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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Tailoring Treatment To Your Symptom Severity


July 29, 2008

Asthma
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Tailoring Treatment To Your Symptom Severity
Tailoring Treatment To Your Symptom Severity
htmAsthmaAssessingTreatment
As your symptoms improve, you and your health-care provider will reassess how you feel and make any changes if needed.
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InteliHealth
2008-07-29
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InteliHealth/Harvard Medical Content
2010-07-15

The National Heart, Lung, and Blood Institute created recommendations for the treatments that are best for different levels of asthma severity. These recommendations also address the changes you and your health care professional should be considering.

Keep in mind that your particular treatment plan is designed to fit the symptoms you have before you start treatment. As your symptoms improve, you and your health-care provider will reassess how you feel and make any changes if needed. Please — make changes only with the advice of your doctor.

The National Heart, Lung, and Blood Institute's recommendations are as follows:

If you have mild asthma symptoms that occur once or twice a week. You may need to use only a reliever, such as an albuterol inhaler, on the days you are having symptoms. If you know the trigger of your asthma and if the trigger is unavoidable, you may want to use your inhaler before an exposure that you can predict. Or if you have exercise-induced asthma, you should consider taking the prescribed number of puffs before exercising.

If you have mild asthma symptoms that occur daily. You may need to use a reliever every day, even on good days. You may also want to use a controller every day, because this can make your asthma less active and can limit how often you need to use the reliever.

If you have moderate asthma symptoms. You should be using an inhaled corticosteroid controller every day. This inhaled drug is the best available for reducing inflammation and controlling asthma symptoms. You also will use a reliever to help treat symptoms when they appear. Some people need a second controller, such as a long-acting airway opener, that is especially helpful for nighttime symptoms. Examples of long-acting airway opening medicines are salmeterol (Serevent), formoterol (Foradil), and the combination inhaler that pairs salmeterol with a corticosteroid (Advair). Doctors are cautious about the use of these long-acting airway openers because of a public health advisory warning that the US Food and Drug Administration issued in 2005. These inhalers may put some people at risk for having more severe or even fatal asthma flares, even though they appear to reduce the frequency of flares for most people who use them. Because problems have been rare and because the medications provide valuable symptom relief for many people, lung specialists continue to recommend these medicines to many patients, although the drugs are used with more caution.

A new type of controller, Omalizumab immunotherapy, blocks a part of your allergy response. This controller might be added if other treatments are not working for allergic asthma. Your health care professional may suggest that you try different combinations of controllers and relievers to find the medicines that work best for you. You can test these combinations by trying one for a month or so and seeing how you feel.

If you have severe asthma symptoms. You'll need an intense drug regimen to improve your breathing enough so asthma doesn't limit your activities. Be aware that your asthma is severe enough that a flare-up could put you in the hospital or threaten your life. Taking daily corticosteroid pills is the best way to control inflammation. You will probably also need to use a long-acting airway opener that acts in concert with the pills. Omalizumab immunotherapy (see above) is a treatment for allergic asthma that may be helpful. Also, you'll be advised to use your reliever, as needed, to control symptoms.

 

 

 

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