11 Oct A Six Step Approach to Asthma Control
Asthma is a life-long disease that occurs when the immune system responds to harmless allergens in the environment. Short-acting medications can treat attacks when they occur. But it is a progressive disease that can harm the lungs. ‘Progressive’ means that if damage builds up over time, symptoms become more frequent and severe. So for severe cases, prevention is the better than treatment.
There are two main types of asthma medications. Of course, there are new drugs out there – but these are the most widely-used:
- A beta-agonist:Short-acting BAs, or ‘rescue inhalers’ calm down the immune system once it starts to react. A long-acting BA works daily or weekly when other drugs aren’t enough to prevent an attack.
- Corticosteroids (inhaled or oral): steroids suppress the immune system to stop attacks before they happen. Unfortunately, they have strong side-effects. These include weight gain, osteoporosis (weakening of the bones), high blood pressure, and high blood sugar. That’s why patients start out on an inhaled steroid. Inhaled drugs target the lungs, and are less likely to affect the rest of the body. But severe, uncontrolled asthma may need an oral steroid.
Which medications should I take?
All these drugs can be overwhelming. But there is a system! Doctors use a “Six Step” approach that balances the benefits of asthma control against the side-effects. Mild to moderate asthma begins with Step 1. If you still have frequent attacks, you and your doctor will discuss the risk and benefits of moving to the next step.
Step 1: Rescue inhaler as needed
Step 2: Add a low-dose inhaled corticosteroid to Step 1
Step 3: Change Step 2 to a medium-dose inhaled corticosteroid
Step 4: Add a long-acting BA to Step 3
Step 5: Change step 3 to a high-dose inhaled corticosteroid
Step 6: Add an oral (pill) corticosteroid to Step 5.
Keeping in step: why prevention is critical
It may seem ok to ‘push through’ asthma attacks with rescue inhalers and other treatments. But inflammation builds with each one. If symptoms are not addressed, a patient on Step 6 would need:
- rescue inhaler as needed
- a long-acting beta agonist
- a high-dose inhaled corticosteroid
- An oral corticosteroid
That is a lot of medications with serious side effects. Still, the good news is that the earlier you start prevention, the less likely you are to move up steps.
Warning signs to watch for
What are the signs that your asthma is not well-controlled?
- Asthma symptoms wake you up at night more than once per month
- You need a rescue inhaler more than twice per week
- Asthma interfere with normal activities
- Your lung function declines. A doctor measures lung function using a spirometer. It gauges how well your lungs pull in and push out air, and how much air you can take in.
If you notice any of these, it’s time to schedule a check-up. You may need to move up a Step to control symptoms. The good news is that asthma can also improve. When symptoms are under control, the lungs can heal. You can discuss moving back a down to a step with fewer medications.