Treatment Overview

Although asthma cannot be cured, you can manage the symptoms with medications, especially inhaled corticosteroids and beta2-agonists. You will probably work with your health professional to develop a management plan consisting of a daily treatment plan and an asthma action plan. These plans help you meet treatment goals and get your asthma under control. The goals of asthma treatment are to:¹⁸

• Prevent symptoms.
• Keep your peak flow and lung function as close to normal as possible.
• Be able to do your normal daily activities, including work, school, exercise, and recreation.
• Prevent asthma attacks.
• Have few or no side effects from medicine.

For more information, see:

Asthma: Taking charge of your asthma.

Emergency treatment

If you have a severe asthma attack (the red zone of your asthma action plan), use medication based on your action plan and talk with a health professional immediately about what to do next. This is especially important if your peak expiratory flow (PEF) does not return to the green zone or stays within the yellow zone after you take medication. You may have to go to the hospital or an emergency room for treatment. Be sure to tell the emergency staff if you are pregnant.

At the hospital, you will probably receive inhaled beta2-agonists and corticosteroids. You may be given oxygen therapy. Your lung function and condition will be assessed. Depending on your response, further treatment in the emergency room or a stay in the hospital may be necessary.

Some people are at increased risk of death from asthma, such as people who have been admitted to an intensive care unit for asthma or who have needed a breathing tube (intubation) for asthma. These people need to seek medical care early when they have symptoms.

Medical checkups

You need to monitor your asthma and have regular checkups to keep it under control and to ensure correct treatment. The frequency of checkups depends on how your asthma is classified. Checkups are recommended:

• About every 6 to 12 months for people with mild intermittent or mild persistent asthma that has been under control for at least 3 months.
• Every 3 to 6 months for those with moderate persistent asthma.
• Every 1 to 2 months for people with uncontrolled or severe persistent asthma.
• Every month if you are pregnant.

During checkups, your health professional will ask whether your symptoms and peak expiratory flow have held steady, improved, or become worse and will ask about asthma attacks during exercise or at night. You track this information in an asthma diary. You may be asked to bring your peak expiratory flow meter to an appointment so your health professional can see how you use it.

Initial treatment

There are many components to managing asthma. After your diagnosis, your health professional may only discuss the components you need to know immediately. These include:

• Oral or injected corticosteroids (systemic corticosteroids). These medications may be used to get your asthma under control before you start taking daily medication. In the future, you also may take oral or injected corticosteroids to treat any sudden and severe symptoms (asthma attacks), such as shortness of breath. Oral corticosteroids are used more than injected corticosteroids. Oral corticosteroids include prednisone and dexamethasone.
• Inhaled corticosteroids. These are the preferred medications for long-term treatment of asthma. They reduce the inflammation of your airways, and you take them every day to keep asthma under control and to prevent asthma attacks. Inhaled corticosteroids include beclomethasone dipropionate, triamcinolone acetonide, fluticasone propionate, budesonide, and flunisolide.
• Short-acting beta2-agonists. These medications are used for asthma attacks. They relax the airways, allowing you to breathe easier. Short-acting beta2-agonists include albuterol and pirbuterol.
• A combination of an inhaled corticosteroid and long-acting beta2-agonist. This combination is often used to treat persistent asthma.
• Basic education about asthma. The more you know about asthma, the more likely it is you will control symptoms and reduce the risk of asthma attacks. Keep in mind that even severe asthma can be controlled, and cases where the condition cannot be controlled are unusual.
• Instruction on how to use a metered-dose inhaler (MDI) or dry powder inhaler (DPI). Inhalers deliver medicine directly to the lungs. If you use your inhaler correctly, you can control your symptoms and avoid asthma attacks that can send you to the emergency room. Most health professionals recommend using a spacer with an MDI. For more information, see:

  Asthma: Using a metered-dose inhaler.

  Asthma: Using a dry powder inhaler.

Your short-term goal is to control your current symptoms. Long-term, your goal is to prevent symptoms so that asthma does not impact your daily activities.

Special considerations in treating asthma include:

• Managing asthma during pregnancy. If a woman had asthma before becoming pregnant, her symptoms may get better or worse during pregnancy. Pregnant women whose asthma is not well controlled may be at risk for a number of complications.
• Managing asthma in older adults. Older adults tend to have worse asthma symptoms and a higher risk of death from asthma than younger people. They may also have one or more other health conditions or take other medications that can make asthma symptoms worse.
• Managing exercise-induced asthma. Exercise often causes asthma symptoms. Steps you can take to reduce the risk of this include using medication immediately before you exercise.
• Managing asthma before surgery. People with moderate to severe asthma are at higher risk of developing problems during and after surgery than people who do not have asthma.

Ongoing treatment

After your initial treatment for asthma, it is important to learn more about the condition and develop an overall plan to manage the disease. You and your health professional will work together to do this. Because asthma develops from a complex interaction of genetics, environmental factors, and the reaction of the immune system, no one management plan is effective for everyone.

