How Is Asthma Diagnosed?
If you suspect you have asthma, your doctor will get a personal and family history as well as examine you. Some doctors may then prescribe an asthma medication (usually an inhaler), ask you to take it for a few weeks, and then schedule a return visit to see if the medication reduced your respiratory symptoms. The most common test to confirm asthma is a spirometry test.
Many primary care doctors now have spirometers in their office. If the results show that you have airway obstruction which is improved after using a bronchodilator (usually containing albuterol), the probability that the respiratory symptoms were due to asthma is very high. However, spirometry is often normal in people with asthma during days they don't have symptoms.
The doctor can then order another breathing test called a methacholine challenge test which determines the degree of twitchiness of the airways. There are many other tests your doctor may order including allergy skin tests (recommended at least once for almost all patients with asthma), allergy blood tests (eosinophil count or IgE levels), and perhaps a chest X-ray.
What Are the Treatments for Asthma?
Asthma is usually a lifelong (chronic) disease. If you have asthma, see a doctor regularly. Treatment for asthma requires several steps:
- Monitoring daily asthma symptoms and need for rescue medication in an asthma diary
- Avoiding asthma triggers
- Taking medications daily that control inflammation and prevent chronic symptoms (long-term-control drugs)
- Ready availability of drugs such as albuterol to treat asthma attacks when they occur
Your Asthma Action Plan
Following a diagnosis of asthma, work with your doctor to develop a treatment plan. Ask your doctor for the resulting written asthma action plan, which includes what you should do when you fall from the green zone of good control into the yellow or red zones. You can download one from WebMD, print it, and ask your doctor to complete it.
Monitoring lung function can improve the ability of some people with asthma to verify that their asthma control is worsening. Discuss the potential value of buying a $20 to $60 peak flow meter (such as the Personal Best) or pocket spirometer (such as the PiKo-1) with your doctor. You can add the readings to your asthma diary and use them as part of your asthma action plan. As with any medical condition, prevention is the best approach.
There are two general types of asthma medications:
Anti-inflammatory drugs are taken daily to control asthma and prevent asthma attacks. Inhaled corticosteroids are the most popular and most likely to be effective anti-inflammatory medications for most people suffering from asthma. They reduce swelling and mucus production in the airways, making them less likely to react to triggers. Inhaled corticosteroids include beclomethasone (QVAR), budesonide (Pulmicort), fluticasone (Flovent), flunisolide (Aerobid, Aerospan), and ciclesonide (Alvesco) all of which are usually taken twice-a-day, and mometasone (Asmanex) and fluticasone furoate (Arnuity Ellipta), which may control asthma in some patients when taken just once-a-day.
Two other popular types of anti-inflammatory medications include the leukotriene modifier pills monteleukast (Singulair), which can be taken just once a day, zafirlukast (Accolate) taken twice a day, and zileutin (Zyflo) taken four times a day. The third type of anti-inflammatory drug is the inhaled cromones: cromolyn (Intal) and nedocromil (Tilade).
The biologic mepolizumab (Nucala) is a once a month injection that targets blood cells which trigger asthma attacks. It keeps interleukin 5 (IL-5) from binding with those cells and in doing so lowers the number of severe asthma incidents. It can also help a patient reduce the amount of their other asthma medications, but it is only recommended for patients 12 and older.
An anti-IgE drug, omalizumab (Xolair), is an injection usually taken once every two to four weeks and works by inhibiting the allergic inflammation that often causes constriction of the airways. Because of its high cost, Xolair is usually reserved for patients with difficult-to-control allergic asthma.
Bronchodilators relieve the symptoms of asthma by temporarily relaxing the muscle bands that tighten around the airways. As a result, breathing improves for about four hours for the short-acting bronchodilators and for about 12 hours for the long-acting inhaled bronchodilators. Short-acting inhaled bronchodilators include the highly popular rescue inhaler albuterol (Ventolin, Proventil, ProAir, and a generic, called salbutamol in Europe) and the new Levalbuterol (Xopenex) with the potential advantage of fewer side-effects for some patients. Long-acting inhaled bronchodilators include salmeterol (Serevent) and formoterol (Foradil or Oxis). When an inhaled corticosteroid is not adequately controlling asthma, a long-acting bronchodilator is often added. According to the FDA, for safety reasons, these long-acting medications should only be used in combination with another controller medication and only for as long as necessary to regain control. Three inhalers combine these two types of asthma controller medications: Advair Diskus (fluticasone in one of three doses, plus salmeterol), Symbicort (budesonide plus formoterol), and Dulera Inhalation Aerosol (mometasone plus formoterol).
WARNING: Bronchodilators are potent drugs. If overused, they can cause dangerous side effects such as high blood pressure and fast or irregular heart beats (arrhythmias). If you are using a short-acting rescue bronchodilator more than twice a week because of asthma symptoms, talk to your doctor. Your asthma needs to be controlled better, possibly with anti-inflammatory drugs like corticosteroids.
There are also some over-the-counter (OTC) drugs purported to treat asthma including Bronkaid Mist (epinephrine) and Asthmanefrin. These drugs are very short-acting bronchodilators, relaxing the muscles around the airways. They provide relief of symptoms for up to an hour, but they don't prevent asthma attacks and are much more likely to cause side effects (including dangerous abnormal heart rhythms) when compared to prescription bronchodilators. They aren't recommended for people with chronic asthma. OTC medications for asthma are generally discouraged and you should talk to a doctor about your asthma symptoms.these over-the-counter medications for asthma are generally discouraged and you should talk to a doctor about your asthma symptoms.