lung and airway disorders
Asthma
Treatment of Asthma
(See also Drugs for Preventing and Treating Asthma .) Drugs to reduce inflammation Drugs to widen the airways An array of drugs can be used to prevent and treat asthma in adults or in children (see also Treatment ). Doctors may use the term "rescue treatment" to describe treatment of an acute attack and "maintenance treatment" to describe treatments aimed at preventing attacks. Most of the drugs used to prevent asthma attacks are also used to treat an asthma attack but in higher doses or in different forms. Some people need to use more than one drug to prevent and treat their symptoms. The Therapy is based on two classes of drugs: Anti-inflammatory drugs Bronchodilators Anti-inflammatory drugssuppress the inflammation that narrows the airways. Anti-inflammatory drugs include corticosteroids (which can be inhaled, taken by mouth, or given intravenously), leukotriene modifiers, and mast cell stabilizers. Bronchodilatorshelp to relax and widen (dilate) the airways. Bronchodilators include beta-adrenergic drugs (both those for quick relief of symptoms and those for long-term control), anticholinergics, and methylxanthines. Immunomodulators,drugs that directly alter the immune system are sometimes used for people with severe asthma, but most people do not need immunomodulators. These drugs block substances in the body that cause inflammation. Education about how to prevent and treat asthma attacks is beneficial for all people who have asthma and often for their family members. Proper use of inhalers is essential for effective treatment. People should know What can trigger an attack What helps to prevent an attack How to use drugs properly When to seek medical care Some people use a handheld peak flow meter to evaluate their breathing and determine when they need intervention, before their symptoms become severe. People who experience frequent, severe asthma attacks should know how to reach help quickly. Peak expiratory flow (the fastest rate at which air can be pushed out of the lungs) can be measured using a small handheld device called a peak flow meter. This test can be used at home to monitor the severity of asthma. Usually, peak flow rates are lowest between 4 AM and 6 AM and highest at 4 PM. However, more than a 30% difference in rates at these times is considered evidence of moderate to severe asthma. People with moderate to severe asthma, particularly those who need daily treatment to control symptoms, often use a peak flow meter to take measurements and compare them to their personal best to help identify signs of worsening asthma or the onset of an asthma attack. All people with asthma should have a written treatment action plan that was devised in collaboration with their doctor. Such a plan allows them to take control of their own treatment and has been shown to decrease the number of times people need to seek care for asthma in the emergency department. An asthma attack can be frightening, both to the person experiencing it and to others around. Even when relatively mild, the symptoms provoke anxiety and alarm. A severe asthma attack is a life-threatening emergency that requires immediate, skilled, professional care. If not treated adequately and quickly, a severe asthma attack can cause death. An acute attack in a person whose asthma has been controlled by drugs is called an exacerbation or flare-up. People who have a mild asthma attack are usually able to treat it without assistance from a health care practitioner. Typically, they use an inhaler to deliver a dose of a short-acting beta-adrenergic drug such asalbuterol, move into fresh air (away from cigarette smoke or other irritants), and sit down and rest. They can use the inhaler 3 times 20 minutes apart if needed. An attack usually subsides in 5 to 10 minutes. An attack that does not subside after using an inhaler 3 times or that gets worse is likely to require additional treatment supervised by a doctor. People who have severe symptoms should typically go to an emergency department. For severe attacks, doctors give frequent treatment using inhaled beta-adrenergic bronchodilator drugs delivered by a device called a nebulizer. Doctors sometimes give these bronchodilator drugs in combination with anticholinergic drugs. People are also given a corticosteroid, such asprednisone, by mouth or by vein (intravenously). Supplemental oxygen may be given during attacks. Generally, people who have a severe asthma attack are admitted to the hospital if their lung function does not improve after they have received an inhaled beta-adrenergic drug and corticosteroids by mouth or vein. People also are hospitalized if they have a seriously low blood oxygen level or a high blood carbon dioxide level. Antibiotics may be needed if a doctor suspects a bacterial lung infection. However, most such infections are due to viruses for which (with a few exceptions) no treatment exists. People experiencing very severe asthma attacks may need to have an artificial airway passed through their mouth and throat (intubation) and be placed on a Mechanical Ventilation . Asthma is a chronic condition that cannot be cured, but individual attacks can often be prevented. Prevention efforts depend on the frequency of attacks and the stimuli that trigger the attacks. Identifying and eliminating or avoiding stimuli that trigger asthma attacks may commonly prevent them. Irritating fumes:People who have asthma should avoid cigarette smoke and other irritating fumes and try to avoid exposure to people with upper respiratory infections. House dust mites:When dust and allergens are triggers, air filters and barriers (such as mattress covers, which reduce the amount of particles from dust mites that are in the air) can help considerably. Exposure to house dust mites can be reduced by removing wall-to-wall carpets and curtains and using air conditioning to keep the relative humidity low (preferably below 50%) in the summer. Animal dander:Animals with fur or hair, most commonly cats and dogs, often must be given away to decrease the overall exposure to animal dander. Other measures that can help include limiting the family pet to certain rooms of the house or, if possible, keeping it out of the house. Washing the pet weekly can also help. Drugs:Avoidingaspirinand NSAIDs helps prevent attacks in people whose asthma is triggered by these drugs. Drugs that block the beneficial effects of beta-adrenergic drugs (called beta-blockers) may worsen asthma. Tartrazine, a yellow coloring used in some drug tablets and food, may also bring on an attack. Exercise:Often, attacks triggered by exercise can be blocked by taking asthma drugs beforehand, but exercise should not be avoided. Cold:For outdoor activity in cold weather, people with asthma can wear a ski mask or scarf that covers the nose and mouth to help keep the air being breathed in warm and moist. Sulfites:Sulfites—commonly added to foods as a preservative—may trigger attacks after a susceptible person eats a certain food or drinks beer or red wine. Sulfites can be avoided by careful attention to diet choices. Allergen Allergen immunotherapy (desensitization) None Drugs,such as inhaled or oral corticosteroids, leukotriene modifiers, long-acting beta-adrenergic drugs, methylxanthines, anticholinergics, or mast cell stabilizers are used to prevent attacks in most people with asthma. A minority of people with asthma have severe disease that remains uncontrolled, causing repeated attacks despite treatment with a combination of therapies. These people may benefit from treatment with immunomodulator drugs that block substances that cause allergic inflammation. 