Patient education: Asthma treatment in adolescents and adults (Beyond the Basics)

ASTHMA TREATMENT OVERVIEW — 

Asthma is a common lung disease affecting millions of people worldwide. It is characterized by inflammation and narrowing of the airways in the lungs (figure 1). Symptoms of asthma include wheezing, coughing, chest tightness, and shortness of breath. These symptoms tend to come and go and are related to the degree of airway narrowing in the lungs. Different things can trigger symptoms in people with asthma, including viral illnesses (eg, the common cold, influenza, coronavirus disease 2019 [COVID-19]), allergens, exercise, medications, or environmental conditions.

Living with asthma can be challenging, but it is usually possible to manage it successfully with medications and other measures. The goals of asthma treatment are to control symptoms as well as possible and prevent asthma attacks (also called "exacerbations").

This topic will discuss the treatment of asthma in adolescents (defined as children 12 years and older) and adults. Other topics about asthma are also available. (See "Patient education: How to use a peak flow meter (Beyond the Basics)" and "Patient education: Inhaler techniques in adults (Beyond the Basics)" and "Patient education: Asthma and pregnancy (Beyond the Basics)" and "Patient education: Exercise-induced asthma (Beyond the Basics)".)

Topics about asthma in children under 12 years are also available. (See "Patient education: Asthma symptoms and diagnosis in children (Beyond the Basics)" and "Patient education: Asthma treatment in children (Beyond the Basics)" and "Patient education: Asthma inhaler techniques in children (Beyond the Basics)" and "Patient education: Trigger avoidance in asthma (Beyond the Basics)".)

UNDERSTANDING ASTHMA CONTROL — 

The approach to asthma treatment depends on the frequency and severity of your symptoms, including asthma attacks, as well as your personal preferences and risk factors. Good asthma control is the goal of asthma management and is achievable in the great majority of patients. Your healthcare provider will work with you to review your symptoms and adjust your treatment plan over time.

Symptom control — Good asthma symptom control is generally defined by the following:

●Uncommon and infrequent daytime asthma symptoms

●Rare to no nighttime awakenings due to asthma (<1 per month)

●Infrequent use of reliever medications

●No interference with normal activities

Be sure to tell your doctor at each visit how often you notice asthma symptoms and how frequently you use your medications. Treatment can then be adjusted until good asthma symptom control is achieved.

Exacerbation risk — In addition to reviewing your symptoms, your provider will want to determine your risk for future asthma attacks, or exacerbations. Even people who usually have minimal asthma symptoms may be at risk for severe exacerbations. The greatest risk factor for asthma exacerbations is a history of frequent asthma attacks or attacks that require a stay in the intensive care unit (ICU). Potential risk factors to discuss with your provider include:

●A history of asthma attacks in the last year, especially ones requiring urgent care or emergency department visits

●A prior severe asthma attack requiring a hospital stay or ICU-level care

●Current smoking or vaping

●Ongoing exposures to known asthma triggers or second-hand smoke

●Low lung function (based on tests your provider ordered or instructed you to perform)

Changes in the kind of medications or how you take medications may help decrease your risk of future asthma attacks.

WHAT CAN I DO ON MY OWN? — 

There are several things you can do to keep your asthma well controlled. These include learning about your condition, understanding how and when to use each of your medications (and when to seek emergency help), avoiding things that trigger or make your symptoms worse, keeping track of your symptoms, and seeing your doctor regularly for monitoring. Well-informed and motivated patients can assume a large measure of control over their asthma care.

Education — It's important to make sure that you learn and understand:

●What asthma is – Being familiar with the definition of asthma, how to recognize symptoms, and the role of medication can empower you in taking care of yourself. This can also help family members and friends understand your condition.

●What triggers your asthma – This allows you to avoid or limit exposure to things that make your symptoms worse. (See 'Controlling asthma triggers' below.)

●When to use your medications – Asthma medicines can work in different ways, so it is important to know which medications to use to treat asthma symptoms quickly and which ones to take regularly to prevent symptoms from happening. Keeping an asthma "action plan" can help prepare you to treat symptoms when they happen. (See 'Action plan' below.)

