What you need to know

How to treat asthma?

Asthma treatment involves learning about asthma triggers and how to recognise them as well as education about the importance of regular therapy in order to control asthma symptoms as well as possible. Asthma triggers are various irritants and substances that can make your asthma symptoms flare up. Asthma triggers vary from person to person and they include

– Allergens in the air, such as pollen, dust mites, mold, pet dander or particles of cockroaches

– Respiratory infections, such as viral infections, colds

– Exercise

– Cold air

– Air pollutants and irritants, such as smoke

– Certain medication, including beta blockers, aspirin, and nonsteroidal anti-inflammatory drugs such as ibuprofen (Brufen) and others

– Strong emotions and stress

– Sulphites and preservatives added to some foods and drinks, including shrimps, dried fruit, processed potatoes, beer and wine

– Gastroesophageal reflux disease (GERD), a condition in which stomach acid flows back into your throat

Asthma medications:

The medication that is right for you depends on many factors, such as your age, symptoms, triggers and what is the best way to control your asthma.

There is preventive medication that helps control asthma long-term and medication for quick-relief of symptoms.

Preventive medication for long-term asthma control reduce inflammation and swelling in your airways that cause the symptoms.

Medication for quick-relief of symptoms (bronchodilators) quickly open narrowed and swollen airways that make breathing difficult.

In some cases you may need medicine for allergies.

Preventive medication for long-term asthma control

They are used every day and they represent the foundation of asthma treatment. These medications help control asthma daily and reduce the possibility of asthma attacks.Types of medication for long-term prevention include:

–Inhaled corticosteroids: These anti-inflammatory medications are the most effective for long-term asthma control.  They reduce swelling of the airways.  You may need to use these medications for several days to several weeks before they achieve maximum benefit.  Budesonide (Pulmicort turbuhaler, Pulmicort Respules) and ciclesonide (Alvesco) are available in Serbia.  Regular use of inhaled corticosteroids helps achieve good asthma control and prevent asthma attacks.  Inhaled corticosteroids generally do not cause serious side effects.  When side effects occur, these are mainly mouth and throat irritation and oral thrush infections. After each inhalation, rinse your mouth with water to reduce the amount of medicine that remains in your mouth.

–Leukotriene modifiers: These medications block the actions of leukotrienes that cause asthma symptoms. They help ease asthma symptoms for up to 24 hours. These medications are taken orally. Montelukast (Singulair or Alvocast) is available in Serbia.

–Long-acting beta-agonists  (LABA): These bronchodilator medications open airways and reduce swelling for at least 12 hours. They are used regularly to control moderate to severe asthma and to prevent symptoms during the night. They are inhaled in the combination with inhaled corticosteroids.

–Combination inhaled medicines: These drugs – such as budesonide-formoterol (Symbicort), beclomethasone-formoterol (Foster), fluticasone furoate-vilanterol (Relvar), fluticasone propionate-salmeterol (Seretide) contain inhaled corticosteroids and a long-acting bronchodilator that widens the airways (bronchodilator from the group of long-acting beta-agonists).

These are used one to two times a day.

–Long-acting bronchodilator from the anticholinergics group They are used exclusively by patients who suffer from severe asthma. These medications are inhaled once a day and they keep the airways open for 24 hours.

Theophylline: (Aminofilin, Durofilin) is a daily pill that helps keep the airways open by relaxing

the muscles around them. It is not used as often as other asthma medication because it has numerous side effects and requires regular blood tests.

Medication for quick relief of symptoms

They are used only as needed for quick and short-term relief of symptoms during an asthma exacerbation or attack. They can also be used before exercise if recommended by your doctor.

These medications are used by inhalation, they open the lungs by relaxing the muscle bands of the airways. Often called “rescue medicines” or “quick-relief inhalers”, they can relieve symptoms or even stop an asthma attack. Their action begins within minutes and lasts for four to six hours. They are not for everyday use.
Possible side effects are tremors and palpitations.

