You’ve followed your asthma action plan to the letter. You take inhaled corticosteroids like clockwork to prevent attacks. You add on a short-acting beta-agonist whenever you get a flare-up. Still, you cough and wheeze, and on many days, it feels like an elephant is sitting on your chest.
If that story sounds familiar to you, it may be time to update your asthma treatment plan. Although asthma isn’t curable, you can switch up your therapy to gain more control over your symptoms.
Asthma treatment isn’t one-size-fits-all. It needs to be personalized based on the severity of your symptoms, and how well you’ve responded to your medicines. When the drugs you’re on aren’t working, your doctor will switch your treatment or add another one to your regimen.
Here are four signs that it’s time to see your allergist, primary care provider, or pulmonologist and revise your treatment plan—and some tips on how to find the right treatment for you.
If you’ve started to experience more frequent or severe asthma attacks, it could be that you’re not carefully following your asthma treatment plan. Or, there might be something in your environment—like dust, pet dander, tobacco smoke, or mold—that’s setting off your symptoms.
You may be able to prevent asthma attacks by getting better about keeping up with your current treatment plan. But if you’re taking your medicine as prescribed and it still isn’t controlling your symptoms, see your doctor.
Here are four signs that your asthma isn’t well controlled:
- You cough, wheeze, or have other symptoms at night.
- Your peak flow level has dropped.
- You need to use your rescue inhaler more often.
- You have trouble breathing when you exercise, or during regular activities.
If you’re experiencing any of the above, you may need to revise your asthma treatment plan. Your doctor could increase the dose of your current medicines, or add another drug.
In addition to established asthma treatments like long-term control and rescue medicines, newer drugs, like the biologics, are available to help you gain more control over severe asthma. Sometimes it can take some trial and error to find the treatment that works best for you. You might need to take different doses or combinations of medicines to find relief.
Long-term control medicines bring down inflammation in your airways to help you breathe. Using a long-term inhaler every day can help prevent symptoms, or make them less severe when they do occur.
Inhaled corticosteroids are the
- beclomethasone (Qnasl, Qvar)
- budesonide (Pulmicort Flexhaler, Rhinocort Allergy)
- ciclesonide (Alvesco, Omnaris, Zetonna)
- flunisolide (Aerospan HFA)
- fluticasone (Flonase, Flovent HFA)
- fluticasone furoate (Arnuity Ellipta)
- mometasone (Asmanex)
Other long-term control options for asthma include:
- cromolyn (Intal Inhaler)
- long-acting beta-agonists—formoterol (Foradil, Perforomist), salmeterol (Serevent Diskus)
- leukotriene modifiers—montelukast (Singulair), zafirlukast (Accolate), zileuton (Zyflo, Zyflo CR)
- theophylline (Theo-24, Elixophyllin)
A few inhalers include a combination of medicines, such as:
- budesonide-formoterol (Symbicort)
- formoterol-mometasone (Dulera)
- fluticasone-salmeterol (Advair Diskus)
You use rescue medications when an asthma attack starts, to open up your airways and relieve symptoms. You may need to carry your quick-relief inhaler with you wherever you go.
Types of quick-relief medications include:
- short-acting beta agonists—albuterol (ProAir HFA, Ventolin HFA)
- levalbuterol (Xopenex)
- pirbuterol (Maxair Autohaler)
- ipratropium (Atrovent)
You can also take corticosteroid pills for short periods of time to manage severe asthma symptoms.
Biologic drugs are a newer option for treating severe asthma. These genetically engineered proteins target specific substances in your immune system that cause inflammation. Biologic drugs may be an option if you have severe asthma that hasn’t improved with inhaled corticosteroids, short-acting beta agonists, and other standard asthma treatments.
Two types of biologic drugs are approved to treat severe asthma:
- Omalizumab (Xolair) treats asthma caused by allergies. You get this medicine as an injection.
- Mepolizumab (Nucala), reslizumab (Cinqair), and benralizumab (Fasenra) treat a severe form of asthma called eosinophilic asthma.
If allergens like dust, pollen, and mold trigger your allergy symptoms, allergy shots may help prevent them. These shots gradually expose you to larger and larger amounts of your allergy trigger to get your immune system used to it. You’ll get allergy shots once a week for a few months, and then taper down to once a month.
Bronchial thermoplasty is a type of surgery used to treat severe asthma that hasn’t improved with medication. It uses heat to reduce the amount of smooth muscle inside your airways. This prevents your airways from tightening as much, which can help cut down on asthma symptoms.
Discuss these treatment options with your doctor. Any changes to your treatment plan will be based on how severe your symptoms are, which medicines you’ve already tried, and how well they’ve worked.
Questions to ask your doctor include:
- Could I benefit from taking a higher dose of my current medicine, or a different medicine?
- What are the benefits—and risks—of the treatment you recommend?
- What kinds of improvements should I see from my treatment?
- What should I do if my asthma doesn’t improve?
See your doctor for regular follow-up visits to make sure your asthma treatment is working for you; if the drug you’re on is no longer working, schedule another appointment to make adjustments to your treatment plan. Finding the right medicine or combination of medicines is the best way to control your symptoms, and improve your quality of life.