Living with severe asthma can be a challenging and distressing experience, but the good news is that there are various treatment options available to help manage this condition. From long-term control medications to quick-relief inhalers, there are several medications that can effectively reduce the severity and frequency of asthma attacks. Additionally, lifestyle changes such as avoiding triggers, maintaining a clean environment, and regular exercise can also greatly improve asthma symptoms. In this article, we will explore the different treatment options for severe asthma and provide insights on how to effectively manage this chronic respiratory condition.
Medications
Bronchodilators
Bronchodilators are a type of medication that can provide immediate relief for asthma symptoms by relaxing the muscles in your airways. There are two types of bronchodilators: short-acting and long-acting. Short-acting bronchodilators, also known as rescue inhalers, are used on an as-needed basis to quickly open up your airways during an asthma attack. Long-acting bronchodilators, on the other hand, are taken regularly to maintain open airways and prevent asthma symptoms from occurring.
Corticosteroids
Corticosteroids, often referred to as steroids, help reduce inflammation in your airways. They can be taken orally, inhaled, or injected depending on the severity of your asthma. Inhaled corticosteroids are the most common form and are used as a long-term treatment to prevent symptoms and asthma attacks. Oral corticosteroids are usually reserved for severe cases or acute exacerbations and are taken for a short period of time to quickly reduce inflammation.
Long-acting beta agonists (LABAs)
Long-acting beta agonists are another type of medication used to relax the muscles in your airways and keep them open. They are typically prescribed in combination with inhaled corticosteroids to provide additional bronchodilation and improve asthma control. LABAs are not intended for immediate relief during an asthma attack and should always be used in combination with an inhaled corticosteroid.
Leukotriene modifiers
Leukotriene modifiers are oral medications that work by blocking the effects of leukotrienes, which are chemicals in the body that cause inflammation and constriction of the airways. They are often used as an alternative or add-on treatment for people with moderate to severe asthma, especially if inhaled corticosteroids are not sufficient in controlling symptoms. Leukotriene modifiers are taken daily and can be used in combination with other asthma medications.
Biologics
Biologics are a newer class of medications that target specific molecules in the immune system that contribute to asthma inflammation. They are typically used for people with severe asthma who do not respond well to other treatments. Biologics are administered either by injection or intravenous infusion, and they work by blocking certain proteins or receptors involved in the inflammatory response. Examples of biologics used to treat severe asthma include omalizumab, mepolizumab, and dupilumab.
Lifestyle Changes
Avoiding triggers
One key aspect of managing severe asthma is identifying and avoiding triggers that can worsen your symptoms or trigger an asthma attack. Common triggers include allergens such as pollen, dust mites, pet dander, and mold, as well as irritants like air pollution, cigarette smoke, and strong odors. By minimizing your exposure to these triggers, you can reduce the frequency and severity of asthma symptoms.
Maintaining a healthy weight
Maintaining a healthy weight is important for overall health, including asthma management. Obesity can worsen asthma symptoms and make it more difficult to control the condition. Excess weight puts extra pressure on the lungs and can cause shortness of breath. By adopting a healthy diet and engaging in regular physical activity, you can achieve and maintain a healthy weight, which may help improve your asthma symptoms.
Regular exercise
Regular exercise plays a crucial role in managing severe asthma. Although physical activity can sometimes trigger symptoms, staying active can help improve lung function, reduce inflammation, and enhance your overall fitness level. It is important to consult with your healthcare provider to develop an exercise plan that takes into account your asthma triggers and medications. They can provide guidance on the best types of exercise and any precautions you should take.
Quitting smoking
If you have severe asthma, quitting smoking is essential. Smoking not only worsens asthma symptoms but also damages your lungs and overall respiratory health. Secondhand smoke is equally harmful, so it is important to avoid exposure to smoke from others as well. Quitting smoking can be challenging, but there are many resources available to help you quit, such as counseling, support groups, and medications. Talk to your healthcare provider for personalized guidance and support.
Allergy Shots
What are allergy shots?
