Treatment of Asthma
Medication for asthma is broadly categorized as either quick-relief medicine or long-term control medicine. Reducing airway inflammation and preventing asthma symptoms is the goal of long-term control medicines, where as immediate relief of asthma symptoms is the goal of quick-relief or “rescue” medicines.
Medications can be ingested in pill form, but most are powders or mists taken orally using a device known as an inhaler. Inhalers permit medicines to travel efficiently through the airways to the lungs.
Inhaler
Medication may also be administered using a nebulizer, providing a larger, continuous dose. Nebulizers vaporize a dose of medication in a saline solution into a steady stream of foggy vapor that is inhaled by the patient.
Long-Term Control
Long-term control medicines are taken every day and are designed to prevent asthma symptom such as airway inflammation. Inhaled corticosteroids are the most effective long-term control medicine – the best at relieving airway inflammation and swelling. They are usually taken daily to greatly reduce the inflammation that initiates the chain reaction of the asthma attack.
Even if taken every day, inhaled corticosteroids are not habit-forming. However, the medicines do have side effects such as the mouth infection known as “thrush”. Thrush occurs when the corticosteroids land in your throat or mouth. Spacers or holding chambers have been developed to help avoid this. Thrush can also be avoided by rinsing the mouth out after inhalation.
Inhaled corticosteroids also increase the risk of cataracts (clouding of the eye’s lens) and osteoporosis (weakening of the bones) if taken for long periods of time.
There are other long-term control medicines available that doctors may prescribe. Most of them are taken by mouth and are designed to open the airways and prevent airway inflammation. Examples include inhaled long-acting B2-agonists (used with low-dose inhaled corticosteroids), leukotriene modifiers, cromolyn and nedocromil, and theophylline.
Quick-Relief Medicines
Quick-relief medicines relieve asthma symptoms when they occur. The most common of these are inhaled short-acting B2-agonists – bronchodilators that quickly relax tight muscles around the airways, allowing air to flow through them.
The quick-relief inhaler should be used when asthma symptoms are first noticed, but should not be used more than 2 days a week. Most people carry the quick-relief inhaler with them at all times. Quick-relief medicines usually do not reduce inflammation and therefore should not be used as a replacement for long-term control medicines.
Emergency Care
Lifesaving treatments at the hospital will consist of direct oxygen (to alleviate hypoxia) and higher doses of medicines. Emergency personnel will likely administer a cocktail of short-acting B-2 agonists, systemic oral or intravenous steroids, other bronchodilators, nonspecific injected or inhaled B-2 agonists, anticholinergics, inhalation anesthetics, the dissociative anesthetic ketamine, and intravenous magnesium sulfate.
Intubation (a breathing tube down one’s throat) and mechanical ventilation may also be used in patients undergoing respiratory arrest.
Children
Although quick-relief medicines can relieve wheezing in young children, long-term control medicines will be used to treat infants and young children if symptoms are likely to persist after 6 years of age.
Like adults, children are treated with inhaled corticosteroids, montelukast, or cromolyn. Often, treatments will be tried for 4 to 6 weeks and stopped if the desired outcome is not seen. Inhaled corticosteroids carry the side-effect of slowed growth, but the effect is generally small and is only apparent for the first few months of treatment.
Elderly
Elderly asthma care may require adjustments to prevent interactions between medicines. Beta blockers, aspirin, pain relievers, and anti-inflammatory medicines can prevent asthma medicines from working correctly and may worsen symptoms. In addition, it may be difficult for older persons to hold their breath for 10 seconds after inhalation of medicines, but spacers have been developed to help this issue.
The increased osteoporosis risk brought on by inhaled corticosteroids may be magnified in older adults with weak bones. It is common to take calcium and vitamin D pills, among other therapies, to keep bones healthy.
Pregnant Women
Proper asthma control is necessary for pregnant women in order to ensure a good supply of oxygen to the fetus. Babies born of asthmatic mothers have a higher chance of premature birth and lower birth weight. For pregnant women, the risks associated with having an asthma attack outweigh any risks associated with asthma medicines.
Non-medical Treatments
Some people treat asthma using unconventional alternative therapies, but there is little formal data to support the effectiveness of these methods. There is research, however, that has found acupuncture, air ionizers, and dust mite control measures, to have little or no effect on asthma symptoms or lung function. Evidence is inconclusive to support or reject osteopathic, chiropractic, physiotherapeutic, and respiratory therapeutic techniques. Homeopathy may mildly reduce the intensity of symptoms, but this finding is not robust. Reference: Medical News Today, 2015.