●How to use your inhalers – Many people with asthma need to use multiple inhalers, and some require different techniques. It's important to know how to use each medication and when you need it. It is often helpful for patients to watch a video demonstrating use of the particular type of inhaler (eg, metered-dose inhaler with spacer, Diskus, Ellipta, Redihaler, Respimat) or nebulizer. You should also practice your technique with your provider or pharmacist, so they can offer you tips to improve your technique.

It helps to develop a strong relationship with your healthcare provider so that you feel comfortable asking questions and sharing your concerns. Ideally, you and your provider will work together to make decisions about treatment.

Monitoring your asthma over time — In order to successfully manage your asthma, you will need to monitor your condition over time. This involves being aware of the frequency and severity of your symptoms and measuring your lung function regularly.

Symptom monitoring — Your healthcare provider may recommend keeping a daily asthma diary to document when your symptoms are not well controlled or when starting a new treatment. In the diary, you can keep track of when you have symptoms (such as coughing, wheezing, or shortness of breath); which medications you took and when; and your peak expiratory flow (PEF), also called "peak flow" (form 1). (See 'Measurement of lung function' below.)

Your provider may also suggest completing a self-assessment form periodically, such as before a routine visit (form 2). This type of assessment can help you and your provider determine whether your treatment plan needs to be adjusted.

Measurement of lung function — Monitoring your lung function involves measuring your PEF (ie, measurement of airflow out of the lungs), or forced expiratory volume in one second (FEV₁; ie, the amount [volume] of air forcibly exhaled in the first second after taking a deep breath). When asthma is causing your airways to narrow, air flows more slowly out of your lungs, causing the PEF or FEV₁ measurement to be lower.

Your healthcare provider might suggest that you check your PEF at home periodically by blowing into a device called a peak flow meter. These devices are inexpensive and easy to use. (See "Patient education: How to use a peak flow meter (Beyond the Basics)".)

FEV₁ is measured by spirometry. This test is usually done in a doctor’s office or pulmonary function laboratory about every one to two years, or more often if asthma symptoms are more frequent or severe. However, it may be done for home monitoring by patients or in conjunction with telehealth visits.

PEF and spirometry are used to monitor your lung function and response to medication and can help guide decisions regarding treatment.

Action plan — An asthma "action plan" is a form or document that your provider can help you put together; it includes instructions about how to monitor your symptoms and what to do when they happen. Different forms are available for this purpose (form 3). An action plan can tell you when to add or increase medications, when to call your provider, and when to get immediate emergency help. This can help you, or your family members, know what to do in the event of an asthma attack. They are also required by most schools, daycare and afterschool programs, and camps. Different people can have different action plans, and your action plan may change over time.

Action plans usually include three categories, based on your symptoms and/or your PEF (see 'Measurement of lung function' above):

●Green – Green means your airways and lungs are functioning well. When symptoms are not present or are well-controlled, you can typically continue your regular medicines and activities.

●Yellow – Yellow means your airways are somewhat narrowed, making it difficult to move air in and out; asthma symptoms may be more frequent or more severe. This is usually treated with a short-term change or increase in medication. You should change or increase your medication according to the plan that was discussed with your provider.

●Red – Red means your airways are severely narrowed, and symptoms are severe; this requires immediate treatment, often with several medications, as well as seeking medical help.

When to call for emergency help — It's important to know when to get emergency help, for example, if your medications do not work quickly to relieve symptoms. Severe asthma attacks can lead to death if not treated promptly.

In most areas of the United States and Canada, you can call 9-1-1 for emergency medical assistance. You should not attempt to drive yourself to the hospital if you are having severe asthma symptoms, and you should not ask someone else to drive. Calling for emergency help is safer than driving for two reasons:

●From the moment emergency personnel arrive, they can begin evaluating and treating your asthma. When driving in a car, treatment is generally delayed until you arrive in the emergency department.

●If a dangerous complication of asthma occurs on the way to the hospital, emergency personnel will be able to treat the problem immediately. It is not safe to try to drive a car and treat a severe asthma attack at the same time.