If you need to use these medicines more often than your doctor recommends, your asthma is not under control, and you need to talk to your doctor.

These medicines include:

–Short-acting beta-agonists: These inhaled bronchodilators act within a few minutes and quickly relieve asthma symptoms during exacerbation. Salbutamol (Ventolin) belongs to this group.

Short-acting beta-agonists can be taken with the aid of a small handheld inhaler or a nebuliser, that turns liquid asthma medication into a fine mist. These are inhaled through a face mask or a mouthpiece.

– Short-acting anticholinergics: This group includes Ipratropium, which acts quickly and immediately relaxes your airways, making breathing easier.  It can be found on the market in combination with a short-acting beta-agonist called fenoterol, and the combination is better known as Berodual.

These medications can relieve your symptoms, but you should not use them if your medication for long-term control keeps your asthma under control.

Keep a record of how many inhales (puffs) of these medicines you take each week. If you use them often, consult a doctor. Medication for long-term asthma control may need to be modified.

-Oral or intravenous corticosteroids: These drugs include prednisone (Pronison) and methylprednisolone (Lemod solu,Urbason)

they relieve inflammation of the airways. They can be taken orally, intravenously, or in the muscle tissue.

Long-term use of these can cause serious sideeffects, such as cataracts, osteoporosis, muscle weakness, reduced resistanceto infections, high blood pressure and others.

Allergy medicine: These include allergy shots (immunotherapy) which may be an option if you have allergic asthma that cannot be controlled by avoiding triggers.  It starts with skin tests to determine which
allergens trigger your asthma symptoms, then you are given a series of injections containing small doses of those allergens.

These medicines are taken under the tongue or you get them under the skin, usually for a period of three to five years. With time, the injections of the allergen to which you are sensitive gradually reduce the response of your immune system and you should lose sensitivity to the allergens.

BiologicsThey are in particular intended for patients with severe asthma.  Your doctor may recommend treatment with biologics if you have asthma symptoms that can not be well controlled with long-term asthma control medications.

These drugs include omalizumab (Ksolair) which are used to treat asthma caused by allergens in the air, i.e.,allergic asthma. If you have allergies, your immune system produces antibodies that lead to the release of a number of molecules that trigger an immune response and result in symptoms of the disease. Omalizumab blocks the action of these antibodies, reducing the immune system response that causes allergy and asthma symptoms.

Omalizumab is administered by injection every two to four weeks. It is not recommended for children under the age of 12. The reaction to it is good and side effects are very rare. In rare cases, this medicine can cause a severe allergic reaction (anaphylaxis).

Biologic medications also include medicines used in non-allergic asthma, which block the release, maturation and action of eosinophils, reducing their number in the body and reducing airway inflammation. These medicines include benralizumab (Fasenra), mepolizumab (Nucala), reslizumab (Cinkair), dupilumab (Dupikent) . Dupikent is still unavailable on out market.

Biologics are used along with other asthma medication.

Bronchial thermoplasty: This treatment is used for severe asthma that
does not improve with inhaled corticosteroids or other medicines for long-term
asthma control. It is not widely available nor suitable for all patients.

During bronchial thermoplasty, the doctor heats the walls of the airways using an electrode.  Heat reduces the amount of smooth muscle inside the airways.  This limits the ability of the airways to constrict, making breathing easier and possibly reducing asthma attacks. Therapy is usually performed during three outpatient visits.

Asthma treatment is based on a stepwise approach

Your therapy should be flexible and based on the ways your symptoms change. Your doctor should enquire about your symptoms each time you visit. Based on your symptoms, your doctor can adjust your therapy.

For example, if your asthma is well controlled, your doctor may prescribe fewer medications. If your asthma is not well controlled or is getting worse, your doctor may increase your medication dose and recommend more frequent visits. It is important that you have a good cooperation with your doctor.


MD PhD Violeta Kolarov