atrovent® (ipatropium) is a quick-relief medication. Atrovent® opens the airway by blocking reflexes through nerves that control the smooth muscle around the airways.
It is slower-acting than the short-acting beta-agonists and can take 15-20 minutes to show a significant effect.
Atrovent® may be useful following an inhaled beta-agonist to achieve a longer-lasting effect, especially during an acute attack.
Atrovent® is available in two inhaled forms: as a metered-dose inhaler, and in a form suitable for use with a nebulizer.
Albuterol and ipatropium can be combined in one medicine. Combivent® is a combination inhaled medicine. DuoNeb® is a combination solution for the nebulizer.
How are steroid pills and syrups used?
Steroid pills and syrups are very effective at reducing swelling and mucus production in the airways. They also help other quick-relief medication work better. They are often necessary for treating more severe episodes of lung disease.
Common steroid pills and liquids include:
Medicine name:
• Deltasone® (prednisone)
• Medrol® (methyl-prednisolone)
• Orapred®, Prelone®, Pediapred® (prednisolone)
How the medicine works?
• Very effective in reducing inflammation in the airways
• Help other quick-relief medicines work better
• The steroids used treating lung disease are corticosteroids and are not the same as the anabolic steroids used illegally by some athletes for bodybuilding. Corticosteroids do not affect the liver or cause sterility
How the medicine is used?
• Available as pills and syrups. Often necessary for treating more severe episodes of asthma
• Usually prescribed as a "burst": 2-7 days, occasionally up to several weeks (see below)
• Side effects with a burst may include increase appetite, fluid retention, moodiness and upset stomach
• For very severe lung disease, routine daily steroid pills may be required. Because long-term treatment can lead to significant side effects, anyone on daily steroid pills should be under the care of an asthma or pulmonary specialist.
What is a steroid burst?
Many people with chronic lung disease periodically require a short-term burst of steroid pills or syrups to decrease the severity of acute attacks and prevent an emergency room visit or hospitalization.
A burst may last two to seven days and may not require a gradually decreasing dosage. For others, a burst may need to continue for several weeks with a gradually decreasing dosage.
You may experience a few mild side effects such as increased appetite, fluid retention, moodiness and stomach upset. These side effects are temporary and typically disappear after the medicine is stopped.
What about routine steroids?
Some people with a chronic lung disease require the use of steroid pills or syrups as part of their routine treatment for weeks, months or longer.
In several lung diseases, the main treatment is high-dose steroid pills for several months or longer.
If you have asthma, it is important that your treatment include an adequate dosage of an inhaled steroid before beginning routine steroid pills.
We recommend that anyone requiring routine steroid pills be under the care of a specialist (pulmonologist or allergist).
What about routine steroid use and side effects?
The use of routine steroid pills or frequent steroid bursts can cause a number of side effects. Steroid side effects usually occur after long-term use with high doses of steroid pills.