Allergy shots, also known as allergen immunotherapy, are a form of treatment for people with allergic asthma. They involve receiving regular injections of gradually increasing doses of allergens to which you are allergic. The goal of allergy shots is to desensitize your immune system to these allergens and reduce your body’s allergic response over time.
How do allergy shots work?
Allergy shots work by exposing your immune system to small amounts of the allergens that trigger your asthma symptoms. By gradually increasing the doses of allergens, your immune system becomes less sensitive to them over time. This can help reduce the severity of your asthma symptoms and decrease the need for medication.
Benefits of allergy shots
Allergy shots can provide long-term relief for allergic asthma. They can significantly reduce allergy symptoms, including nasal congestion, sneezing, and itching. Allergy shots can also improve asthma control, decrease the frequency and severity of asthma attacks, and reduce the need for rescue medications. In some cases, they may even prevent the development of new allergies.
Effectiveness of allergy shots
Allergy shots have been shown to be highly effective in reducing allergy symptoms and asthma exacerbations. However, the effectiveness may vary depending on the specific allergen and individual response. It is important to note that allergy shots require a commitment of several years, as they are typically administered over an extended period of time. Consistency and adherence to the treatment plan are crucial to achieve optimal results.
Potential side effects
While allergy shots are generally safe, they can cause mild side effects. These can include local reactions at the injection site, such as redness, swelling, or itching. Some people may also experience systemic reactions, such as nasal congestion, sneezing, or mild asthma symptoms. Serious allergic reactions, though rare, can occur and may require immediate medical attention. It is important to discuss the potential risks and benefits of allergy shots with your healthcare provider before starting this treatment.
Bronchial Thermoplasty
What is bronchial thermoplasty?
Bronchial thermoplasty is a procedure used to treat severe asthma that is not well controlled with medications alone. It is a non-surgical treatment that targets the smooth muscles lining the airway walls. During bronchial thermoplasty, controlled thermal energy is delivered to the airway walls to reduce the amount of excess smooth muscle, thereby decreasing the airway’s ability to constrict during an asthma attack.
How does bronchial thermoplasty work?
Bronchial thermoplasty works by delivering controlled thermal energy to the airway walls. This thermal energy reduces the amount of smooth muscle, which is responsible for constricting the airways during an asthma attack. By reducing the smooth muscle, bronchial thermoplasty can help improve asthma control and reduce the frequency and severity of asthma symptoms.
When is bronchial thermoplasty recommended?
Bronchial thermoplasty is typically recommended for people with severe asthma who are not well controlled with medications. It is considered an option for individuals aged 18 and older who have a history of frequent asthma exacerbations and who continue to experience asthma symptoms despite optimal medication management. Your healthcare provider will evaluate your specific condition and assess whether bronchial thermoplasty is appropriate for you.
Procedure for bronchial thermoplasty
Bronchial thermoplasty is typically performed as an outpatient procedure, meaning you do not have to stay overnight in the hospital. The procedure is done in three sessions, each targeting a different area of the lungs. During the procedure, a thin, flexible tube called a bronchoscope is inserted into your airways. The bronchoscope delivers the thermal energy to the airway walls, which helps reduce the smooth muscle. The entire procedure takes approximately one hour to complete.
Effectiveness and risks
Bronchial thermoplasty has been shown to provide long-term improvements in asthma control and reduce the frequency of asthma exacerbations. Studies have demonstrated a significant reduction in severe asthma attacks, emergency department visits, and hospitalizations following bronchial thermoplasty. It is important to note that like any medical procedure, bronchial thermoplasty carries some risks. These can include short-term side effects such as coughing, wheezing, and chest discomfort. In rare cases, more serious complications such as infection or worsening of asthma symptoms can occur. It is essential to discuss the potential benefits and risks with your healthcare provider before considering bronchial thermoplasty.
Immunomodulators
What are immunomodulators?
Immunomodulators are a class of medications that work by altering the functioning of the immune system. In the context of asthma treatment, they are used to modify the immune response and reduce inflammation in the airways. Immunomodulators are typically reserved for people with severe asthma who do not respond well to other treatments.
