Millions of people with asthma lead full, active lives, but uncontrolled asthma can be devastating, even fatal. About 20 million people suffer from the disease, and about 4,000 people die from attacks every year.

The good news is that today's doctors are treating asthma more aggressively than ever before. In the past, researchers thought the main culprit behind an asthma attack was the tightening of the tiny muscles that surround the bronchial tubes. But in the 1990s they discovered that when the lungs of someone with asthma are exposed to pollen or other allergens or irritants, the insides of the airways become inflamed and partially blocked with swelling and mucus. Once inflamed, just about anything out of the ordinary -- a blast of cold air, a little pollen or another allergen, exercise, emotional stress or excitement -- can obstruct the already tight airways even more, leaving little room for air to pass through. This sets off the wheezing, shortness of breath, tightness in the chest, and other symptoms of an asthma attack.

The discovery that asthma was actually an inflammatory disease resulted in a bold new approach to treating it. In 1997, the National Heart, Lung, and Blood Institute issued revised guidelines that urged doctors to treat the underlying inflammation -- not just the symptoms of attacks. An expert panel updated the guidelines in 2002 and again in 2007.

If you have asthma, this means you need to carefully follow your doctor's instructions, monitor your symptoms carefully, and avoid anything that triggers the attacks. By working closely with your doctor, you'll have the best chance of looking forward to a lifetime of easy breathing.

Not long ago, doctors usually treated asthma one medication at a time.

Today, most patients with persistent asthma take two or more drugs to ease symptoms and prevent future attacks. Many patients carry inhalers filled with quick-acting bronchodilators, drugs that open airways during an attack. Inhaled corticosteroids, drugs that ease inflammation in the airways, are a popular choice for long-term control. Some patients also take leukotriene inhibitors, a class of medications that reduce mucus in the airways.

If you've just been diagnosed with asthma, your doctor will ask about the severity and frequency of your symptoms. He or she will also ask what medications you're taking and how long they last, whether you're able to sleep at night, and whether you wheeze or cough when you exercise.

Based on this information, he or she will determine what kind of asthma you have and what medications you need. Here's how doctors approach different types of asthma:

Intermittent asthma. This kind of asthma is the least severe. You usually suffer symptoms only a couple of days each week, and you may have occasional attacks during the night. When you aren't having an attack, your peak-flow measurements (the force of your breath) are normal. If you have this kind of asthma, the guidelines recommend a fast-acting bronchodilator to use during an attack. Daily medications may not be necessary.

Mild persistent asthma. If you suffer wheezing and coughing three or more times a week and more than a couple of nights a month, your asthma is considered mild, but more persistent. Your peak flow measurements will probably be normal between attacks, but may vary more than 20 percent throughout the day. In addition to an inhaled medication to ease symptoms, the guidelines recommend an anti-iflammatory "controller" medication, such as an inhaled corticosteroid, or a leukotriene modifier.

Moderate-persistent asthma. If you have trouble breathing every day or about two nights a week, your asthma is a little more severe. Your peak flow readings will probably be low, and may vary more than 30 percent throughout the day. The guidelines recommend using higher doses of inhaled corticosteroids to ease inflammation, or adding a second controller medication, a long-acting bronchodilator(s) or leukotriene modifier to relax your airways.

Severe-persistent asthma. In the most severe cases, you may have trouble breathing every day throughout the day and often every night as well. Your peak flow readings may be below 60 percent of predicted for your age and height, and will probably vary more than 30 percent throughout the day. The guidelines recommend using higher dose inhaled corticosteroids in combination with long acting bronchodilators and possibly leukotriene modifiers. Oral corticosteroids are sometimes also needed.

The following chart summarizes the current strategies for controlling asthma in adults and in children 12 years of age and older.

You and your doctor should draw up a written treatment plan that spells out your day-to-day approach to asthma as well as your long-term goals.

For many patients, avoiding asthma triggers is the key to relief. Your doctor may ask you to keep a symptom diary to help identify your personal triggers. If your doctor suspects an allergy, he or she may perform a skin test to pinpoint the source of your problem. Armed with the findings, your physician will help you with allergen avoidance techniques and can better plan your treatment.

For unknown reasons, childhood asthma has become much more common in recent years. According to the National Center For Health Statistics, close to 7 million Americans under the age of 18 have been diagnosed with the disease.

Fortunately, childhood asthma can usually be easily controlled. For children with mild symptoms, treatment often starts with a leukotriene modifier or low-dose inhaled corticosteroids. But if a child is wheezing every day and many nights, he or she may need a high-dose corticosteroid along with an additional controller medication, such as an inhaled corticosteroid, leukotriene modifier, or long-acting bronchodilator.

Because bronchodilators bring such rapid relief, it can be tempting to overuse them. But taking these drugs too often can actually make asthma worse. Ask your doctor how often your child should be using the quick-relief inhaler. Overuse of the inhaler may be a sign that he or she needs more anti-inflammatory controller mediations to control his disease.

Many primary care physicians can handle your asthma treatment, including family physicians, pediatricians, and internists. They're the doctors who are most familiar with your care and other conditions you might face. However, if your problems are not under adequate control after following your primary physician's treatments, you may be referred to a specialist who handles lung diseases and allergies. Handling asthma and its treatment is his or her area of specialty.

Here are some of the reasons you or your child may be referred to a specialist, according to the National Asthma Education and Prevention Program:

•You've had life-threatening attacks

•You're not meeting the goals of asthma therapy even after three to six months of treatment

•You show signs and symptoms that aren't typical for asthma, or your diagnosis is questionable

•You may have other disease conditions that complicate asthma management

•You need additional testing, education, or guidance on avoiding allergies, or you have trouble following the treatment plan

•You have the most severe forms of asthma

•You're being considered for allergy shots

-- Arthur Cantos, RN, is the clinical product manager for Consumer Health Interactive and former nurse manager of the cardiothoracic unit at UCSF Medical Center. Psyche Pascual is the articles editor at CHI.

Further Resources

National Heart, Lung, and Blood Institute Information Center 301-251-1222 http://www.nhlbi.nih.gov

Allergy and Asthma Network/Mothers of Asthmatics, Inc. 800-878-4403 http://www.podi.com/health/aanma

American Academy of Allergy, Asthma, and Immunology 800-822-ASMA http://www.aaaai.org

American College of Allergy, Asthma, and Immunology 800-842-7777 http://allergy.mcg.edu

American Lung Association 800-LUNG USA http://www.lungusa.org

Asthma and Allergy Foundation of America 800-7-ASTHMA http://www.aafa.org

National Jewish Medical and Research Center 800-222-LUNG http://www.njc.org

References

First published November 21, 2001
Last updated October 28, 2008
Copyright © 2001 Consumer Health Interactive

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