The treatment of asthma is complex and challenging because it must take into account the different and possibly evolving stages of severity of a patient's particular asthma. The National Asthma Education and Prevention Program (NAEPP) was initiated by the National Heart, Lung, and Blood Institute and published its first set of asthma management guidelines in 1991. The recently updated guidelines in 2007 continue to emphasize the important role of corticosteroids in both long-term and acute asthma care.
Inhaled Corticosteroids for Long-Term Asthma Treatment
Inhaled corticosteroids (such as budesonide, fluticasone and triamcinolone) are safe and well-tolerated and are the most effective long-term therapy for mild, moderate or severe persistent asthma regardless of age. They work by reducing airway inflammation that is a main part of the disease process. Patients taking these medications should be educated on the proper use of an inhaler to be able to take the right dose. Sometimes it is necessary for corticosteroids to be prescribed along with other medications in order to control the asthma.
Oral Corticosteroids for Short-Term Asthma Treatment
Oral corticosteroids, like prednisone, are usually given as a short-term treatment for asthma attacks or exacerbations (only for the most severe, difficult to control asthma, due to the risk of side effects) because they can take care of symptoms quickly. Like inhaled corticosteroids, they help to reduce and reverse airway inflammation. They are usually given over a 5 to 10-day period and have been shown to reduce the risk of relapse.
Importance of Compliance
Uncontrolled asthma is a frequent reason for unnecessary emergency department visits and often poor compliance (not taking medications correctly or forgetting to take them at all) plays a role in this. However, health care professionals hold the responsibility to adequately treat asthma with a daily controller medication as needed. Another set of asthma treatment guidelines, issued by the Global Initiative for Asthma, state that ER physicians should start prescribing or continue oral corticosteroids for asthma patients even before they leave the ER. To avoid getting to this point, asthma patients should be well educated about their disease, learn how to use their corticosteroid inhaler, avoid environmental risk factors (including factors that induce allergic reactions such as tobacco smoke) and develop an asthma "action plan" to better manage this illness at its different stages.
References
- National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Managment of Asthma (Full Report 2007)
- Self TH, Twilla JD, Rogers ML, Rumbak MJ. Inhaled corticosteroids should be initiated before discharge from the emergency department in patients with persistent asthma. J Asthma. 2009;46(10):974-9.
