How Is Asthma Treated?
Asthma can be a lifelong lung condition that causes the airways to become inflamed and prone to narrowing, causing symptoms like shortness of breath and chest tightness that range from mild to severe.
There is no cure for asthma, but treatments can effectively prevent and relieve symptoms, minimize the frequency and severity of asthma attacks, and maintain good lung function. Treatment options for asthma include inhaled medications, such as corticosteroids and bronchodilators, and lifestyle modifications, like avoiding triggers.
If you have asthma, your care may be overseen by your primary care physician, an allergist (medical doctors who specialize in treating allergic conditions), and/or a pulmonologist (medical doctors who specialize in treating lung conditions). Your healthcare provider will develop a personalized treatment based on your symptoms, medical history, and needs.
Medications
Medications are essential to asthma treatment, helping reduce inflammation, relax the airways, and control symptoms. Four types of medicines are used to treat asthma: quick-relief, long-term control, combination quick-relief and controller medicines, and biologics.
There are a few ways to take asthma medications:
Inhaler (puffer): A small, handheld device that delivers medicine through a spray mist you breathe in.
Nebulizer: A device that converts liquid medicine into a mist breathed in through a mask or mouthpiece.
Injection: Biologics are administered through a shot or infusion every few weeks.
Oral: These are capsules, pills, or liquids that are taken by mouth.
Quick Relief Medicines
Quick-relief medicines, also known as rescue or short-acting medications, immediately relieve asthma symptoms during an asthma attack. If you have mild asthma or asthma that only occurs during physical activity (exercise-induced asthma), these medicines may be the only treatment you need.
Quick-relief medicines are used as needed to relax the muscles surrounding the airways to help open the airways and ease symptoms. It’s a good idea to always carry your quick-relief inhaler with you in case of an asthma attack.
Quick relief asthma medicines include:
Short-acting beta2-agonists (SABAs): SABAs quickly open the airways by relaxing the surrounding muscles and clearing mucus out of the lungs.
Short-acting anticholinergics: These relax the muscles around the airways to make breathing easier. Anticholinergics may be prescribed to people who do not tolerate SABAs or may be used in combination with SABAs in emergencies.
Oral corticosteroids: These are taken by mouth (e.g., capsule, liquid) on a short-term basis to reduce airway inflammation and swelling when symptoms persist for days and other medications are not helping.
Long-term Control Medicines
Long-term control, or maintenance medications, prevent and manage asthma symptoms long-term. These medicines are taken daily—even when you don’t have asthma symptoms—to help reduce inflammation and keep your airways open. Long-term control medicines reduce the frequency and severity of asthma attacks and improve lung function.
Long-term control medicines include:
Inhaled corticosteroids: These are used to reduce inflammation and mucus production in the airways. These medicines are the most effective and safe long-term control treatment for asthma.
Long-acting inhaled beta2-agonists (LABAs): These relax airway muscles to help prevent asthma symptoms. These are similar to SABAs, but work for up to 12 hours. These medicines should never be taken alone in an emergency; they are typically only used if you use inhaled corticosteroids and your symptoms are still not well-controlled.
Leukotriene modifiers: Taken in capsule or pill form, these medicines block the action of leukotrienes (inflammatory chemicals that can trigger asthma attacks) to reduce airway inflammation and swelling.
Inhaled mast cell stabilizers: These prevent mast cells from releasing histamine (a chemical that the body releases when it's having an overactive immune response) and other inflammation-causing chemicals in response to an allergen. These medicines help prevent inflammation and narrowing of the airways, especially for allergic asthma.
Combination Quick-Relief and Control Medicines
Combination and quick-relief and controller medicines contain both a short-acting bronchodilator and a long-acting medication in one inhaler. Combo inhalers are typically prescribed for people with moderate to severe asthma to provide immediate symptom relief and long-term inflammation control. Though combination medicines are recommended in current clinical guidelines for treating asthma, they are not yet approved for this use by the U.S. Food and Drug Administration (FDA).
Biologics
Biologics treat severe asthma that does not respond well to standard treatments. These medicines target specific cells and antibodies that cause inflammation in response to asthma triggers. They work to help reduce the frequency of asthma attacks and symptom severity.
Depending on the medication used, biologics are given by injection or intravenous (IV) infusion in a doctor’s office every few weeks. There are several biologic drugs available for treating asthma, including:
Cinqair (reslizumab)
Nucala (mepolizumab)
Xolair (omalizumab)
Fasenra (benralizumab)
Dupixent (dupilumab)
Tezspire (tezepelumab-ekko)
Your healthcare provider may order blood tests to determine the most effective biologic for you.
Bronchial Thermoplasty
Bronchial thermoplasty (BT) is a medical procedure that may be recommended for people with severe, uncontrolled asthma. Over time, severe asthma can cause the muscle tissue lining the airways to thicken, narrowing the airways and worsening symptoms.
During a BT, a thin bronchoscope tube is passed through the mouth and into the airways. Once the tube is in place, a small, heated electrode delivers heat to the smooth muscle tissue in the airways and removes the excess tissue. A BT procedure is typically performed in three separate sessions, each targeting a different part of the lungs to open the airways and reduce asthma attacks and other symptoms.