Controlling asthma triggers — The factors that set off and worsen asthma symptoms are called "triggers." Identifying and avoiding your asthma triggers is essential in keeping symptoms under control. Common asthma triggers generally fall into several categories:

●Allergens, including dust, pollen, mold, cockroaches, mice, cats, and dogs

●Respiratory infections, such as the common cold, the flu, or COVID-19 (coronavirus disease 2019)

●Irritants, such as tobacco smoke, aerosolized chemicals, and strong odors or fumes

●Physical activity, especially if you are breathing cold or dry air while exercising

●Certain medications, including beta blockers (used to treat high blood pressure)

●Emotional stress

●Hormonal changes related to the menstrual cycle (in some women) or pregnancy

Although this is uncommon, some people develop asthma symptoms after exposure to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Inhalation or ingestion of food allergens can also sometimes lead to asthma symptoms.

After identifying potential asthma triggers, you and your healthcare provider should develop a plan to deal with the triggers. This can involve avoiding the trigger, limiting your exposure to the trigger if it’s not practical to avoid it entirely, or taking an extra dose of medication in advance (for example, before you exercise).

Vaccinations against respiratory infections, including influenza, pneumococcal pneumonia, and COVID-19, can help prevent these common triggers of asthma exacerbations.

Trigger avoidance is discussed in more detail separately. (See "Patient education: Trigger avoidance in asthma (Beyond the Basics)".)

Regular medical appointments — People with asthma need to see their healthcare provider regularly. For those whose asthma is well-controlled, this may mean appointments once or twice a year. If your asthma is not well-controlled, you will likely need to go more frequently.

At these visits, your provider will ask about the severity and frequency of your asthma symptoms to assess how well your treatment is working. If your asthma has been well-controlled for at least three to six months, your provider may suggest continuing with your current treatment or possibly decreasing ("stepping down") your medication. If your provider thinks you are a candidate for stepping down, they will work with you to decide which medication(s) to decrease or stop, and they will monitor you closely to ensure that your symptoms remain under control.

It's important to let your provider know if your asthma symptoms get worse at any point in time. If this happens, they will review your medications, ensure that you are avoiding triggers and using your inhaler(s) properly, and suggest changes in medications or dosing as appropriate. If you have not been using your medications for your symptoms or as prescribed, it is important to tell your provider so they can help find strategies and medication regimens that work better for you.

Sometimes other, related conditions can make asthma symptoms worse. These may need to be addressed to achieve good asthma control. Examples include gastroesophageal (acid) reflux (when stomach contents back up into the esophagus, causing symptoms like heartburn and regurgitation); nasal congestion, allergies, or sinus disease; excess weight; and sleep apnea (a condition that makes you stop breathing for short periods during sleep).

ASTHMA QUICK-RELIEF MEDICATIONS — 

Quick-relief medications, or "relievers," contain a kind of medicine that rapidly opens the airways to provide relief for asthma symptoms when they happen. They may also contain additional medicines to decrease inflammation ("anti-inflammatory relievers"), but the anti-inflammatory medicines take more time to work. If you have infrequent asthma symptoms, you may only need these quick-relief medicines for your asthma.

Short-acting beta-agonists — Short-acting beta-agonists (SABAs) are a type of "bronchodilator" medication. They relieve symptoms rapidly by temporarily relaxing the muscles around narrowed airways, allowing more air to get through. These medications are sometimes referred to as "quick-acting relievers" or "rescue medication." Some people also refer to them as "emergency inhalers." You should carry your quick-relief asthma medication with you at all times.

SABAs include albuterol (called salbutamol in many countries; brand names: ProAir HFA, Proventil HFA, Ventolin HFA) and levalbuterol (also called levosalbutamol; brand name: Xopenex HFA). "HFA" means the medicine comes in a metered-dose inhaler (MDI) using the propellant hydrofluoroalkane (HFA) (figure 2 and figure 3). Albuterol is also available in another type of inhaler, called a dry powder inhaler (DPI; sample brand name: ProAir RespiClick). SABAs are quick-acting medications (within three to five minutes), and administration through an inhaler allows the medication to be delivered to your airways and take effect rapidly while minimizing side effects. Your inhaler will come with specific instructions for use; more information about inhaler techniques is also available in the tables (table 1 and table 2 and table 3) and separately. (See "Patient education: Inhaler techniques in adults (Beyond the Basics)".)

