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Asthma has no cure, the goal of any treatment therefore is to control or manage Asthma. By doing this we prevent future severe attacks, minimize the need for emergency treatment, maintain a normal lifestyle and activity level and support proper lung and heart functioning. We manage Asthma with the use of medications and control of the environment. Sometimes our doctor will also prescribe monitoring and exercises done with breathing apparatus like the peak flow indicator and spirometer, but these measures are not as common. What we use and when we use it is determined by the severity of the asthma that we live with.
We have a separate article on environmental control, so we will deal primarily with the medications. There are three types I will deal with here, Controller Medications, Relief Medications and Adjunct Treatments.
Controller Medications are primarily Corticosteriods. These are typically inhaled with a breathing aparatus so as to concentrate on the lungs directly. Sometimes things I have listed under Adjunct medications are used also, but their functions are different and many physicians are hesitant to prescribe them as a primary Controller Medication. Corticosteroids function in such a way as to minimize inflamation of air passages, this cuts back on mucus and therefore prevents the second part of asthma: the constriction of the airways.
Rescue Medications are usually Bronchodialators and do what it sounds like they do, they dialate air passages to increase airflow during a "spasm". These come in two forms:
Beta2Antagonists - these are related to adrenaline and the effects are seen within minutes. They do not reduce inflammation and side effects are typically shakiness and racing heart.
Anticholinergenics - these take slightly longer, dialate the airways, and the effects last longer than the Beta2 form.
Adjunct Medications include the following:
Leukotriene Inhibitors - These block chemicals which promote the inflammatory response in the lungs. This, in theory, prevents inflammation before it needs to be controlled. Some doctors are prescribing these as controller medications, but I have run across studies which indicate they are better used as adjuncts rather than primary controls. For an article on this topic, click here:New vs Old
Methylxanthines - These chemicals are similar to the chemicals in caffiene and have similar side effects. What they do for Asthma relief is to dialate breathing passages. They are sometimes used as daily preventatives for some patients whose passages remain constricted for long periods of time.
Cronolyn Sodium - These are allergy medications and are taken primarily before exposure to known allergens to prevent attacks. These can be taken daily during pollen season for those who have problems, or before cleaning when exposure to dust causes problems.
How these medications are used depends largely on the degree of suffering the Asthma patient experiences. Below are classification of Asthma and how treatments work in each:
1. Mild/Intermitent: Usually symptoms occur less than two times a week during the day and two times a month or less at night. At this stage with proper environmental adjustments the only treatment needed will be the use of the Bronchodialator (Rescue Treatment). If the rescue inhaler is taken more than 2-3 times a week, it indicates that long term control is needed.
2. Mild/Persistent: Symptoms occur at night 3-4 times a month and during the day about 3-5 times a week. Doctor will prescribe long term control medication, usually the inhaled corticosteriod; sometimes, especially in children, Leukotriene agents may be used instead. One must pay closer attention to the environment and use the rescue inhaler as needed. Use of the rescue inhaler on a daily basis means therapy is not effective and treatment needs adjusted.
3. Moderate: Moderate sufferers have almost daily symptoms and often about as many times in the evening. Doctors will prescribe the steroidal control medication - sometimes in combination with the Leukotriene Inhibitor or the Longer acting Bronchodialators - for daily control with the rescue inhaler for emergencies. At this stage, environmental control is of utmost importance and can not be ignored. If you use your rescue medicine more than once a day, then treatment needs adjusted.
4. Severe: Severe Asthma patients have symptoms more than once a day and frequently at night. If they are not controlling their environment well, doing so may drop them down a notch on the treatment scale. Making sure to avoid triggers or preparing oneself properly is critical at this stage. If the adjunct treatments were not present during the moderate stages they are often added here as preventative measures. Doctors will often monitor airflow and breathing with the devices mentioned above to get a good picture of how the patient is doing on a daily basis.
Conventional Treatment is standard practice, well established and safe for Asthmatics. If your doctor offers you a daily pill or inhalant, don't go off the deep end. I invite you to study your treatment patterns and medicines with your doctor to make sure you are getting what you need. If you find your treatment to be less effective than you think possible, you can explore a change in medication, or adding Complimentary Medicinal Treatments to your regimen. Anything you do to help your Asthma is a good investment of time and effort, but make sure to keep your doctor in the loop. Some herbs and medicines do not get along well, some treatments are dangerous to heart or liver patients and children. It is always wise to give all the information you have to the person whom you are trusting with your health.
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