With the wide array of medications available today, the vast majority of people with asthma can achieve excellent control of their breathing and lead active lives, according to Michael J. Akerman, MD, FACP, FCCP, Pulmonologist with Highland Medical, P.C., Palisades Pulmonary, and Director of Pulmonology at Montefiore Nyack Hospital.
“The goal recommended by asthma care guidelines is for every person to be able to go about their daily activities without asthma symptoms,” said Dr. Akerman, who is also a Clinical Associate Professor of Medicine at SUNY Downstate Medical Center and NYU Langone Medical School. “My approach is that every person should be able to say, ‘Sometimes I feel like I don’t have asthma anymore!’ If you are taking your medications but still have symptoms, there is usually a lot more that can be done to help you feel better.”
People with asthma often are given two kinds of medications: long-term control medications to prevent symptoms, which are taken daily; and quick-relief medications that are taken only as needed for symptom relief.
Dr. Akerman says more than 90% of asthma patients can achieve asthma control with proper use of asthma medication. In some cases, he finds the person’s asthma isn’t well controlled because they aren’t taking their asthma medication as prescribed due to fear of side effects, even if they haven’t experienced any. “I tell my patients that if they have any side effects, they should tell me right away, because we can switch to different treatment options.”
Biologics For Difficult-to-Treat Asthma
For those patients whose asthma is not controlled, even when they take their asthma medications regularly, newer drugs called biologics, can be very helpful.
Biologicals—Xolair, Nucala, and Cinqair—are injections given once or twice a month. They are not the same as “allergy shots,” Dr. Akerman noted. They are antibodies which block the connection between chemical messengers from the immune system and the part of lung cells that cause an asthma attack. “These drugs have a very small side effect rate,” he said. “For patients who were on other medications, such as steroids, without good asthma control, these medications can be a game-changer. I’ve had patients who started on biologics and have been able to get back to their normal activities—shopping, swimming, or taking their grandchildren to the park.”
He notes that while biologics can be very expensive, insurance companies often will pay for them after patients have tried other medications without success.
When Should I Call the Doctor?
Everyone with asthma should have an Asthma Action Plan, a written plan that you develop with your doctor to help control your asthma. The plan shows your daily treatment, such as what kinds of medicines to take and when to take them. Your plan describes how to control asthma long-term and how to handle asthma attacks. The plan explains when to call the doctor or go to the emergency room.
For example, if you are using your regular asthma medications but they are not fully relieving your symptoms, your action plan will tell you what other medications you should take to improve your asthma control. Having a plan in place is very important because untreated asthma can be deadly, said Dr. Akerman. “In most people, asthma slowly worsens over hours or days. Having a plan allows you to nip it in the bud before it gets out of control and becomes life threatening.” If the symptoms do become severe, then the person experiencing the asthma attack should always head to the emergency room, where they will receive steroids and advanced treatment to calm airway inflammation.
Partner With Your Doctor
Dr. Akerman tells his patients that controlling asthma is achievable but it can take time. Besides medications he also looks at asthma triggers, as well as other problems that affect the patient’s asthma. “This isn’t something you can magically fix in just one visit,” he said. “As with anything else in life, to achieve asthma control, you have to put in work. We can give people back their normal life, but it takes commitment from both the doctor and patient. We sometimes have to try different medicines until we find the right combination that works for the patient. If you have moderate to severe asthma, there are no shortcuts. It’s an ongoing process.”