Some people who cannot use MDIs (aka inhalers) may be prescribed use of a nebulizer to deliver albuterol. This typically includes young children or those incapable of learning how to use or physically incapable of using an inhaler. Nebulized medication delivery is also sometimes used in health care settings; nebulizers are not more effective than inhalers as long as the inhalers are used properly.

SABAs like albuterol and levalbuterol are meant to be used as needed for relief of asthma symptoms, or preventively prior to an activity that is known to provoke symptoms (for example, 5 to 20 minutes before exercise). There is no benefit to using them on a regular, scheduled basis, and regular use may actually make your asthma worse. If your symptoms are consistently occurring on more than two days per week, you should discuss your treatment plan with your healthcare provider. Other medications are more effective for controlling persistent symptoms.

Another kind of SABA, epinephrine, is available without a prescription. It comes in an inhaler (brand name: Primatene Mist) or as a liquid that you inhale through a small device (brand name: Asthmanefrin). However, inhaled epinephrine can cause dangerous side effects, especially if you use too much, so healthcare providers generally do not recommend these nonprescription devices for treating asthma symptoms.

Combined anti-inflammatory and fast-acting beta-agonists — Anti-inflammatory relievers, sometimes referred to by the acronym "AIR," are medicines that combine fast-acting bronchodilators with another kind of medicine, inhaled glucocorticoids, that decreases swelling and inflammation of the airways over time. With this type of medicine, when you use your rescue inhaler more, you also get a higher dose of medication to suppress inflammation in your airways. Use of AIR has been found to reduce asthma attacks compared with using SABAs alone as relievers, resulting in its promotion by national and international asthma guidelines.

Inhaled steroids with formoterol — Formoterol is a type of medication called a rapid-onset, long-acting beta-agonist (LABA). It starts to work quickly, like SABAs, but the effects last longer. It always comes together with an inhaled steroid medication that reduces inflammation in the airways (see 'Inhaled steroids' below). Various inhalers that combine inhaled steroids with formoterol are available (sample brand names: Breyna, Dulera, Symbicort). They can be used as needed as AIR alone in patients with more mild asthma or can also be used daily as controller medicines. (See 'Inhaled steroids plus a long-acting bronchodilator' below.)

Inhaled steroids with albuterol — Like inhaled steroids with formoterol, the use of inhaled steroids and albuterol together provides both anti-inflammatory and reliever therapy. For combination albuterol-budesonide (brand name Airsupra), the usual dose is two inhalations every four to six hours as needed. A low-dose inhaled glucocorticoid can also be used separately along with albuterol (aka salbutamol) by provision of two separate inhalers, although this is less convenient.

ASTHMA CONTROLLER MEDICATIONS — 

People with more frequent asthma symptoms or those who are at an increased risk of exacerbations generally need to take medication daily to keep their asthma under control, even if they do not have symptoms every day. The medications prescribed for use every day are called "long-term controller" medications.

Most controller medications come in an inhaler, while others are taken as a tablet. These medications are frequently used in combinations to increase their efficacy and reduce side effects.

While controller medications help to reduce the frequency of asthma attacks, you will still need to always keep quick-relief medications with you so you can treat symptoms if they do happen. Those who use inhaled steroids with formoterol as both a controller and reliever medication (aka, single maintenance and reliever therapy [SMART]) should also be sure to carry their inhaler with them at all times for quick relief. (See 'Asthma quick-relief medications' above.)

Inhaled steroids — Inhaled steroids (also known as glucocorticoids or corticosteroids) decrease inflammation (eg, swelling) of the airways over time. The steroids used to treat asthma are entirely different from the ones athletes sometimes take to build muscle. Regular treatment with an inhaled steroid reduces the frequency of symptoms (and the need to use short-acting medication for symptom relief), improves quality of life, and decreases the risk of serious attacks.

A number of different inhaled steroid medications are available, all of which are taken once or twice a day. Sometimes, a daily inhaled steroid is prescribed along with a long-acting or short-acting bronchodilator. (See 'Inhaled steroids plus a long-acting bronchodilator' below and 'Inhaled steroids with formoterol' above and 'Inhaled steroids with albuterol' above.)

