The goal of asthma management is to maintain asthma under control, including (daytime/nocturnal symptoms, limitation of activities, need for reliever treatment, lung function) and prevent exacerbations (severe attack of asthma) and reduce decline in lung function. Each patient should be assessed to establish his or her level of asthma control. If asthma is not controlled on the current regimen, treatment should be stepped up.
In general patients should take action to avoid the trigger factors causing their asthma symptoms (e.g. Tobacco smoke airborne allergens and drugs, foods, and additives known to cause symptoms).
Reliever or rescue medications should be provided for quick relief of symptoms. Increased use of rescue medications indicates that asthma is not well controlled and that a medical review is required.
Many patients need daily preventive medicines to control symptoms and prevent attacks,
- Inhaled glucocorticosteroids (ICS) are the most effective controller medications currently available.
- Leukotriene receptor antagonists are not as effective as low doses of ICS. They may be of benefit in asthma patients with rhinitis.
- When low dose ICS is not sufficient to achieve asthma control, the combination of ICS and long acting ß2-agonists (LABA) is the preferred option. The use of LABA alone is not recommended.
- Anti-IgE Omalizumab is recommended in patients with severe allergic asthma that remain symptomatic despite treatment with high dose ICS.
- Oral glucocorticosteroids may be required for severe uncontrolled asthma. They are important in the treatment of severe acute exacerbation.
- Ongoing monitoring is essential to maintain asthma control and/or modify treatment. After an exacerbation, a follow-up visit should be performed within one month.