Overview

Asthma is a long-term condition affecting children and adults. The air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways. This causes asthma symptoms such as cough, wheeze, shortness of breath and chest tightness. These symptoms are intermittent and are often worse at night or during exercise. Other common triggers can make asthma symptoms worse. Triggers vary from person to person, but can include viral infections (colds), dust, smoke, fumes, changes in the weather, grass and tree pollen, animal fur and feathers, strong soaps and perfume.

Symptoms

The most common symptom of asthma is wheezing. This is a squealing or whistling sound that occurs when you breathe.

Other asthma symptoms may include:

• coughing, especially at night, when laughing, or during exercise
• tightness in the chest
• shortness of breath
• difficulty talking
• anxiousness or panic
• fatigue
• chest pain
• rapid breathing
• frequent infections
• trouble sleeping

The type of asthma that you have can determine which symptoms you experience.

Some people experience symptoms consistently throughout the day. Others may find that certain activities can make symptoms worse.

Not everyone with asthma will experience these particular symptoms. If you think the symptoms you’re experiencing could be a sign of a condition such as asthma, make an appointment to see your doctor.

Also, keep in mind that even if your asthma is well-managed, you may still occasionally experience a flare-up of symptoms. Flare-ups often improve with the use of quick-acting treatments, like an inhaler, but may require medical attention in severe cases.

Signs of an asthma flare-up may include:

• coughing
• wheezing
• throat clearing
• difficulty sleeping
• chest pain or tightness
• fatigue

If your symptoms worsen or don’t improve with the use of an inhaler, you should seek immediate medical treatment.

You should also seek treatment if you experience symptoms of an asthma emergency, including:

• severe breathing difficulty
• gasping for air
• confusion
• pale lips or fingernails
• dizziness
• difficulty walking or talking
• blue lips or fingernails

How Is Asthma Treated?

Each person’s asthma is different. You and your healthcare provider will work together to establish the best treatment plan based on your symptoms and needs. 

After your healthcare provider diagnoses your asthma, you will be prescribed medicines that help control asthma. By taking the right medicine at the right time, you can: 

• Breathe better 
• Do more of the things you want to do 
• Have fewer asthma symptoms

Asthma Treatment

Many asthma treatments can ease your symptoms. Your doctor will work with you to make an asthma action plan that will outline your treatment and medications. They might include:

• Inhaled corticosteroids. These medications treat asthma in the long term. That means you’ll take them every day to keep your asthma under control. They prevent and ease swelling inside your airways, and they may help your body make less mucus. You’ll use a device called an inhaler to get the medicine into your lungs. Common inhaled corticosteroids include:
  • Beclomethasone (QVAR)
  • Budesonide (Pulmicort)
  • Fluticasone (Arnuity Ellipta, Armonair Respiclick, Flovent)
• Leukotriene modifiers. Another long-term asthma treatment, these medications block leukotrienes, things in your body that trigger an asthma attack. You take them as a pill once a day. Common leukotriene modifiers include:
  • Montelukast (Singulair)
  • Zafirlukast (Accolate)
• Long-acting beta-agonists. These medications relax the muscle bands that surround your airways. You might hear them called bronchodilators. You’ll take these medications with an inhaler, even when you have no symptoms. They include:
  • Ciclesonide (Alvesco)
  • Formoterol (Perforomist)
  • Mometasone (Asmanex)
  • Salmeterol (Serevent)
• Combination inhaler. This device gives you an inhaled corticosteroid and a long-acting beta-agonist together to ease your asthma. Common ones include:
  • Budesonide and formoterol (Symbicort)
  • Fluticasone and salmeterol (Advair Diskus, AirDuo Respiclick)
  • Fluticasone and vilanterol (Breo)
  • Mometasone and formoterol (Dulera)
• Theophylline. It opens your airways and eases tightness in your chest. You take this long-term medication by mouth, either by itself or with an inhaled corticosteroid.
• Short-acting beta-agonists. These are known as rescue medicines or rescue inhalers. They loosen the bands of muscle around your airways and ease symptoms. Examples include:
  • Albuterol (Accuneb, ProAir FHA, Proventil FHA, Ventolin FHA)
  • Levalbuterol (Xopenex HFA)
• Anticholinergics. These bronchodilators prevent the muscle bands around your airways from tightening. Common ones include:
  • Ipratropium (Atrovent FHA)
  • Tiotropium bromide (Spiriva)

You can get ipratropium in an inhaler or as a solution for a nebulizer, a device that turns liquid medicine into a mist that you breathe in through a mouthpiece. Tiotropium bromide comes in a dry inhaler, which lets you breathe in the medicine as a dry powder.

• Oral and intravenous corticosteroids. You’ll take these along with a rescue inhaler during an asthma attack. They ease swelling and inflammation in your airways. You’ll take oral steroids for a short time, between 5 days and 2 weeks. Common oral steroids include:
  • Methylprednisolone (Medrol)
  • Prednisolone (Flo-pred, Orapred, Pediapred, Prelone)
  • Prednisone (Deltasone)

You’re more likely to get steroids injected directly into a vein if you’re in the hospital for a bad asthma attack. This will get the medication into your system more quickly.

• Biologics. If you have severe asthma that doesn’t respond to control medications, you might try a biologic:
  • Omalizumab (Xolair) treats asthma caused by allergens. You get it as an injection every 2 to 4 weeks.
  • Other biologics stop your immune cells from making things that cause inflammation. These drugs include:
    • Benralizumab (Fasenra)
    • Mepolizumab (Nucala)
    • Reslizumab (Cinqair)

Tezepelumab-ekko (Tezspire) is a first-in-class medicine indicated for the add-on maintenance treatment of adult and pediatric patients aged 12 years and older. Taken by injection, it targets a specific molicule that causes inflammation in the airways.

Home remedies

Medication will probably be key to getting your asthma under control, but you can do some things at home to help.

• Avoid asthma triggers.
• Exercise regularly.
• Stay at a healthy weight.
• Take care of conditions that can trigger symptoms, such as GERD.
• Do breathing exercises to ease symptoms so you need less medication.
• Some people use complementary treatments such as yoga, acupuncture, biofeedback, or supplements like vitamin C and ding chuan tang. Talk to your doctor before trying any of these.

Asthma Attack Prevention

Your action plan will include different ways to keep your asthma under control and prevent attacks. These might include:

• Know your triggers, and stay away from them.
• Follow your doctor’s instructions on taking your asthma medications. Let them know if you notice that you’re using a quick-relief inhaler more often.
• Keep track of your condition and learn the signs that it might be getting worse. A peak flow meter can help.
• Know what to do if you think your asthma is getting worse.
• Talk to your doctor about vaccines to lower your chances of certain conditions. You might get vaccinations for COVID-19, flu, pneumonia, shingles, or whooping cough (pertussis).