Side effects — Unlike oral steroids (taken as a tablet or liquid by mouth), very little of the inhaled steroid is absorbed into the bloodstream, and there are few side effects.

The most common side effect of low-dose inhaled steroids is thrush, which causes mouth and/or throat soreness and a white coating on your tongue, gums, and/or throat, and is a yeast infection in the mouth, the medical term for which is "oral candidiasis." This can usually be prevented by rinsing your mouth and gargling with water immediately after using your inhaler. If you have a metered-dose inhaler (MDI), it may also help to use a spacer device; this promotes delivery of medication directly to the lungs with less deposited in the mouth (figure 3). Rinsing is not necessary for most people who use inhalers containing inhaled steroids infrequently as part of anti-inflammatory reliever (AIR) therapy (see 'Combined anti-inflammatory and fast-acting beta-agonists' above). If you do develop thrush or have symptoms of thrush, let your provider know so that you can be treated.

A hoarse voice and sore throat are less common side effects of inhaled steroids; these can often be managed by switching to a different medication, type of inhaler, or the addition of a spacer device.

Higher doses of inhaled steroids are sometimes used to control more severe asthma. Rare but possible side effects of long-term, high-dose inhaled steroid treatments include cataracts, increased pressure in the eye (glaucoma), easy bruising of the skin, increased bone loss (osteopenia, osteoporosis), and a small decrease in growth (for adolescents). You should rinse your mouth after using high doses of inhaled steroid treatments.

The risk of these complications is far less with inhaled steroids compared with oral steroids (eg, prednisone). Nevertheless, to minimize the risk, your healthcare provider will prescribe the lowest possible dose to control your asthma.

Inhaled steroids plus a long-acting bronchodilator — Many adults and adolescents with more frequent asthma symptoms or risk for exacerbations will receive a prescription for an inhaled steroid in combination with a long-acting beta-agonist (LABA). LABAs work for 12 or more hours, longer than short-acting beta-agonists (SABAs); they include formoterol, salmeterol, and vilanterol. A single inhaler that contains both a steroid and a LABA is usually preferred (sample brand names: Advair, Breo, Dulera, Symbicort). An inhaler containing budesonide and formoterol (brand names: Breyna, Symbicort) can be used as a daily controller medication and may also be used for quick relief of asthma symptoms when they happen; this is because formoterol takes effect as quickly as a SABA such as albuterol. This convenient approach using a single inhaler is called maintenance and reliever therapy (sometimes “MART” or “SMART” for short). (See 'Inhaled steroids with formoterol' above.)

Tiotropium (brand name: Spiriva) is another type of long-acting bronchodilator, called a long-acting muscarinic antagonist (LAMA). It is used more frequently for treating chronic obstructive pulmonary disease (COPD) but is sometimes used (along with an inhaled steroid) as an asthma controller medication in addition to other treatments.

Leukotriene modifiers — Leukotriene modifiers are long-term controller medications that you take as a tablet, rather than through an inhaler. They include montelukast (brand name: Singulair), zafirlukast (brand name: Accolate), and zileuton (brand name: Zyflo). Leukotriene modifiers work by opening narrowed airways, decreasing inflammation, and decreasing mucus production. They are occasionally used as an alternative to inhaled steroids for mild asthma, particularly for those with other allergy symptoms that can also respond to this therapy. They have very few common side effects, although agitation or depression can occur. Leukotrienes alone are typically less effective in controlling asthma than inhaled steroids. They are more frequently used in addition to inhaled steroids for more severe asthma.

Leukotriene modifiers can be used to prevent symptoms before exposure to a trigger or before exercising; however, they need to be taken two or more hours in advance. (See "Patient education: Exercise-induced asthma (Beyond the Basics)".)

MEDICATIONS FOR MORE SEVERE ASTHMA — 

People with more frequent or severe asthma symptoms may need to take other medications in addition to those described above. These medicines are called "biologics" because they contain antibodies that target different components of the hyperactive allergic immune response. They are given by subcutaneous or intravenous injection in intervals from two weeks to two months. They are often used to avoid or help people come off of oral steroids.