How do immunomodulators work?
Immunomodulators work by targeting specific molecules or pathways involved in the immune response. They can inhibit the production or activity of inflammatory cells and mediators that contribute to asthma inflammation. By modulating the immune system, immunomodulators can help reduce airway inflammation and control asthma symptoms.
Types of immunomodulators
There are several types of immunomodulators used in the treatment of severe asthma. These include monoclonal antibodies that target specific proteins or receptors involved in the immune response, as well as other immune-modulating medications. Examples of immunomodulators used for severe asthma treatment include omalizumab, mepolizumab, dupilumab, and benralizumab. Each medication has its own mechanism of action and is prescribed based on individual patient characteristics and needs.
Benefits and risks
Immunomodulators have been shown to significantly improve asthma control and reduce asthma exacerbations in people with severe asthma. By targeting specific pathways in the immune system, these medications can provide long-term relief and reduce the need for other asthma medications. However, like any medication, immunomodulators carry potential risks and side effects. It is important to discuss the potential benefits and risks with your healthcare provider and closely monitor your response to treatment.
Mepolizumab
What is mepolizumab?
Mepolizumab is a monoclonal antibody medication used to treat severe eosinophilic asthma. It specifically targets interleukin-5 (IL-5), a protein involved in the production and activation of eosinophils, which are a type of white blood cell associated with allergic inflammation in the airways.
How does mepolizumab work?
Mepolizumab works by blocking the activity of IL-5, thereby reducing the production and activation of eosinophils. By suppressing eosinophil levels, mepolizumab helps reduce airway inflammation and prevent asthma exacerbations in people with severe eosinophilic asthma.
Who is eligible for mepolizumab treatment?
Mepolizumab is indicated for the treatment of severe eosinophilic asthma in adults and adolescents aged 12 and older. It is specifically targeted for people who have blood eosinophil levels of 150 cells per microliter or higher, despite optimal treatment with high-dose inhaled corticosteroids and another controller medication.
Administration and dosage
Mepolizumab is administered as a subcutaneous injection once every four weeks. The recommended dosage may vary depending on individual patient characteristics and response to treatment. Your healthcare provider will determine the appropriate dosage and provide instructions on how to administer the injections.
Potential side effects
Common side effects of mepolizumab include headache, injection site reactions (such as redness, swelling, or pain), back pain, fatigue, and fever. These side effects are generally mild to moderate in severity and typically resolve on their own. Serious allergic reactions are rare but can occur. If you experience any unusual or severe symptoms after receiving a mepolizumab injection, seek immediate medical attention.
Omalizumab
What is omalizumab?
Omalizumab is a monoclonal antibody medication used to treat moderate to severe allergic asthma. It specifically targets immunoglobulin E (IgE), a protein involved in allergic reactions.
How does omalizumab work?
Omalizumab works by binding to and neutralizing IgE antibodies, preventing them from triggering an allergic response. By reducing the levels of IgE in the body, omalizumab helps decrease the severity of allergic reactions and asthma symptoms in people with allergic asthma.
Who is eligible for omalizumab treatment?
Omalizumab is indicated for the treatment of moderate to severe allergic asthma in adults and children aged 6 and older. It is specifically targeted for individuals who have a positive skin or blood test for allergens and have persistent symptoms despite treatment with inhaled corticosteroids.
Administration and dosage
Omalizumab is administered as a subcutaneous injection every two to four weeks, depending on the individual’s weight and total IgE level. The dosage is determined by your healthcare provider and may require adjustments based on your response to treatment.
Possible side effects
Common side effects of omalizumab include injection site reactions, such as redness, swelling, or itching. It may also cause a temporary increase in the risk of serious allergic reactions, so it is important to be closely monitored after receiving an omalizumab injection. Serious side effects are rare but can occur. If you experience any unusual or severe symptoms, seek immediate medical attention.
Nucala (Mepolizumab)
What is Nucala?
