ASTHMA TREATMENT GUIDELINES
WHAT TO EXPECT FROM YOUR DOCTOR
Asthma can’t be cured, but it can be controlled. If you have asthma, (or if your child does) you need a comprehensive, tailored treatment plan – developed in partnership with your doctor – to manage the disease.
With proper treatment, you can expect to get a full night’s sleep without disruptive coughing spells, awake with a clear chest in the morning, avoid acute asthma attacks that require emergency room visits or hospitalization and lead a normal, active life.
The American College of Allergy, Asthma and Immunology (ACAAI) has the following treatment guidelines for asthma patients. You should expect your doctor to do the following five things:
1. Test and monitor. Effective asthma management requires accurate diagnosis and ongoing monitoring. Your doctor should:
• Take a detailed medical history, including a review of your symptoms, when and how often they occur, your family history and the impact of the disease on your daily activities.
• Perform a physical examination with special focus on your lungs, chest, airways, nose and sinuses.
• Test your lung function with special tests such as spirometry and peak flow monitoring that measure the power of your lungs. These tests typically involve blowing into a special tube to measure lung function.
• Order additional tests if needed, such as chest X-rays, blood tests or allergy tests.
2. Help you identify and control your triggers. Most asthma attacks are triggered by allergens such as pollen, mold, dust mites, animal dander and cockroach waste. Other common triggers include exercise, cold dry air, cigarette smoke and household cleaners. Once you and your doctor have identified your triggers, you can develop strategies for removing or reducing your exposure to them.
3. Explain your treatment options. Several types of medications treat asthma and its symptoms. They are:
• Long-term medications: Long-acting anti-inflammatory medications prevent symptoms and long-term lung damage by treating the underlying airway inflammation, congestion, constriction and hyperresponsiveness. The newest and most frequently prescribed anti-inflammatory drugs are inhaled corticosteroids.
• Quick-relief medications: Quick-relief, or “rescue” medications, are inhaled or taken by mouth to treat an asthma attack. They relieve symptoms and open airways quickly. You and your doctor should evaluate how frequently you use these medications. Excessive reliance on rescue medications may mean you need to take more anti-inflammatory drugs or other treatments to prevent asthma attacks.
• Anti-allergy therapies: Among those who have asthma, half of all adults and 80 percent of children have allergic asthma. If your asthma is triggered by allergens, you may need to have your doctor help you avoid the allergens, or you may need allergy shots, also known as immunotherapy, to prevent allergic reactions that can trigger asthma attacks. Immunotherapy and allergen avoidance may reduce your need for other medications. The FDA is reviewing clinical trials of anti-IgE therapy. If approved, this new treatment might benefit patients with severe allergic asthma.
4. Provide ongoing education and support. You can’t manage asthma by yourself. Your environment and the people around you play a major role in how well your asthma stays under control. Your doctor should give you and your family members ongoing information about your condition, including information about how your lungs function and the changes that are caused by asthma. Other information you should expect from your doctor include allergen avoidance strategies such as use of dust-mite proof mattress and pillow covers, and strategies for dealing with other environmental triggers, such as pet dander and cigarette smoke. You and your doctor should discuss lifestyle issues, such as outdoor activities, school sports and family vacations. Your doctor also should explain the proper use and care of peak flow meters and asthma medication delivery systems including metered-dose inhalers, spacers and nebulizers.
5. Develop a written plan. Because there are so many aspects to managing asthma, and because it is an ongoing process, you should receive a written plan that you and your doctor can periodically review and update, and that you can use to monitor how well your disease is being controlled.
If these components are not part of the asthma treatment plan your doctor provides, or if you feel your asthma could be under better control, ask for a referral to a specialist. Allergists are physicians who specialize in allergies and asthma and provide tailored, comprehensive care to their patients every day.
The National Heart, Lung, and Blood Institute (NHLBI) recommends that you see an asthma specialist such as an allergist if you have difficulty achieving or maintaining control of your asthma, have had a life-threatening asthma attack or are not meeting the goals of your asthma therapy after three to six months of treatment. The NHLBI also recommends that you see a specialist if you have atypical or difficult to diagnose symptoms, have other conditions such as severe allergies or sinusitis that complicate your asthma, need additional diagnostic tests or education and treatment guidance, have severe persistent asthma, are a candidate for allergy shots or if you have required more than two bursts of oral corticosteroids in the past year.
For more information about allergy and asthma treatment options, call the ACAAI toll-free number 800-842-7777 or visit its Web site at www.acaai.org.