Anti-IgE agent — Omalizumab (brand name: Xolair) is a medication that targets immunoglobulin E (IgE) or allergy antibodies. Omalizumab can help in people whose asthma symptoms are triggered by allergies. It works best in people who are allergic to year-round allergens (such as dust mites, mold, animal dander, or cockroaches) as confirmed by skin or blood tests. Omalizumab is given by injection every two to four weeks. It is given either in the doctor's office or at home after the first several doses are observed in the office because allergic reactions may rarely occur.

Anti-IL-5 agents — Interleukin 5 (IL-5) is a protein that is associated with a certain type of asthma called "eosinophilic asthma,” which is usually tested for by examining a blood sample for increased eosinophils (a type of white blood cell). People with this type of asthma who have severe symptoms may benefit from medications directed against IL-5 or its receptor, such as benralizumab (brand name: Fasenra), mepolizumab (brand name: Nucala), and reslizumab (brand name: Cinquair).

These medications are typically given by injection or intravenously (through an IV) in a doctor's office or clinic, although in most cases a person can be trained to do the injections at home. The schedule varies from every four to every eight weeks, depending on which medication you take. Allergic reactions to reslizumab can sometimes happen with this medication, so you will need to be observed for at least 20 minutes following administration.

Anti-IL4/IL-13 agent — IL-4 and IL-13 are also proteins that contribute to eosinophilic asthma. People with severe eosinophilic asthma may benefit from a medication called dupilumab (brand name: Dupixent) that blocks the action of IL-4 and IL-13. Dupilumab is also effective for people who have required daily oral steroids (eg, prednisone) to control their asthma. It is given by injection every two weeks; most people are able to do their own injections at home after receiving training.

Anti-TSLP agent — Thymic stromal lymphopoietin (TSLP) is another protein that can contribute to severe asthma. Patients with both eosinophilic asthma and noneosinophilic asthma may benefit from the anti-TSLP agent tezepelumab (brand name: Tezspire). It is given by injection in a doctor’s office every four weeks. Many people are able to do their own injections at home after receiving training.

MEDICATIONS FOR ASTHMA ATTACKS

Recognizing an asthma attack — In general, an asthma attack or "exacerbation" refers to an increase in symptoms above one's usual level in a way that interferes with normal activities. These symptoms usually include chest tightness, shortness of breath, wheezing, and coughing. If you check your lung function (with peak flow or home spirometry), it may be significantly reduced. Asthma attacks can come on over a few days or can happen suddenly. Some people have mild asthma attacks that can be treated at home, while others have severe asthma attacks that require emergency medical services and even hospitalization. Review your asthma action plan to make sure you know exactly what medicines to take at what dose and when your healthcare provider wants you to call the office or call for emergency help.

Quick relief medicine — For most people, treating an asthma attack involves using a quick-relief (reliever) medicine (albuterol, albuterol-budesonide, levalbuterol, or budesonide-formoterol). The use of quick-relief medicines for asthma attacks should be discussed with your doctor and written down as part of your asthma action pan. Typical dosing is as follows:

●Albuterol or levalbuterol: Two to four inhalations from a metered-dose inhaler (MDI) or dry powder inhaler (DPI; depending upon the dose that is usually effective for you; typically, two inhalations are used for mild to moderate symptoms and four inhalations for more severe symptoms). For MDIs, use of a valved holding chamber ("spacer") device is preferable. Via nebulizer, one vial (2.5 mg/3 mL albuterol or 1.25 mg/3 mL levalbuterol) should be given. If you still have symptoms after 20 minutes, you can repeat the dose.

●Albuterol-budesonide (Airsupra): Two inhalations, preferably using a valved holding chamber ("spacer") device. If you still have symptoms after 20 minutes, you can repeat the dose up to six inhalations in the first hour. You should not use more than 12 inhalations in 24 hours.

●Budesonide-formoterol (Symbicort, Breyna): The usual dose of budesonide-formoterol for acute symptom relief is one to two inhalations (4.5 mcg formoterol per inhalation). For those prescribed two inhalations, wait for a few minutes between doses and use the second dose if symptoms persist. You may repeat one to two inhalations every 20 minutes for up to six inhalations in one hour, if needed. You should not use more than 12 inhalations in 24 hours.