Nucala is the brand name for the medication mepolizumab, which is a monoclonal antibody used for the treatment of severe eosinophilic asthma in adults and adolescents.
Mechanism of action
Nucala works by inhibiting the activity of IL-5, a protein involved in the production and activation of eosinophils. By reducing eosinophil levels, Nucala helps decrease airway inflammation and prevent asthma exacerbations in individuals with severe eosinophilic asthma.
Indications for Nucala
Nucala is indicated for the treatment of severe eosinophilic asthma in patients aged 12 and older. It is specifically targeted for individuals with blood eosinophil levels of 150 cells per microliter or higher, despite optimal treatment with high-dose inhaled corticosteroids and another controller medication.
Dosage and administration
Nucala is administered as a subcutaneous injection once every four weeks. The recommended dosage may vary depending on individual patient characteristics and response to treatment. Your healthcare provider will determine the appropriate dosage and provide instructions on how to administer the injections.
Common side effects
Common side effects of Nucala include headache, injection site reactions (such as redness, swelling, or pain), back pain, fatigue, and fever. These side effects are generally mild to moderate in severity and typically resolve on their own. Serious allergic reactions are rare but can occur. If you experience any unusual or severe symptoms after receiving a Nucala injection, seek immediate medical attention.
Dupixent (Dupilumab)
What is Dupixent?
Dupixent is the brand name for the medication dupilumab, which is a monoclonal antibody used for the treatment of moderate to severe asthma in adults and adolescents.
Mechanism of action
Dupixent works by blocking the activity of two proteins, interleukin-4 (IL-4) and interleukin-13 (IL-13), which are involved in allergic and eosinophilic inflammation. By inhibiting these proteins, Dupixent helps reduce airway inflammation and improve asthma control in individuals with moderate to severe asthma.
Indications for Dupixent
Dupixent is indicated for the treatment of moderate to severe asthma in patients aged 12 and older who have uncontrolled symptoms despite treatment with inhaled corticosteroids and another controller medication.
Dosage and administration
Dupixent is administered as a subcutaneous injection every two weeks. The recommended dosage may vary depending on individual patient characteristics and response to treatment. Your healthcare provider will determine the appropriate dosage and provide instructions on how to administer the injections.
Possible side effects
Common side effects of Dupixent include injection site reactions, such as redness, swelling, or itching. It may also increase the risk of certain infections, such as conjunctivitis (pink eye) and upper respiratory tract infections. Serious side effects are rare but can occur. If you experience any unusual or severe symptoms, seek immediate medical attention.
Surgery
Bronchial thermoplasty
Bronchial thermoplasty is a non-surgical procedure used to treat severe asthma that is not well controlled with medications alone. During bronchial thermoplasty, controlled thermal energy is delivered to the airway walls to reduce the amount of excess smooth muscle, thereby decreasing the airway’s ability to constrict during an asthma attack.
Lung volume reduction surgery
Lung volume reduction surgery is a surgical procedure that involves removing damaged portions of the lungs to improve lung function and reduce breathlessness in people with severe emphysema, a type of chronic obstructive pulmonary disease (COPD). This surgery can sometimes be considered for people with severe asthma who have significant airflow obstruction and hyperinflation of the lungs.
Lung transplant
Lung transplant is a surgical procedure that involves replacing a diseased lung with a healthy lung from a donor. It is considered a last resort treatment option for individuals with severe, end-stage asthma who do not respond well to other treatments. Lung transplantation can provide a new lease on life for those with severe asthma and can significantly improve lung function and overall quality of life.
In conclusion, treatment options for severe asthma include a combination of medications, lifestyle changes, allergy shots, bronchial thermoplasty, immunomodulators, and in some cases, surgery. Each treatment option has its own benefits, risks, and eligibility criteria, so it is important to work closely with your healthcare provider to develop a personalized treatment plan that addresses your specific needs and goals. With the right treatment approach, individuals with severe asthma can achieve better asthma control, reduce symptoms, and improve their overall quality of life.