Asthma management consists of:

• A daily asthma treatment plan. A daily asthma treatment plan outlines in writing how to treat and control inflammation in your lungs. The plan helps you keep asthma under control and prevent asthma attacks. The plan also tells you which medications to take every day. A daily treatment plan may include an asthma diary where you record your peak expiratory flow (PEF), symptoms, triggers, and quick-relief medication used for asthma attacks. This valuable tool helps you and your health professional manage your asthma. A daily asthma treatment plan is often combined with an asthma action plan.
• An asthma action plan. An asthma action plan contains directions to treat asthma attacks at home. It helps you identify triggers that can be changed or avoided, be aware of your symptoms, and know how to make quick decisions about medication and treatment. See an example of an asthma action plan (What is a PDF document?) . For more information, see:

  Asthma: Using an asthma action plan.

• Monitoring peak expiratory flow. It is easy to underestimate the severity of your symptoms. You may not notice them until your lungs are functioning at 50% of your personal best peak expiratory flow (PEF). Measuring PEF is a way to keep track of asthma symptoms at home. It can help you know when your lung function is becoming worse before it drops to a dangerously low level. You can do this with a peak flow meter. For more information, see:

  Asthma: Measuring peak flow.

• A plan to deal with factors that can make asthma worse (triggers). Being around triggers increases symptoms. Try to avoid situations that expose you to irritants (such as smoke or air pollution) or to substances (such as animal dander) to which you may be allergic. If substances at work are causing your asthma or making it worse (occupational asthma), you may have to change jobs. See information on:

  Asthma: Identifying your triggers.

• A plan to treat other health problems. If you also have other health problems, such as inflammation and infection of the sinuses (sinusitis) or gastroesophageal reflux disease (GERD), you will need treatment for those conditions.

• Using your prescribed medications correctly. Your health professional may adjust your medications depending on how well your asthma is controlled. Medications include:
  • Inhaled corticosteroids. These are the preferred medications for long-term treatment of asthma. Inhaled corticosteroids include beclomethasone dipropionate, triamcinolone acetonide, fluticasone propionate, budesonide, and flunisolide.
  • Long-acting beta2-agonists (such as salmeterol and formoterol), which are used along with inhaled corticosteroids.
  • Oral or injected corticosteroids (systemic corticosteroids) to treat any sudden and severe symptoms (asthma attacks), such as shortness of breath. Oral corticosteroids are used more than injected corticosteroids. Oral corticosteroids include prednisone and dexamethasone.
  • Quick-relief medication, such as short-acting beta2-agonists and anticholinergics (ipratropium) for asthma attacks. If you are using quick-relief medication on more than 2 days a week (except for exercise), you probably need long-term treatment. Overuse of quick-relief medication can be harmful.
• Education. Continue to learn about asthma. This questionnaire can help you determine what you already know about asthma and what you may need to discuss with your health professional.

If you have persistent asthma and react to allergens, you may need to have skin testing for allergies. Allergy shots (immunotherapy) may be helpful. For more information, see:

Should I take allergy shots (immunotherapy) for allergic rhinitis and allergic asthma?

You can expect to live a normal life if you control symptoms by following your daily treatment and action plans. Control of your asthma symptoms can help keep your lungs as healthy as possible.

Special considerations in treating asthma include:

• Managing asthma during pregnancy. If a woman had asthma before becoming pregnant, her symptoms may become better or worse during pregnancy. Pregnant women whose asthma is not well controlled may be at risk for a number of complications.
• Managing asthma in older adults. Older adults tend to have worse asthma symptoms and a higher risk of death from asthma than younger people. They may also have one or more other health conditions or be taking other medications that can make asthma symptoms worse.
• Managing exercise-induced asthma. Exercise often causes asthma symptoms. Steps you can take to reduce the risk of this include using medication immediately before you exercise.
• Managing asthma before surgery. People with moderate to severe asthma are at higher risk of developing problems during and after surgery than people who do not have asthma.

Treatment if the condition gets worse

If your asthma is not improving, make an appointment with your doctor to:

• Review your asthma diary to see if you have a new or previously unidentified trigger, such as animal dander. Talk to your health professional about how best to avoid triggers.
• Review your medications, to be sure you are using the right ones and are using them correctly.
• Review your asthma plans, to be sure they are suitable for your condition.
• Determine whether you have a condition with symptoms similar to asthma, such as sinusitis.
• Make sure you are using your inhaler correctly.

If your medication is not working to control airway inflammation, your health professional will first check to see whether you are using the inhaler correctly. If you are using it correctly, your health professional may increase the dosage, switch to another medication, or add a medication to the existing treatment.

Your doctor may suggest other medications, such as leukotriene pathway modifiers (zafirlukast, zileuton, or montelukast). Less commonly, your doctor may recommend mast cell stabilizers (cromolyn sodium or nedocromil) or theophylline (Theo-Dur, Slo-bid, Uniphyl, or Uni-Dur).

If your asthma does not improve with treatment, you may require more intensive treatment, including larger doses of corticosteroids or other medication. An asthma specialist generally prescribes these medications.

If you have persistent asthma and react to allergens, you may need to have skin testing for allergies. Allergy shots (immunotherapy) may be helpful.

What to think about

If you have been diagnosed with asthma, it is important that you treat it. You may feel good most of the time—so much so that you find it hard to believe you have a long-lasting condition. But all asthma—even mild asthma—may result in changes to your airways that speed up and make worse the natural decrease in lung function that occurs as we age.³