The Asthma Program has been designed to provide comprehensive treatment with an individualized approach. Treatments may include standard therapies such as daily inhaled and oral medications to control asthma, and quick relief bronchodilators. Non-traditional remedies such as herbal therapy, acupuncture, and hypnosis are being investigated for possible benefit for certain patients.
Rescue medications such as short-acting beta agonists (e.g., albuterol, Proventil, Ventolin, Proair, Xopenex, Maxair) work by relaxing the muscle that lines the airway so that the airway opens further, relieving asthma symptoms. Drugs in this category also help decrease mucus that can clog breathing passages in the lungs. Other rescue medications such as anti-cholinergic inhalers (e.g. ipratropium or Atrovent) act on some of the nerves that affect airway diameter and cause it to increase. They also decrease mucus production. Although they are generally less effective than the short-acting beta agonists at relieving asthma symptoms, they may be particularly useful for older individuals, for nighttime symptoms or during an asthma attack related to an upper respiratory infection (i.e., cold).
Long-Term Control Medications
Long-term medications, such as inhaled corticosteroids (e.g., Alvesco, Asmanex, Flovent, Pulmicort, Qvar), are first line treatment for in any patient who experiences asthma symptoms at least twice each week or have attacks (exacerbations) at least once per year. Inhaled corticosteroids can temporarily reverse inflammation and its consequences when taken regularly to help prevent and control asthma symptoms.
Other types of “controller” medications include combinations of two types of inhaled medicines such inhaled corticosteroids plus long-acting beta agonists or inhaled corticosteroids plus long-acting anti-cholinergics. Other “controller” medications are oral medicines such as anti-leukotriene agents (e.g., Singulair, Accolate, Zyflo), and xanthines (e.g., Theophylline, Theodur, Slobid). Patients with severe allergic asthma may be treated with injectable medications (anti-IgE, Xolair). The goal of all “controller” medication is to minimize symptoms, improve lung function, prevent attacks, and improve quality of life.
Novel therapies for asthma in various phases of development focus on targeting different pathways in the immune system involved in asthma. These can be inhaled, oral, or injectable medications. Another treatment, bronchial thermoplasty, is an FDA-approved therapy for treating severe asthma. It delivers radiofrequency energy to the airway smooth muscle in order to reduce the amount of muscle present (i.e., increased airway smooth muscle is believed to be an important problem in asthma).
Your Asthma Program physician will discuss the risks and benefits of various asthma therapies with you in order to develop the treatment plan that is right for you.
The Mount Sinai-National Jewish Respiratory Institute offers a number of clinical trials offering novel therapies for asthma that would not otherwise be available to patients. You may ask our asthma specialists about our ongoing clinical trials or learn more about them from the National Institutes of Health.
Adjuncts to Asthma Care
Adjuncts to asthma care include devices and instruments that improve the delivery of medicines to the lungs, monitor asthma control, and assist in guiding therapy. Some of the tools that are used include:
- Action Plans: Every patient with asthma should have a written action plan for self-management that is developed together with a physician. This plan helps to guide the patient in terms of managing their asthma under different circumstances. Vital to the action plan is use of a peak flow meter. The peak flow meter provides a portable way for patients to assess their lung function outside of the doctor’s office. Peak flow readings provide the basis for the written action plan.
- Holding chambers (also known as spacers): These devices are used with certain inhalers to increase delivery of medication to the lower airways (the site where they work).