Asthma - Treatment
Establish the Goals of Asthma
Therapy With the Patient
The goals of asthma therapy provide the
criteria that the clinician and patient will use
to evaluate the patient’s response to therapy.
The goals will provide the focus for all subsequent
interactions with the patient.
First, determine the patient’s personal goals of therapy
by asking a few questions, such as: “What would
you like to be able to do that you can’t do now or can’t
do well because of your asthma?” “What would you
like to accomplish with your asthma treatment?”
Then, share the general goals of asthma therapy
with the patient and the family.
Finally, agree on the goals you and the patient will set
as the foundation for the patient’s treatment plan.
General Goals of Asthma Therapy
- Prevent chronic asthma symptoms and asthma
exacerbations during the day and night.
(Indicators: No sleep disruption by asthma.
No missed school or work due to asthma. No or
minimal need for emergency department visits or
hospitalizations.)
- Maintain normal activity levels—including
exercise and other physical activities.
- Have normal or near-normal lung function.
- Be satisfied with the asthma care received.
- Have no or minimal side effects while receiving
optimal medications.
The Asthma Medications:
Long-Term Control and Quick Relief
- Long-term-control asthma medications are taken
daily to achieve and maintain control of persistent
asthma. The most effective long-term-control medications
for asthma are those that reduce inflammation.
Inhaled steroids are the most potent inhaled
anti-inflammatory medication currently available.
Inhaled steroids are generally well tolerated
and safe at recommended doses. To reduce the
potential for adverse effects, patients taking
inhaled steroids should:
- Use a spacer/holding chamber.
- Rinse and spit following inhalation.
- Use the lowest possible dose to maintain
control. Consider adding a long-acting inhaled
beta2 -agonist to a low-to-medium dose of
inhaled steroid rather than using a higher dose
of inhaled steroid.
- Quick-relief medications are used to provide
prompt treatment of acute airflow obstruction
and its accompanying symptoms such as cough,
chest tightness, shortness of breath, and wheezing.
These medications include short-acting inhaled
beta2 -agonists and oral steroids. Anticholinergics
are included in special circumstances.
Inhaled Steroids: The Most Effective Long-Term-Control
Medication for Asthma
The daily use of inhaled steroids results in the following:
- Asthma symptoms will diminish. Improvement will continue gradually (see study 1).
- Occurrence of severe exacerbations is greatly reduced.
- Use of quick-relief medication decreases (see study 2).
- Lung function improves significantly, as measured by peak flow, FEV 1 , and airway
hyperresponsiveness.
Problems due to asthma may return if patients stop taking
inhaled steroids.
Frequency of dosing
Once-daily dosing with inhaled steroids for patients with mild asthma and twice-a-day dosing for many
other patients, even with high doses of some preparations, have been effective.
