Treating severe asthma usually involves a two-part strategy:
- You take long-term control medications like inhaled corticosteroids every day to prevent symptoms. You may also take long-acting beta-agonists.
- You take quick-relief (“rescue”) medications like short-acting beta-agonists to stop asthma attacks when they start.
If the treatment you’re on is doing a good job of controlling your symptoms, you should be able to stick with the same plan. But if you’re still having frequent attacks of shortness of breath, coughing, and other issues, your doctor might consider adding on to your therapy.
When to add a new treatment
Talk to your doctor if you feel like your asthma isn’t well-controlled. Signs might include the following:
- You’ve missed work or other activities because of asthma symptoms.
- Your peak flow number is lower than usual.
- You use your rescue inhaler more than twice a week.
- You’ve ended up in the emergency room because of an asthma attack.
Your doctor will first make sure that you’re taking your current medicine the right way, and that you know how to use your inhaler. Your doctor should also look for factors that might be causing your continued symptoms. For example, are you exposed to allergy triggers like dust and pollen more often than usual? Have you recently been sick with the flu?
The next step is to add a medicine to your regimen and try it for a few weeks. If that drug doesn’t help, your doctor will try another one.
Several different medicines might work along with your standard drug regimen to help you manage your asthma more effectively. These include the following:
Leukotriene receptor antagonists
Leukotrienes are substances that your immune cells release during an asthma attack. They cause your airways to narrow. Leukotriene receptor agonists like montelukast (Singulair) block the actions of leukotrienes to relieve symptoms that include:
- trouble breathing
- chest tightness
When added to asthma treatment, montelukast can help reduce the number of attacks.
The anticholinergic drug tiotropium (Spiriva) relaxes muscles around your airways to help you breathe easier. Adding this drug to inhaled corticosteroids and long-acting beta-agonists may help control your asthma better.
These drugs are man-made versions of natural proteins your immune system produces. They’re used to treat many different diseases, from cancer to rheumatoid arthritis.
Omalizumab (Xolair) is used as an add-on therapy in people with severe allergic asthma that isn’t well-controlled with inhaled corticosteroids and long-acting beta-agonists. Mepolizumab (Nucala) and reslizumab (Cinqair) are add-on therapies for people with an especially hard-to-manage form of asthma called eosinophilic asthma. Monoclonal antibodies are typically given as an infusion or injection.
Allergy shots (immunotherapy) may help if your asthma attacks are triggered by allergens. They prevent your immune system from overreacting to substances that include:
- pet dander
Nondrug add-on therapies
Drugs aren’t the only therapeutic approach to managing severe, uncontrolled asthma. A few non-medication therapies are worth trying too.
Methods like the Buteyko technique, Papworth method, and yoga breathing (pranayama) teach you how to slow your breathing rate and breathe through your mouth rather than your nose. These breathing exercises may help you breathe easier and feel better.
If allergies set off your asthma symptoms, try to avoid your triggers. Wash your bedding and vacuum your rugs often to cut down on dust mites. Set your indoor humidity level below 60 percent to prevent mold from gathering. When pollen is in the air, stay indoors with the windows closed and the air conditioning on. And keep pets out of the bedroom while you sleep.
Cigarette smoke is an irritant that can provoke asthma attacks and make them more severe. Ask your doctor about ways to quit, which can range from nicotine replacement products to counseling.
If you continue to experience symptoms of severe asthma while you’re already adhering to treatment, talk with your doctor. You may need to consider including an additional medication in your regimen or making a few lifestyle changes. Your doctor can help you find an effective option that will complement your current treatment.