Asthma is a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial susceptibility to spasm and constriction, as well as an underlying inflammation of the airways. The interaction of these features of asthma determines the clinical manifestations and severity of asthma and the response to treatment. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial hyperresponsiveness to a variety of stimuli.
Two major environmental factors have emerged as the most important in the development, persistence, and possibly severity of asthma: airborne allergens and viral respiratory infections. Tobacco smoke, air pollution, occupations, and diet have also been associated with an increased risk for the onset of asthma, although the association has not been as clearly established as with allergens and respiratory infections.
Current therapeutic approaches allow most people who have asthma to participate fully in activities they choose.
Understanding what triggers your asthma as well as how your medications work is extremely important in the treatment of your asthma.
Treatment with anti-inflammatory drugs can, to a large extent, reverse some of the processes involved which cause asthma symptoms; however, the successful response to therapy often requires weeks to achieve.
Medications for asthma are categorized into two general classes: long-term control medications used to achieve and maintain control of persistent asthma and quick-relief medications used to treat acute symptoms and exacerbations.
Corticosteroids: (Usually inhaled): Block late-phase reaction to allergen, reduce airway hyperresponsiveness, and inhibit inflammatory cell migration and activation. They are the most potent and effective anti-inflammatory medication currently available.
Long Acting Beta Agonists: Salmeterol and formoterol are bronchodilators that have a duration of at least 12 hours after a single dose. Long acting beta agonists are not to be used alone for long term control of asthma, but are used in combination with inhaled corticosteroids for long-term control and prevention of symptoms in moderate or severe persistent asthma.
Combinations of Inhaled Corticosteroids and Long Acting Beta Agonists: These combinations make it a bit easier to take medications for long term control of asthma. Brands include Advair, (fluticasone, an inhaled corticosteroid, plus Salmeterol, a long acting beta agonist) and Symbicort, (budesonide, an inhaled corticosteroid, plus formoterol, a long acting beta agonist).
Cromolyn sodium and nedocromil: Are used as alternative, but not preferred, medication for the treatment of mild persistent asthma. They can also be used as preventive treatment prior to exercise or unavoidable exposure to known allergens.
Leukotriene modifiers: Montelukast and zafirlukast, as well as zileuton are available. LTRAs are alternative or adjunctive therapy for asthma that is not controlled with an inhaled corticosteroid. LTRAs are not first line treatment for mild persistent asthma.
Methylxanthines: Sustained-release theophylline is a mild to moderate bronchodilator used as alternative, not preferred, adjunctive therapy with inhaled corticosteroids.
Short acting beta agonists: Albuterol, levalbuterol, and pirbuterol are bronchodilators that relax smooth muscle. These medications are the therapy of choice for relief of acute symptoms and prevention of Exercise-Induced Asthma.
Systemic corticosteroids: Although not short acting, oral systemic corticosteroids are used for moderate and severe exacerbations as adjunct to short acting beta agonists to speed recovery and prevent recurrence of exacerbations.
Anticholinergics: Ipratropium bromide provides additive benefit to short acting beta agonists in moderate-to-severe asthma exacerbations. This medication may also be used as an alternative bronchodilator for patients who do not tolerate short acting beta agonists.
KNOW HOW TO TAKE YOUR INHALED MEDICATIONS EFFECTIVELY! Check with your practitioner to review how to take your inhalers so that they work the best they can.
HOW TO CONTROL THINGS THAT MAY MAKE YOUR ASTHMA WORSE:
The following is a list of things, (in bold print), that may make your asthma worse. Not everyone is sensitive to everything, but if you feel your symptoms are made worse by any of the following, take a moment to put the recommended steps into place in order to limit your exposure.