Side effects, which may occur in some people taking high-dose steroid pills, include:
| Side Effects | Prevention &/or Treatment of Side Effects |
|
■ Endocrine (hormones): • Suppression of the adrenal glands • Delayed sexual development • Changes in menstrual cycle • Increase and change in fat placement causing fullness in the face and weight gain • Increased blood sugar (diabetes) • Emotional changes such as moodiness, depression, euphoria or hallucinations. ■ Fluid and Electrolytes • Salt and water retention • High blood pressure (hypertension) • Loss of potassium ■ Eyes • Increased pressure in the eye (glaucoma) • Clouding of vision in one or both eyes (cataracts) ■ Skin • Increase in body hair and acne • A tendency to bruise easily • Thinning of the skin and poor wound healing ■ Nutrition • If you are eating more food, be sure you choose low-fat, low-sugar items to control calories. Ask your healthcare provider or dietitian to help you with a specific diet plan. • Eat a well balanced diet that meets the Food Pyramid Guidelines. • Take your steroid dose with food to decrease stomach irritation. ■ Muscles • Muscle weakness or cramps ■ Bones • Joint pain (especially as steroids are decreased) • Thinning of bones (osteoporosis) may lead to fractures or compressions, especially of the backbone and the hip • Loss of blood supply to bones (aseptic necrosis) may cause severe bone pain and may require surgical correction ■ Immune System • General suppression of the immune system causes an increased risk to a variety of infections, for example chickenpox |
■ Endocrine (hormones): • Your healthcare provider may prescribe your steroid pills at specific times. Make sure you take your steroid pills as prescribed and do not stop them suddenly. • If you have taken oral steroids, talk with your healthcare provider about obtaining a medical alert bracelet. • Talk with your healthcare provider if you are having moodiness or depression that doesn't seem to get better. ■ Fluid and Electrolytes • Limit the amount of salt and foods that are high in sodium to prevent fluid retention and swelling. Condiments and processed foods tend to be high in sodium. • Add foods that are high in potassium to your diet. ■ Eyes • Visit the eye doctor (Ophthalmologist) at least yearly. Inform him or her that you take steroid pills routinely. ■ Skin • Ask your healthcare provider about how acne can be treated. • Keep the skin well moisturized. ■ Nutrition • Increase in appetite • Irritation of stomach and esophagus with possible ulcer symptoms and, rarely, bleeding ■ Muscles • Routine exercise may be recommended to prevent or decrease muscle weakness. ■ Bones • To prevent osteoporosis (loss of calcium in the bones), it is important to eat foods high in calcium, such as dairy products. If you need to control calories, low fat dairy products may be used. • Your healthcare provider or dietician may recommend certain supplements, such as calcium, vitamin D and a multi-vitamin. • Weight bearing exercise may also be recommended by your healthcare provider. • Medication may be prescribed to improve osteoporosis. ■ Immune System • Good handwashing • Avoid exposure to any infectious disease. • If you or your child is exposed to chicken pox or measles while receiving oral steroids or high dose inhaled steroids, notify your healthcare provider immediately to determine if any special treatment is needed. |
Want to learn more about steroids?
Learn the basics about steroids including what corticosteroids are; what steroids are produced in the body; some more steroid medicines; important dosing considerations; and our research on steroids.
Learn more about some common inhaled steroids including how inhaled steroids are typically prescribed; how the dosage of steroids is determined; side effects of inhaled steroids, and some recommendations to decrease or prevent side effects.
Long-term control medications are taken daily to control and prevent lung disease symptoms. These medicines should be taken every day to prevent asthma symptoms even when the asthma seems better.
Long-term control medication is an important part of a treatment program for individuals with persistent asthma. These medicines are helpful in preventing symptoms but should not be used to relieve symptoms.
Several different types of long-term control asthma medications:
■ Combination Medications
Combination medicines combine an inhaled steroid with a long-acting beta-agonist. They improve symptoms of lung disease and increase lung function.
■ Inhaled Steroids
Inhaled steroids are the most effective long-term control medicine currently available. They improve symptoms of lung disease and increase lung function.
■ Oral Steroids (Steroid Pills and Syrups)
Steroid pills and syrups reduce swelling and help other asthma medicines work better.
■ Theophylline
Theophylline, a long-term asthma control medication, is used for asthma control, but not as the first choice of medications.
■ Anti-IgE
Anti-IgE is a form of treatment for asthma management and allergic diseases. This medication may be added to medications in people with severe, persistent asthma.
■ Leukotriene Modifiers
Leukotriene modifiers are long-term control asthma medications that reduce swelling inside the airways and relax smooth muscles around the airways. They are effective at improving asthma symptoms and lung function, but not to the same extent as inhaled steroids.
A combination treatment for some lung diseases like asthma combines an inhaled steroid with a long-acting beta agonist.
The inhaled steroid prevents and reduces swelling inside the airways.
