Step wise treatment for asthma helps to maintain uniformity in treating patients. In addition this kind of approach is helpful to get the highest possible symptom relief by using least possible medications. Also it is easy to understand and gives a freedom of either stepping up or stepping down according to the severity of symptoms.
Step 1 -Mild intermittent asthma
For those whose symptoms are mild and getting attacks occasionally, short acting beta agonists (salbutamol, terbutaline) are helpful. These medications relate the symptoms almost immediately by relaxing the muscles of the wind pipe. Here they are called relievers.
Step 2 – Regular preventer therapy
In those patients, whose symptoms are not properly treated by relievers alone, corticosteroid inhalers will be given in addition to the existing relievers. Corticosteroid prevents inflammation occurring in the wind pipe. Here they are called preventers. Normally Preventers will be needed for those patients who have
o asthma symptoms more than twice a week,
o Waking up during sleep at least once a week due to asthma,
o Those had an asthma attack in the last two years, or
o Those who use short-acting beta2-agonist inhaler (salbutamol, terbutaline) more than twice a week.
Step 3 – Add-on therapy
If symptoms are not getting controlled using corticosteroid inhalers, the next step is to add long acting relievers (long acting b-agonists) like salmetrol or formetrol. The effect of long acting relievers may stay up to 12 hours. Long active relievers should always be combined with corticosteroid inhalers, as one study showed using long active relievers alone may increase the asthma attack. To prevent this problem, it is better to use combined inhalers which contain a corticosteroid and long acting beta2 agonists that are available in the market. Also it is easy for the patients to have one inhaler rather than two.
Patients are tested initially with lowest dose. If symptoms are still worse, the doses of long acting relievers and corticosteroids could be increased.
Step 4 – Persistent poor control
If patient sill has symptoms, doctor would try other medication like leukotriene receptor antagonists or theophyllins to get adequate asthma control. If treatment is still not successful, the amount of inhaled corticosteroids may be increased to its maximum safe dose, and additional preventer medicines will be tried.
For some patients in whom symptoms can not be controlled by above steps, powerful drugs will trial to get adequate asthma control. These include corticosteroid tablets or methortrexate. As they have many side effects, patient should be monitored frequently by an expert.
This is final of seven parts “Walking with a Doc Series – Asthma“.