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Treatment

Treatment focuses on:

  • Preventing or stopping the inflammation

  • Relaxing the muscles that line the airways

If you have chronic asthma, work with your doctor to write an asthma-management plan. The plan specifies:

  • How to avoid asthma triggers

  • When and how regular medications should be taken

  • How to handle acute attacks

  • How a peak-flow meter should be used

Several types of medication are available to treat asthma. Some treat acute attacks (the "quick relievers"). Others prevent attacks from happening (the "controllers").

It is important to take preventive asthma medications as prescribed. You should take them even when you are not having symptoms.

  • Bronchodilators. Bronchodilators relax the muscles around the airways to improve airflow. They are commonly inhaled.

    One class of bronchodilators is called beta agonists. It includes albuterol, metaproterenol, and pirbuterol. Beta agonists can be prescribed alone as quick relievers, for mild, occasional symptoms. They also are used as "rescue" medications to stop an attack. They can be inhaled in an inhaler or taken with a nebulizer. A nebulizer is a device that mixes medications with a mist for inhalation.

    Other bronchodilators are used as "controllers" to reduce the number of asthma attacks. These include salmeterol (Serevent) and theophylline (several brand names). They are not useful for an asthma attack because they take too long to begin working.

  • Anti-inflammatory medications. These are controllers. They are usually taken regularly, regardless of whether a person is having asthma symptoms. They work by reducing inflammation. This decreases mucous production and reduces constriction of airway muscles.

    Anyone with asthma symptoms that occur more than a couple times per week should consider taking an anti-inflammatory medication. The first choice is usually an inhaled corticosteroid.

    Corticosteroids also can be taken as pills when inhaled corticosteroids are not completely successful. People requiring emergency care or hospitalization often receive corticosteroids intravenously.

    Other inhaled anti-inflammatories are also available. Leukotriene modifiers are taken by mouth. These drugs block chemicals that cause inflammation and airway narrowing in many people with asthma.

    Another anti-inflammatory medicine is omalizumab (Xolair), which blocks inflammation by attacking IgE antibodies. IgE antibodies are major players in allergic reactions. This drug helps control symptoms in people with severe allergic asthma that is unresponsive to other therapies and requires frequent oral corticosteroids.

  • Immunotherapy. Some people with asthma also benefit from immunotherapy. In immunotherapy, the person is injected with increasing amounts of allergens. The aim is to desensitize the person's immune system. Immunotherapy appears to be most effective for mild to moderate asthma symptoms caused by sensitivity to indoor allergens.

Severe asthma attacks must be treated in a hospital. There, oxygen can be administered, and drugs may be given intravenously or with a nebulizer. In life-threatening cases, the patient may need a breathing tube placed in the large airway and artificial ventilation.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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