The long acting beta-agonist opens the airways in the lungs by relaxing smooth muscle around the airways.
In studies, a combination medicine like this reduced asthma symptoms and improved lung function.
It is a convenient way to take these two medicines, which are both helpful in controlling, moderate to severe persistent asthma.
Common combination asthma medications include:
Medicine name
• Advair® (combination of fluticasome and salmeterol)
• Dulera® (combination of mometasone and formoterol)
• Symbicort® (combination of budesonide and formoterol)
How the medicine works
• Prevents inflammation and reduces swelling inside the airways
• Opens the airways in the lung by relaxing smooth muscle around the airways
How the medicine is used
• Available as an MDI and dry powder inhaler
• Usually prescribed to take 2 times every day
• Talk with your doctor about side effects.
What are some common inhaled steroids?
Common inhaled steroids include:
• Asmanex® (mometasone)
• Alvesco® (ciclesonide)
• Flovent® (fluticasone)
• Pulmicort® (budesonide)
• Qvar® (beclomethasone HFA)
How are inhaled steroids typically prescribed?
An inhaled steroid is typically prescribed as a long-term control medicine. This means that it is used every day to maintain control of your lung disease and prevent symptoms.
An inhaled steroid prevents and reduces swelling inside the airways, making them less sensitive. It may also decrease mucus production.
In addition, inhaled steroids may help reduce symptoms associated with other chronic lung conditions.
An inhaled steroid will not provide quick relief for asthma symptoms.
Inhaled steroids are the most effective long-term control medicine currently available for asthma. They improve asthma symptoms and lung function. They also have been shown to decrease the need for oral steroids and hospitalization.
How is the dosage of steroids determined?
Your health care provider may adjust the dosage of your inhaled steroid based on your symptoms, how often you use your quick relief medicine to control symptoms and your peak flow results.
You still may need a short burst of oral steroids when you have more severe symptoms.
Learn about important considerations when your dosage changes.
What about side effects and inhaled steroids?
The most common side effects with inhaled steroids are thrush (a yeast infection of the mouth or throat that causes a white discoloration of the tongue), cough or hoarseness.
Rinsing your mouth (and spitting out the water) after inhaling the medicine and using a spacer with an inhaled metered-dose-inhaler reduces the risk of thrush.
When a dose is prescribed that is normal or higher than the normal dose in the package insert, some systemic side effects may occur.
Keep in mind, however, that an inhaled steroid has much less potential for side effects than steroid pills or syrups.
There have been concerns regarding the possibility of growth suppression in children. Recent studies have not shown growth suppression over several years of treatment.
What are some recommendations to minimize or prevent steroid side effects?
• Take your long-term control medicines as prescribed to keep your chronic lung disease under good control. This will help decrease the steroid pills to the lowest possible dose.
• Monitor your lung disease. If you notice your peak flow numbers are decreasing, or you are having increased symptoms, call your health care provider.
A short burst of steroid pills given early may prevent the need for a longer burst if treated later.
Want to learn more about steroids?
Learn the basics about steroids including what corticosteroids are; what steroids are produced in the body; some more steroid medicines; important dosing considerations; and our research on steroids.
Learn more about some common steroid pills and syrups (oral steroids) including how oral steroids are used, what a 'steroid burst' is, and routine use and possible side effects.
Theophylline, another long-term asthma control medication, is available as a tablet, capsule, or syrup.
Theophylline relaxes the smooth muscles around the airways.
A theophylline blood level between 5-15 mcg/ml usually gives relief of symptoms while avoiding side effects.
Theophylline is not one of the first medications used for long-term control of asthma or other chronic lung diseases. There are safer and more effective medicines available, such as inhaled steroids and leukotriene modifiers.
Side Effects
The side effects of theophylline may include stomach upset, headache and although rare, seizures and heart arrythmias.
In addition, blood levels need to be monitored and certain medicines can cause theophylline levels to increase.
