Asthma

TABLE OF CONTENTS

Treatments

Non-drug

Prescription Drugs

Advair Diskus (Fluticasone/salmeterol) Arnuity Ellipta (Fluticasone furoate) Breo Ellipta (Fluticasone/vilanterol) Dulera (Mometasone/formoterol fumarate) Flovent HFA (Fluticasone propionate) Proair HFA (Albuterol) Pulmicort Flexhaler (Budesonide) Qvar (Beclomethasone) Singulair (Montelukast) Symbicort (Budesonide/formoterol fumarate) Ventolin HFA (Albuterol) Xolair injection (Omalizumab) Zyflo CR (Zileuton)

Over-the-counter Drugs

What Leading Medical Organizations Recommend When Treating Asthma

WHAT TO TRY FIRST

The National Heart, Blood and Lung Institute recommends a stepwise approach to treating asthma in adults and children 12 and older. The goals of treatment are to:

Control symptoms now -  to reduce everyday symptoms, maintain normal activity and only need to use "quick relief" inhaler (Short-Acting Beta2-Agonists - SABA - such as albuterol) infrequently.

Lower chance of future serious problems - to prevent exacerbations, lower chance of needing emergency care or hospitalization and try to limit treatment side effects. Everyone should avoid or limit exposure to asthma triggers.

First-choice medications depend on how often people have asthma:

Intermittent asthma (symptoms 2 days or less a week, nighttime awakenings 2 times a month or less, asthma doesn't interfere with normal activity).  Preferred treatment is "quick relief" SABA inhaler (such as albuterol) as needed for symptoms.

There are 3 categories of persistent asthma:

  1. Persistent mild asthma (daily symptoms, nighttime awakenings 3 to 4 times a month, asthma causes minor limitations).
  2. Persistent moderate asthma (symptoms more than 2 days but not every day, nighttime awakenings once a week but not every night, asthma causes some limitations).
  3. Persistent severe asthma (symptoms throughout the day, nighttime awakenings every night, asthma causes major limitations)

The first-choice medications for persistent asthma are added in steps depending on how people respond.

  • Step 1  Low-dose inhaled steroids (such as fluticasone or beclomethasone)
  • Step 2  Low-dose inhaled steroids + "controller" inhaler (Long-Acting Beta2-Agonists - LABA - such salmeterol) OR medium-dose inhaled steroids
  • Step 3  Medium-dose inhaled steroids + "controller" inhaler
  • Step 4  High-dose inhaled steroids + "controller" inhaler + consider omalizumab if you have allergies.
  • Step 5   High-dose inhaled steroids + "controller" inhaler + steroid pills (such as prednisone) + consider omalizumab if you have allergies

People who reach Step 4 should see an asthma specialist. 

WHAT ELSE TO TRY

The alternative medications for persistent asthma are added in steps depending on how people respond.   If alternative treatment is used and people do not respond enough, stop and use first-choice treatment before stepping up.

  • Step 1  Cromolyn, leukotriene receptor antagonist (such as montelukast), or theophylline (theophylline is the last-choice because blood levels need to be checked regularly).
  • Step 2  Low-dose inhaled steroids + (leukotriene receptor antagonist, theophylline or zileuton).  Theophylline (because blood levels need to be checked regularly) and zileuton (because blood tests for liver damage need to be checked and limited evidence that it helps added onto other treatments) are last choices.
  • Step 3  Medium-dose inhaled steroids + (leukotriene receptor antagonist, theophylline or zileuton).  Theophylline (because blood levels need to be checked regularly) and zileuton (because blood tests for liver damage need to be checked and limited evidence that it helps when added onto other treatments) are last choices.
  • Step 4  High-dose inhaled steroids + "long-acting" inhaler + consider omalizumab if you have allergies.

Consider allergy shots in Steps 2 through 4 for people with allergic asthma. 

SOURCE

National Heart, Lung and Blood Institute. Asthma Care Quick Reference: Diagnosing and Managing Asthma. Published September 2012.