Treatment Overview

Although asthma cannot be cured, you can manage the symptoms with medicines, especially inhaled corticosteroids and beta2-agonists. You will probably work with your doctor to develop an asthma action plan. This plan will help you meet treatment goals and get your asthma under control. The goals of asthma treatment are to:¹⁹

• Prevent symptoms.
• Keep your peak flow and lung function as close to normal as possible.
• Be able to do your normal daily activities, including work, school, exercise, and recreation.
• Prevent asthma attacks.
• Have few or no side effects from medicine.

For more information, see:

Asthma: Taking Charge of Your Asthma.

Emergency treatment

If you have a severe asthma attack (the red zone of your asthma action plan), use medicine based on your action plan and talk with a doctor immediately about what to do next. This is especially important if your peak expiratory flow (PEF) does not return to the green zone or stays within the yellow zone after you take medicine. You may have to go to the hospital or an emergency room for treatment. Be sure to tell the emergency staff if you are pregnant.

At the hospital, you will probably receive inhaled beta2-agonists and corticosteroids. You may be given oxygen therapy. Your lung function and condition will be assessed. Depending on your response, further treatment in the emergency room or a stay in the hospital may be needed.

Some people are at increased risk of death from asthma, such as people who have been admitted to an intensive care unit for asthma or who have needed a breathing tube (intubation) for asthma. These people need to seek medical care early when they have symptoms.

Medical checkups

You need to monitor your asthma and have regular checkups to keep it under control and to ensure correct treatment. Checkups are recommended every 1 to 6 months, depending on how well your asthma is controlled.

During checkups, your doctor will ask whether your symptoms and peak expiratory flow have held steady, improved, or become worse and will ask about asthma attacks during exercise or at night. You track this information in an asthma diary. You may be asked to bring your inhaler and peak expiratory flow meter to an appointment so your doctor can see how you use them.

Initial treatment

There are many components to managing asthma. After your diagnosis, your doctor may only discuss what you need to know immediately. These include:

• Oral or injected corticosteroids (systemic corticosteroids). These medicines may be used to get your asthma under control before you start taking daily medicine. In the future, you also may take oral or injected corticosteroids to treat any sudden and severe symptoms (asthma attacks), such as shortness of breath. Oral corticosteroids are used more than injected corticosteroids. Oral corticosteroids include prednisone and methylprednisolone.
• Inhaled corticosteroids. These are the preferred medicines for long-term treatment of asthma. They reduce the inflammation of your airways, and you take them every day to keep asthma under control and to prevent asthma attacks. Inhaled corticosteroids include mometasone, triamcinolone, fluticasone, budesonide, and ciclesonide.
• Short-acting beta2-agonists. These medicines are used for asthma attacks. They relax the airways, which allows you to breathe easier. Short-acting beta2-agonists include albuterol and pirbuterol.
• A combination of an inhaled corticosteroid and long-acting beta2-agonist. This combination is often used to treat persistent asthma.
• Basic education about asthma. The more you know about asthma, the more likely it is you will control symptoms and reduce the risk of asthma attacks. Keep in mind that even severe asthma can be controlled. And cases where the condition cannot be controlled are unusual.
• Instruction on how to use a metered-dose inhaler (MDI) or dry powder inhaler (DPI). Inhalers deliver medicine directly to the lungs. If you use your inhaler correctly, you can control your symptoms and avoid asthma attacks that can send you to the emergency room. Most doctors recommend using a spacer with an MDI. For more information, see:

  Asthma: Using a Metered-Dose Inhaler.

  Asthma: Using a Dry Powder Inhaler.

Your short-term goal is to control your current symptoms. Long-term, your goal is to prevent symptoms so that asthma does not impact your daily activities.

Special considerations in treating asthma include:

• Managing asthma during pregnancy. If a woman had asthma before becoming pregnant, her symptoms may get better or worse during pregnancy. Pregnant women whose asthma is not well controlled may be at risk for a number of complications.
• Managing asthma in older adults. Older adults tend to have worse asthma symptoms and a higher risk of death from asthma than younger people. They may also have one or more other health conditions or take other medicines that can make asthma symptoms worse.
• Managing exercise-induced asthma. Exercise often causes asthma symptoms. Steps you can take to reduce the risk of this include using medicine immediately before you exercise.
• Managing asthma before surgery. People who have moderate to severe asthma are at higher risk of having problems during and after surgery than people who do not have asthma.
• Managing asthma symptoms at night. Sometimes allergens that get in the airway can cause problems up to 8 hours later. This is called a late allergic response (LAR). Or your controller medicine may wear off during sleep, causing you to wake up. Your doctor may be able to change the dose or timing of medicine to make sure it lasts through the night.

Ongoing treatment

After your initial treatment for asthma, it is important to learn more about the condition and develop an overall plan to manage the disease. You and your doctor will work together to do this. Because asthma develops from a complex interaction of genetics, environmental factors, and the reaction of the immune system, no one management plan is effective for everyone.