Common Theophyllines
Medicine Name
• Uniphyl®
• Theo-24 and others (theophylline)
How the Medicine Works
• Relaxes the smooth muscles around the airways
• Needs to be taken on a regular schedule to maintain a blood level
• Theophylline blood level between 5-15 mcg/ml usually gives relief of symptoms while avoiding side effects.
• There are safer and more effective medicines available, such as inhaled steroids and leukotriene modifiers.
How the Medicine is Used
• Available as pills, syrups
• Prescribed to take 1-2 times every day, depending on the product
• Common side effects may include difficulty sleeping, stomach upset, headache and increased irritability.
• Many people experience side effects for the first few days of taking theophylline, and then the side effects decrease or disappear.
• If side effects continue or worsen, notify your doctor.
• Notify your doctor if you have a fever of 100 degrees F or more for 24 hours.
• May need a blood test to monitor levels in the blood.
Anti-IgE is a form of treatment for allergic conditions that has been approved for the treatment of moderate to severe persistent asthma and chronic idiopathic urticaria (hives with an unknown cause). Anti-IgE interferes with the function of IgE. IgE is an antibody in the immune system.
How does anti-IgE work?
Allergens (such as pollens) are introduced to the body. Pre-made IgE against these allergens attaches to them and tells the rest of the immune cells to initiate an allergic reaction. This may bring on symptoms such as coughing, wheezing, nasal congestion, hives and swelling.
Anti-IgE attaches to IgE in the blood and helps prevent the allergic reaction.
What anti-IgE medicine is available now?
Omalizumab (Xolair®) is the anti-IgE medicine now available.
Xolair is made to be similar to natural antibodies and is designed specifically to capture most of the IgE and block the allergic response.
Xolair is approved by the FDA for use with patients 6 years of age and older who:
• Have incomplete control of moderate to severe persistent asthma
• Have year-round allergies
• Are taking routine inhaled corticosteroids.
Xolair has been shown to decrease asthma episodes in some of these patients.
Xolair has also been approved for patients 12 years of age and older who:
• Have chronic idiopathic urticaria (CIU; chronic hives without a known cause) who continue to have hives that are not controlled by conventional antihistamine treatments.
Xolair is given by a shot (injection) one to two times a month. The shots are given in the doctor’s office. The dosage varies, depending on the person's diagnosis, weight and IgE blood level.
Xolair is a long-term control medicine. This means it is given routinely to prevent asthma symptoms. It is not a quick relief medicine. Some patients improve quickly. Some patients show a gradual benefit. Xolair does not appear to work for all patients.
Are there any side effects or adverse reactions to Xolair?
Common side effects of Xolair include a reaction at the injection site, viral infections, upper respiratory tract infection, sinusitis, headache, sore throat, pain, dizziness, nausea and vomiting. These side effects were about as common in patients who received placebo injections.
Several rare, yet severe side effects were reported in the original studies. They include malignancy and anaphylaxis.
In the initial studies, cancers (including breast, skin, prostate and salivary gland) were seen in 0.5 percent (20 of 4127) of patients treated with Xolair. The rate was 0.2 percent (5 of 2236) in patients treated with the placebo dose. A subsequent 5-year study of 5007 Xolair treated and 2829 non-Xolair treated adolescent and adult patients found similar rates of primary cancers (per 1000 patient years) in each group (12.3 compared to 13.0 respectively).
In the initial studies, anaphylaxis was seen in less than 0.1 percent of the patients treated with Xolair. Since Xolair was approved in June 2003, additional reports of anaphylaxis have been reported to the FDA. Information was gathered from about 57,300 patients treated with Xolair (from June 2003-December 2006). The reaction rate was estimated to be 0.1 percent and at least 0.2 percent. The serious reactions occurred in at least 1 of every 1,000 patients. The reactions these patients had included combinations of symptoms of anaphylaxis.
