Asthma Treatment Options: Short-Term, Long-Term and Immunotherapy

When it comes to asthma treatments, there are plenty of options, and no single treatment is right for everyone. The one that's best for you depends on your age, your symptoms and the severity of your asthma. Work with your doctor to come up with an asthma treatment plan to manage your particular condition.

Asthma treatments come in many forms, including inhaled medication, oral medication and injections. Most inhaled medications are taken with a handheld device called an inhaler, which may sometimes be used in combination with a spacer device. Another option is a nebulizer, which turns medication in liquid form into a vapor. This option can be a good one for people who struggle to use an inhaler. Oral medications may be taken as pills or liquid, and injections can be under the skin or intravenous.

There is no cure for asthma, but there are three types of asthma treatments: short-acting medications, long-acting medications and immunotherapy. Most people with asthma need both short- and long-acting medications, and additional immunotherapy can be useful for those who have both asthma and allergies.

Short-acting medications

These medications are also called quick-relief or rescue medications because they can treat an asthma attack quickly. You take these medications at the first sign of an asthma attack, but you don't use them every day. Needing to use a short-acting medication more than twice a week indicates that your asthma is not in good control. If you have exercise-induced asthma, you might also take a short-acting medication before exercising.

• Short-acting beta agonists. These inhaled medications are the most common rescue medications. They help your airway open by relaxing the smooth muscles around them. You may start to feel relief within minutes, and it lasts 4 to 6 hours.
• Anticholinergics. These medications are also inhaled and open airways by relaxing smooth muscles, decreasing inflammation, and clearing mucus. Anticholinergics may be used alone or combined with short-acting beta agonists in one inhaled medication.

Long-acting medications

Long-acting medications are the most important treatments because they are the best for preventing asthma attacks. You take these medications regularly, even if you don't have symptoms. These medications are also called long-term controllers. Unless you have very mild asthma, you will need one of these medications.

They include:

• Inhaled corticosteroids. Steroids are strong medications used to control inflammation. They are the most effective long-term asthma medications because they control tightness, swelling and mucus production for months.
• Oral corticosteroids. Oral corticosteroids may be used for a few days to treat an asthma attack that doesn't respond to other treatments. If you have severe asthma that is difficult to control then daily treatment with oral corticosteroids may also be recommended.
• Leukotriene modifiers. These medications are taken as oral pills or liquid. They block immune system chemicals called leukotrienes that cause asthma symptoms, reducing swelling and opening airways. These medications work for about 24 hours.
• Long-acting beta agonists. These inhaled drugs work for about 12 hours. They are always combined with an inhaled corticosteroid. They are used for moderate to severe asthma.
• Biologic drugs. These drugs are given by injection or IV infusion. They are only used for severe asthma when other treatments are not helping. They work by preventing your immune system from causing inflammation. Treatments are usually given every few weeks. Biologics are always combined with another long-term treatment.
• Theophylline. This medication is taken as a daily pill or liquid. It opens airways by relaxing smooth muscles. This treatment is useful for nighttime asthma. However, this is rarely used today because of toxicity.
• Cromolyn sodium. This is an inhaled drug that prevents any inhaled irritants from triggering asthma.

Immunotherapy

If your asthma is triggered by allergies, immunotherapy may be an option for you. Not all people with asthma have allergies, and not all people with allergies have asthma. However, if you have both allergies and asthma, immunotherapy may help.

By far the most common type of immunotherapy is the allergy shot. After being tested to find out what you are allergic to, immunotherapy involves getting tiny amounts of the allergy-causing substance (allergen) injected under your skin. Over time, your immune system stops reacting to the allergen. A new type of immunotherapy uses tablets or drops placed under your tongue.

Other allergy treatments may include antihistamine oral medications and nasal sprays, steroid nasal sprays and cromolyn nasal spray.

It also helps to learn your triggers and avoid them whenever possible. Common triggers include allergens, irritants in the air, extreme weather and stress.

In addition to taking medication and avoiding environmental triggers, another important part of controlling your asthma is managing other health conditions that can trigger asthma. For example, having acid reflux, being very overweight, and having sleep apnea can also be triggers. If you have any of these conditions, work with your doctor to get them under control.

The bottom line

If you have asthma, remember this about treating it:

• Asthma is not curable but it can be controlled with the right treatment.
• There are many treatment options for asthma because it does not affect everyone in the same way.
• Work closely with your doctor to find the best asthma treatment for you and to manage any other conditions that may affect your asthma.
• Make an asthma treatment plan and keep track of your symptoms. If your symptoms get worse or better, adjust your treatment plan as needed.