Asthma management consists of:

• An asthma action plan. An asthma action plan tells you which medicines to take every day and how to treat asthma attacks. It also may include an asthma diary where you record your peak expiratory flow (PEF), symptoms, and triggers. This helps you identify triggers that can be changed or avoided, be aware of your symptoms, and know how to make quick decisions about medicine and treatment. See an example of an asthma action plan(What is a PDF document?). For more information, see:

  Asthma: Using an Asthma Action Plan.

• Monitoring peak expiratory flow. It is easy to underestimate the severity of your symptoms. You may not notice them until your lungs are functioning at 50% of your personal best peak expiratory flow (PEF). Measuring PEF is a way to keep track of asthma symptoms at home. It can help you know when your lung function is becoming worse before it drops to a dangerously low level. You can do this with a peak flow meter. For more information, see:

  Asthma: Measuring Peak Flow.

• A plan to deal with factors that can make asthma worse (triggers). Being around triggers increases symptoms. Try to avoid situations that expose you to irritants (such as smoke or air pollution) or to substances (such as animal dander) to which you may be allergic. If substances at work are causing your asthma or making it worse (occupational asthma), you may have to change jobs. See information on:

  Asthma: Identifying Your Triggers.

• A plan to treat other health problems. If you also have other health problems, such as inflammation and infection of the sinuses (sinusitis) or gastroesophageal reflux disease (GERD), you will need treatment for those conditions.

• Using your prescribed medicines correctly. Your doctor may adjust your medicines depending on how well your asthma is controlled. Medicines include:
  • Inhaled corticosteroids. These are the preferred medicines for long-term treatment of asthma. Inhaled corticosteroids include mometasone, triamcinolone, fluticasone, budesonide, and ciclesonide.
  • Long-acting beta2-agonists (such as salmeterol and formoterol), which are used along with inhaled corticosteroids.
  • Oral or injected corticosteroids (systemic corticosteroids) to treat any sudden and severe symptoms (asthma attacks), such as shortness of breath. Oral corticosteroids are used more than injected corticosteroids. Oral corticosteroids include prednisone and methylprednisolone.
  • Quick-relief medicine, such as short-acting beta2-agonists and anticholinergics (ipratropium) for asthma attacks. If you are using quick-relief medicine on more than 2 days a week (except for exercise), you probably need to add or change controller medicine treatment. Overuse of quick-relief medicine can be harmful.
  • Leukotriene pathway modifiers (such as zafirlukast, zileuton, or montelukast).
• Education. Continue to learn about asthma. This questionnaire can help you find out what you already know about asthma and what you may need to discuss with your doctor.

If you have persistent asthma and react to allergens, you may need to have skin testing for allergies. Allergy shots (immunotherapy) may be helpful. For more information, see:

Allergies: Should I Take Allergy Shots?

You can expect to live a normal life if you control symptoms by following your asthma action plan. Control of your asthma symptoms can help keep your lungs as healthy as possible.

Special considerations in treating asthma include:

• Managing asthma during pregnancy. If a woman had asthma before becoming pregnant, her symptoms may become better or worse during pregnancy. Pregnant women whose asthma is not well controlled may be at risk for a number of complications.
• Managing asthma in older adults. Older adults tend to have worse asthma symptoms and a higher risk of death from asthma than younger people. They may also have one or more other health conditions or be taking other medicines that can make asthma symptoms worse.
• Managing exercise-induced asthma. Exercise often causes asthma symptoms. Steps you can take to reduce the risk of this include using medicine immediately before you exercise.
• Managing asthma before surgery. People who have moderate to severe asthma are at higher risk of having problems during and after surgery than people who do not have asthma.

Treatment if the condition gets worse

If your asthma is not improving, make an appointment with your doctor to:

• Review your asthma diary to see if you have a new or previously unidentified trigger, such as animal dander. Talk to your doctor about how best to avoid triggers.
• Review your medicines, to be sure you are using the right ones and are using them correctly.
• Review your asthma action plan, to be sure it is still suitable for your condition.
• Determine whether you have a condition with symptoms similar to asthma, such as sinusitis.
• Make sure you are using your inhaler correctly.

If your medicine is not working to control airway inflammation, your doctor will first check to see whether you are using the inhaler correctly. If you are using it correctly, your doctor may increase the dosage, switch to another medicine, or add a medicine to the existing treatment.

Your doctor may suggest other medicines, such as leukotriene pathway modifiers (zafirlukast, zileuton, or montelukast). Less commonly, your doctor may recommend mast cell stabilizers (cromolyn) or theophylline.

If your asthma does not improve, you may require more intensive treatment, including larger doses of corticosteroids or other medicine. An asthma specialist typically prescribes these medicines. For severe asthma that cannot be controlled with medicines, a newer treatment called bronchial thermoplasty may be used. For this therapy, heat is applied to the airways to reduce the thickness of the airways and improve the ability to breathe.^{20, 21}

If you have persistent asthma and react to allergens, you may need to have skin testing for allergies. Allergy shots (immunotherapy) may be helpful.

What to think about

If you have been diagnosed with asthma, it is important that you treat it. You may feel good most of the time—so much so that you find it hard to believe you have a long-lasting condition. But all asthma—even mild asthma—may result in changes to your airways that speed up and make worse the natural decrease in lung function that occurs as we age.³