** Symptoms of anaphylaxis include:
• Increased trouble breathing, coughing, chest tightness or wheezing
• Dizziness, fainting, rapid or weak heartbeat
• Swelling in the mouth and throat or trouble swallowing
• Flushing, itching, hives or a feeling of warmth
• Vomiting, diarrhea, or stomach cramping.
Although rare, an anaphylaxis reaction can be serious and life-threatening. An anaphylactic reaction may occur with the first dose or after any dose of Xolair. The reaction may occur soon after the shot is given. It may also occur 24 hours or more after the shot is given.
What's the safest way to get anti-IgE injections?
Although anaphylaxis is rare, several steps improve your safety when receiving Xolair are:
• The Xolair shots are given in the doctor’s office.
• You will need to stay at the doctor’s office for 2 hours after the initial three shots are given. After the initial three shots, you will need to stay in the doctor's office for 1 hour after the subsequent shots.
• The doctor’s office should be readily able to rapidly recognize and treat an anaphylactic reaction.
• You will be instructed in the use of an epinephrine auto-injector. This is an easy-to-give shot that you can use if having an anaphylactic reaction after leaving the doctor’ office.
• You should wear a medical alert bracelet.
• If you feel you are having an anaphylactic reaction, you need to get medical help right away.
Although anaphylaxis is very rare, these steps can increase your safety when receiving anti-IgE treatment.
Remember to talk with your doctor if you have any questions.
Leukotriene modifiers are long-term asthma control medications. They reduce swelling inside the airways and relax smooth muscles around the airways.
Leukotriene modifiers are available as pills and liquids.
They are effective at improving asthma symptoms and lung function, but not to the same extent as inhaled steroids.
Common leukotriene modifiers include:
• Accolate® (zafirlukast)
• Singulair® (montelukast)
• Zyflo® (zileuton)
How the Medicine Works?
• Reduces inflammation inside the airways
• Relaxes the smooth muscles around the airways
How the Medicine is Used?
• Available as pills, syrup
• Prescribed to take 1-2 times every day
• Can interact with other medicines
Bronchodilators relieve asthma symptoms by relaxing the muscle bands that tighten around the airways. This action rapidly opens the airways, letting more air come in and out of the lungs. As a result, breathing improves. Bronchodilators also help clear mucus from the lungs. As the airways open, the mucus moves more freely and can be coughed out more easily.
There are two forms of bronchodilators:
• Short-acting bronchodilators relieve or stop asthma symptoms; you take these to stop an asthma attack.
• Long-acting bronchodilators help control asthma symptoms by keeping the airways open for 12 hours; this helps prevent asthma attacks.
There are two main types of bronchodilator medicines:
• Beta 2-agonists (short and long-acting forms)
• Anticholinergics.
Short-acting Beta 2-agonists inhaled medicines include:
• Albuterol (Proventil® HFA, Ventolin® HFA, ProAir®HFA, Accuneb®)
• Levalbuterol (Xoponex® HFA, Xoponex® nebulizer solution)
• Pirbuterol (Maxair®)
• Albuterol and ipratropium bromide combination (DuoNeb® solution, Combivent Respimat®)
If you need to use your short-acting beta 2-agonists more than twice per week, talk to your doctor. This is a sign of unstable asthma and your doctor may want to change the dose of the long-term control medicines you take.
Long-acting/Beta 2-agonists include:
• Salmeterol (Serevent®)
• Formoterol (Foradil®)
• Combination medications: salmeterol and fluticasone (Advair®); formoterol and budesonide (Symbicort®); formoterol and mometasone (Dulera®). These contain both the long-acting beta agonist and an inhaled corticosteroid.
Anticholinergic drugs
There are two anticholinergic bronchodilators currently available — ipratropium bromide (Atrovent® HFA), which is available as a metered dose inhaler and nebulizer solution, and tiotropium bromide (Spiriva®), which is a dry powder inhaler.