Immunotherapy
Immunotherapy involves controlled exposure to allergens that trigger asthma symptoms in people with allergic asthma. Before immunotherapy starts you will undergo allergy testing to determine which allergens trigger your symptoms and ensure your treatment is effective.
Immunotherapy involves a series of injections or sublingual tablets containing gradually increased doses to build tolerance and desensitize the immune system to allergens to reduce allergic reactions. The length of treatment depends on your response to immunotherapy but can last several years until your allergy symptoms are reduced or eliminated.
Complementary and Alternative Medicine
Some complementary and alternative medicine (CAM) therapies may help manage symptoms. Currently, no CAM treatments can replace standard medical treatments, but some CAM therapies may be an effective way to boost your quality of life.
Acupuncture
A component of traditional Chinese medicine, acupuncture involves inserting thin needles into the skin at specific points on the body. Some research suggests that acupuncture may help reduce inflammation and improve asthma symptoms when paired with standard asthma treatments.
Breathing Exercises
Breathing exercises and techniques like the Buteyko method may help manage asthma symptoms by helping you focus on the pace and rhythm of your breathing. Research suggests that breathing exercises may help relax the airways, reduce hyperventilation symptoms, and boost lung function in people with mild to moderate asthma. Breathing exercises may also help reduce stress and anxiety, which can worsen asthma symptoms.
Related:Daily 'Breath Training' May Help Lower Blood Pressure as Much as Medication—Here's How to Do It
Editor’s Note: This article informs you about possible observed health changes related to the use of complementary or alternative medicine based on limited available research. Not all complementary and alternative medicines have been evaluated for safety and efficacy in clinical trials. You should consult a licensed healthcare professional for diagnosis and treatment for any health conditions and inform them about any change you make to your regimen.
Lifestyle and Asthma Management
Lifestyle modifications are an important part of asthma management and can help control your symptoms, reduce the frequency of asthma attacks, and improve your quality of life.
Avoid Triggers
Identifying and avoiding triggers that trigger or worsen your asthma can help control symptoms and prevent asthma attacks. Common asthma triggers include:
Common allergens, such as mold, pollen, pet dander, and dust mites
Cigarette smoke
Exercise
Certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs)
Stress and strong emotions
Infections, such as influenza, the common cold, and respiratory syncytial virus (RSV)
Cold weather
Regular Exercise
While physical activity can be difficult when you live with asthma, regular exercise can help improve lung function, boost your immune system, help you maintain healthy body weight, and relieve stress. If vigorous exercise triggers your asthma symptoms, start with low-intensity activities such as walking, yoga, or tai chi, and carry your emergency inhaler with you for peace of mind.
Use a Peak Flow Meter
A peak flow meter is an important tool that helps people with asthma monitor lung function. The small handheld device measures how well air moves out of the lungs and can identify changes in your breathing, even before symptoms appear. Daily use of a peak flow meter can help you track changes in your peak flow readings over time and get a better understanding of what medications and lifestyle modifications are most effective for you.
A peak flow meter is very effort-dependent and may be difficult, especially for children and older adults who may have reduced lung capacity. It can be a helpful tool for some, but not a requirement to have at home.
Develop an Asthma Action Plan
An asthma action plan is an individualized plan that outlines how to manage your asthma. Your healthcare provider will work with you to develop your asthma action plan, which may include the following:
A list of your triggers
Symptom tracking
A list of your asthma medications and instructions on when and how to take them
When to call your healthcare provider or seek emergency medical care
Emergency phone numbers
Asthma action plans have three different colored zones: green, yellow, and red.
Green zone: Your asthma is well-controlled and your peak flow reading is 80% or more of your best peak flow level.
Yellow zone: Your asthma is not well-controlled (e.g., waking at night with symptoms), and your peak flow is 50-80% of your best peak flow level.
Red zone: Your asthma is severely uncontrolled, you are having trouble breathing, your medications are not helping, and your peak flow is less than 50% of your best peak flow level.
Your healthcare provider will discuss the steps that need to be taken when you are in each zone. For example, if you are in the yellow zone, your medications may need to be adjusted or changed to better control your symptoms.
Living With Asthma
Asthma management, including following your treatment plan and implementing lifestyle modifications, is essential for living well with asthma. If left untreated or poorly managed, asthma can cause permanent lung damage and your medicines will not work as well.
The good news is that effective asthma treatments help maintain good lung function, control symptoms, and prevent asthma attacks. Work with your healthcare provider to develop your asthma action plan and have regular check-ups with your provider to ensure your asthma is well-managed and controlled. With the right treatments, most people with asthma can live full, productive lives.
A Quick Review
Asthma can be a lifelong condition that requires ongoing treatment to control symptoms, prevent asthma attacks, and help maintain good lung function. Asthma treatments include quick-relief and long-term control medications to relax and open the airways, reduce inflammation, and prevent asthma attacks. Lifestyle interventions, such as avoiding triggers, regular exercise, and following your asthma action plan are essential to asthma management.
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