Basics of Pharmacological Management of Asthma

The goal of bronchial asthma management is control of the condition by pharmacological and non-pharmacological measures. Total control is described as follows.

Absence of daytime symptoms
Absence of night time awakening due to bronchial asthma
No need for rescue medication
No exacerbations
No restrictions on physical exertion such as exercise
Minimal side effects from medication
Normal lung function (FEV1 and/or PEF should be more than 80 % of best or predicted values)

The stepwise management

Pharmacological management of bronchial asthma is offered stepwise. First step of management depends on the initial severity of the condition. Early control of asthma should be achieved by the most appropriate step of management. Then, control of the condition should be maintained by stepping up medication as needed or stepping down, when control is adequate. However, the health-care professional should verify compliance with existing medication, get rid of triggering factors, and inhaler technique.

Sometimes, health-care professionals prescribe inhaled medication to control bronchial asthma. Inhaled medication includes steroids, β2 agonists (short-acting or long-acting), and a long-acting β2 agonist and steroid in combination. However, there is no difference in efficacy in prescribing combination inhalers or separate inhalers. Usually, combination inhalers are recommended to ensure that the long-acting β2 agonist is not inhaled without steroid and improve compliance (inhaler adherence).

Stepping down the therapy

Health-care professionals should review people with asthma regularly because, stepping down the medication is essential. They consider following factors, when selecting which medication to step down initially and at what rate.

The severity of bronchial asthma
Time on existing dose
The adverse effects of the particular treatment
The health benefits achieved
The patient’s choice

People with bronchial asthma should be kept up at the lowest possible dose of inhaled steroid. Inhaled steroid dose should be lowered slowly because, people tend to deteriorate at different rates. Reductions in the dose of inhaled steroid should be considered every three months, reducing the dose by roughly 25-50 % every time.

Exercise-induced bronchial asthma management

This management applies to adults and children aged five to twelve years.

For many individuals, exercise-induced bronchial asthma is a manifestation of poorly controlled bronchial asthma and regular medication such as inhaled steroids should be evaluated.

If exercise exacerbates bronchial asthma in individuals taking regular inhaled steroids who are otherwise properly managed at rest, health-care professionals should think about including one of the following medications.