The most effective treatment for asthma is identifying the triggers and avoiding exposure to those agents. Desensitization to allergens has been shown to be a treatment option for certain patients. Smoking cessation and avoidance of secondhand smoke is recommended for all asthmatics.
In patients with EIA, higher levels of ventilation and cold, dry air tend to exacerbate attacks. Therefore, it is advisable to avoid activities, which results in inhalation of large amounts of cold air such as skiing and running. Activities such as swimming in an indoor, heated pool with warm, humid air is less likely to provoke a response.
Drug therapy is aimed at the reduction of bronchospasm and airway inflammation. The medical treatment depends on the severity of the illness and the frequency of the symptoms. Medications used in the treatment of asthma may be divided into two categories: long-term control medications that are taken regularly and quick-relief medications that are taken for rapid relief of bronchoconstriction.
The 1997 NAEPP report recommends a two “step care” approaches to asthma therapy.1 One approach is to start therapy at the level consistent with the severity of the patient’s disease and increase treatment in steps if control is not obtained. The second therapy is more aggressive and focuses on initiation of therapy at a higher step than the patient’s level of disease severity and to gradually step down once control is achieved.
Bronchodilators are recommended for short-term relief in all patients. These are typically provided in pocket-sized, metered-dose inhalers (MDIs). No additional medication is needed for patients with occasional attacks. For patients with mild persistent disease characterized by more than two attacks a week, low-dose inhaled corticosteroid or alternatively, an oral leukotriene modifier, a mast-cell stabilizer or theophylline may be administered. For patients with daily attacks, a higher dose of glucocorticoid along with a long-acting inhaled β2 agonist may be prescribed. Alternatively, a leukotriene modifier or theophylline may substitute for the β2 agonist. In severe asthmatics, oral glucocorticoids may be added to these treatments during severe attacks.
Once the control is achieved, regular monitoring and follow-up are essential. A step up in therapy may be needed or a step down may be initiated in order to identify the minimum medication necessary to maintain control. With the proper use of prevention drugs, asthmatics can avoid the complications that result from overuse of relief medications.
- National Asthma Education and Prevention Program (National Heart, Lung, and Blood Institute) Second Expert Panel on the Management of Asthma. Expert panel report 2: guidelines for the diagnosis and management of asthma. Bethesda, MD.: National Institutes of Health, 1997; Publication no. 97-4051.