Asthma Treatments and Control: Doctor Q&A

  • Successfully managing asthma depends on following asthma treatments tailored to your symptoms and triggers.  Pulmonologist Dr. Glen W. Petersen of Alta Bates Hospital in Berkeley, California, discusses asthma control and care.


     What are the biggest factors someone should focus on for maintaining asthma control?


     Asthma is a condition largely manageable such that a normal lifestyle is usually achievable.  Maintaining asthma control rests on principles of assessing lung function on a regular basis, avoiding known triggers which exacerbate asthma, forming a partnership with the health care team, and having a plan for managing problems that occur over time that may include the use of medications and consultation with your health care provider.

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    Many people with asthma also have allergies. What causes this association?


    Asthma can be thought of as having two components: inflammation of the airways, which leads to thickening of the wall of the airway, and airway constriction (bronchoconstriction).  Triggers to these two components, including allergies to various substances, can induce inflammation and bronchoconstriction causing chest tightness, wheezing and shortness of breath.  Allergic asthma is best treated by avoiding the substances (allergens) in the environment; use of medications, if needed; and, in some cases, consultation with an allergy specialist to identify specific allergens.


    There are a range of asthma triggers that vary by patient. How can one learn to spot their triggers and avoid them?


    Identifying triggers is very useful in order to be able to avoid them, if possible.  Paying attention to which environments or specific exposures bother you often requires the skill and patience of a detective.  For example, are symptoms related to being at home or at work or some other given locale?  Are there fragrances or odors that worsen symptoms?  At times, a trigger cannot be identified despite best efforts and consultation with an allergist may be required.  Once a trigger is identified, try to avoid it. If it’s unavoidable, medication can help manage the problem.


    A lot of people talk about having an Asthma Action Plan. Why is this so important for asthma management?


    It is important to have a plan to deal with variations in the activity of asthma between visits to your health care provider.  For example, having a range of frequencies of taking inhaled bronchodilators depending on symptoms is a common strategy.  An Action Plan is especially important when unexpected worsening occurs so that immediate action can be taken to avoid further worsening or visits to the emergency room.  The plan lists ways of increasing treatment on a short-term basis, adding more medications, when to call and consult with your physician, and when to go to the emergency room.  Good planning helps avoid asthmatic crises.


    How do rescue medications differ from everyday maintenance/controller medications?


    Generally speaking there are two categories of asthma medication.  Controller agents, such as inhaled steroids, are primarily for preventing the development of airway inflammation and are used daily, regardless of symptoms.  Rescue inhalers, Albuterol for example, reverse airway constriction quickly by relaxing the muscles circling the airways allowing them to open wider for easing breathing.  They work quickly, as opposed to controller agents which work slowly over longer periods.


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    A smaller percentage of asthma patients use nebulizer treatments. When should a patient use a nebulizer?


    Nebulizers generate mist from a solution of bronchodilator medications that is inhaled over 10 to 15 minutes.  Nebulization may deliver medications more effectively to the airways in some patients who are unable to use a metered dose inhaler efficiently—such as young children, elderly patients, patients with chest wall muscle weakness, or patients with severe asthma attacks who need emergency care.


    What’s the biggest concern for treating asthma efficiently in the long term?


    The biggest concerns for treating asthma efficiently in the long term include maintaining good health generally, monitoring the activity of asthma symptoms, avoiding complications of asthma exacerbations, and watching for signs of complications from therapy.


    Any lifestyle changes you'd recommend? 


    Adequate sleep, a balanced diet, not smoking, limited alcohol intake, regular exercise and having a routine to monitor and treat your asthma.


    What can people do to help their doctor treat them most effectively?


    Keep your doctor informed of the status of your asthma.  Visit on a regular basis to review the treatment and Action Plan.  Occasionally, a situation may arise when you need to call your doctor for clarification of needed treatment or intervention outside of the Action Plan.


Published On: April 21, 2014