Management of Asthma
Goals of Management:
- Control symptoms
- Improve lung function
- Prevent exacerbations
- Maintain a good quality of life
Non-pharmacological Management:
- Avoidance of triggers: Identify and avoid known triggers such as allergens, smoke, pollution, and exercise.
- Lifestyle modifications: Engage in regular exercise, maintain a healthy weight, and get adequate sleep.
- Breathing techniques: Learn proper breathing techniques, such as diaphragmatic breathing and pursed-lip breathing.
- Education and self-management: Educate patients about their condition and provide them with self-management tools.
Pharmacological Management:
1. Bronchodilators:
- Short-acting beta-agonists (SABAs): Salbutamol, terbutaline (albuterol, ventolin)
- Long-acting beta-agonists (LABAs): Salmeterol, formoterol (serevent, foradil)
- Anticholinergics: Ipratropium, tiotropium (atrovent, spiriva)
2. Anti-inflammatory Medications:
- Inhaled corticosteroids (ICSs): Budesonide, fluticasone, beclomethasone (pulmicort, flovent, qvar)
- Oral corticosteroids: Prednisone, methylprednisolone (for exacerbations)
3. Combination Inhalers:
- Fixed-dose combination inhalers: Contain both a LABA and an ICS (e.g., symbicort, flutiform)
4. Leukotriene Modifiers:
- Montelukast, zafirlukast (singulair, accolate)
5. Biologics:
- Omalizumab (xolair): For moderate to severe allergic asthma
Step-Down Approach to Management:
- Start with a low dose of medication and gradually increase as needed.
- Once symptoms are well-controlled, gradually reduce medication while monitoring for exacerbations.
Monitoring and Assessment:
- Regular assessments of lung function, symptoms, and medication adherence
- Peak flow monitoring (in some cases)
- Asthma action plans to guide patients in managing exacerbations
Special Considerations:
- Severe asthma: Requires close monitoring, specialized treatment plans, and access to emergency care.
- Childhood asthma: Management strategies may differ depending on age and developmental stage.
- Asthma in pregnancy: Close monitoring and adjustments to medication are necessary.
- Comorbidities: Consider other conditions that may impact asthma management, such as allergies, respiratory infections, and gastroesophageal reflux disease (GERD).