Theophylline
Theophylline is another type of bronchodilator that is used to control asthma. Brand names include Uniphyl®, Elixophyllin®, Theochron and Theo-24®.
■ Beta 2 Agonists
Beta 2 Agonists are a group of medications formulated to act on special receptors called beta-2 receptors, located predominantly on smooth muscle and mucous membrane in the lungs and smaller airways. They also act on cells called mast cells to prevent release of substances which play a role in asthma attacks. Additionally, they may help clear mucous from the lungs. As the airways dilate, any mucous present can move more freely and can be coughed out of the airways.
• Short/Intermediate acting agents: Salbutamol, Isoproterenol, Albuterol, Metaproterenol, Terbutaline.
Increasing usage of beta agonists is a sign of unstable asthma, that needs to be better controlled. If you need to use your short acting beta agonist more than 2-3 times a week, you should seek your doctor about management of your asthma.
• Longer acting agents: Salmeterol and Formoterol
It has been suggested that bronchodilator medications taken through the mouth or given as an injection into the veins is more effective than inhaled routes of delivery because this allows bypassing of mucous plugs that may block the airways. However, there is an increased risk of side effects associated with these modes of delivery. There have been clinical studies performed which compare beta agonists given by two different routes – nebulised (inhaled) and intravenously (through the veins). Some earlier studies suggested advantages with giving medications through the veins, but subsequent studies with medications such as terbutaline and albuterol have demonstrated equivalent or superior effects on lung function using the nebulized (inhalation) route.
The muscarinic receptor antagonists are a group of bronchodilators that includes medications such as ipratropium and oxitropium. The drug used most commonly in treatment of asthmatics is ipratropium. There are sensory nerve endings present in the lining of our airways – when these are activated, they induce constriction and narrowing of the airways. Muscarinic receptor antagonists act to relax constriction of airways due to activation of these nerves by stimulation of the parasympathetic system. These medications have been shown to be particularly effective in allergic irritant asthma. As their name suggests, muscarinic receptor antagonists act to block muscarinic receptors, but they do not discriminate between the different types.
They can help decrease mucous secretion and may increase the lung’s ability to clear airway secretions. Muscarinic receptor antagonists are given via inhaled delivery systems, (ie through the nose) because they are not well absorbed into the body’s circulation. Their peak effect occurs about 30 minutes after administration, lasting for about 3-5 hours. Often, these medications are used with the beta 2 adrenoceptor antagonists. Ipatropium can also be used to dilate the airways in patients with chronic bronchitis and to treat spasm of the airways precipitated by beta 2 adrenoceptor antagonists. It has been shown to be as effective as inhaled beta 2 agonists in the treatment of stable lung disease. These medications are often employed in maintenance treatment of patients with lung disease such as bronchitis, emphysema, and severe asthma.
■ Xanthines
There are three main active, naturally occurring methylxanthines – theophylline, theobromine and caffeine. Theophylline is the most commonly used xanthine in treatment of asthma, also used as aminophylline. Theophylline has a proven dilatory action on the airways, although it is less effective compared to the beta 2 adrenoceptor agonists.
Mode of Medication Delivery:
The inhaled route of delivery is the preferred route of drug administration for patients with asthma and other lung diseases. This offers the greatest and quickest deposition of drug straight into the lungs, resulting in the lowest effective dose and the least side effects. Inhaled medications can be given via nebulisers, metered dose inhalers or dry powder inhalers. For the most effective administration of inhaled medications, you musts have a correct technique when using the delivery devices. An asthma education nurse is often very helpful and educational in these circumstances. Most cases of asthma respond well to regular low dose corticosteroids and inhaled beta 2 agonists, used as needed. Beta 2 agonists have been proven to be the most effective and rapidly acting agents acting to dilate the airways immediately, for asthma treatment. Increasing use of bronchodilator therapy should alert you to review the current management of your disease, as this may indicate that you have not gained the most effective control of disease.