Asthma attacks that do not respond to or worsen despite reliever medicines require additional medical help.

Oral steroids — For significant asthma attacks, most providers will recommend a 5- to 10-day course of oral steroids (also called corticosteroids or glucocorticoids). Examples of these medications include prednisone and methylprednisolone (brand name: Medrol). Side effects include insomnia, hunger, agitation, and mood alteration, but they generally can be tolerated for a short period during which restoration of normal breathing is the priority. If you have diabetes, steroids can cause your blood sugar to go up. Check with your provider about adjusting your diabetes medicine. Repeated or prolonged courses of oral steroids can lead to weight gain, swelling, acne, high blood pressure, increased pressure in the eye (glaucoma), easy bruising of the skin, bone loss (osteoporosis), cataracts, increased risk of infection, and growth impairment (in adolescents). Your provider will adjust your asthma controller medicines to minimize need for repeated use of oral steroids as much as possible.

Other medications — Some medications may help treat related symptoms, but they do not improve breathing, and we discourage use of these medications to treat an asthma attack. These include antihistamines, cough suppressants, mucolytics (medications to thin out mucus in the lungs), expectorants, and other over-the-counter "cold and flu" remedies. Similarly, nontraditional "home remedies" (for example, drinking caffeinated beverages or inhaling steam with peppermint or eucalyptus oil) may provide comfort, but they will not rescue you from the dangers of an asthma attack.

ASTHMA IN PREGNANCY — 

About 8 percent of pregnant women have asthma. With good asthma treatment during pregnancy, nearly all women can have a normal pregnancy and give birth to a healthy baby. It is essential to keep asthma well-controlled during pregnancy to ensure that enough oxygen reaches the growing baby. Asthma medications are generally safe for use during pregnancy and should not be stopped without discussing with your doctor. In particular, long-acting beta-agonists and inhaled steroid medications have excellent safety profiles. For those with severe asthma using biologics, omalizumab and mepolizumab have been better studied than the newer agents dupilumab and tezepelumab.

If you are considering pregnancy, it's a good idea to talk to your healthcare provider before you start trying. Your primary care provider can help you make sure that you know as much as possible about your condition and have a treatment plan in place. During pregnancy, you will most likely see both your asthma specialist for monitoring as well as your obstetrician or midwife.

More detailed information about asthma during pregnancy is available separately. (See "Patient education: Asthma and pregnancy (Beyond the Basics)".)

WHERE TO GET MORE INFORMATION — 

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Asthma in adults (The Basics)
Patient education: Avoiding asthma triggers (The Basics)
Patient education: How to use your metered dose inhaler (adults) (The Basics)
Patient education: How to use your dry powder inhaler (adults) (The Basics)
Patient education: Medicines for asthma (The Basics)
Patient education: Asthma and pregnancy (The Basics)
Patient education: Exercise-induced asthma (The Basics)
Patient education: Inhaled corticosteroid medicines (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: How to use a peak flow meter (Beyond the Basics)
Patient education: Inhaler techniques in adults (Beyond the Basics)
Patient education: Asthma and pregnancy (Beyond the Basics)
Patient education: Exercise-induced asthma (Beyond the Basics)
Patient education: Asthma symptoms and diagnosis in children (Beyond the Basics)
Patient education: Asthma treatment in children (Beyond the Basics)
Patient education: Asthma inhaler techniques in children (Beyond the Basics)
Patient education: Trigger avoidance in asthma (Beyond the Basics)
Patient education: How to use your soft mist inhaler (adults) (The Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Antileukotriene agents in the management of asthma
Allergen avoidance in the treatment of asthma and allergic rhinitis
An overview of asthma management in children and adults
Asthma in adolescents and adults: Evaluation and diagnosis
Evaluation of severe asthma in adolescents and adults
Identifying patients at risk for fatal asthma
Natural history of asthma
Characterizing severe asthma phenotypes
Acute exacerbations of asthma in adults: Home and office management
Initiating asthma therapy and monitoring in adolescents and adults
Ongoing monitoring and titration of asthma therapies in adolescents and adults
Treatment of severe asthma in adolescents and adults

The following organizations also provide reliable health information.

●The National Library of Medicine

     (www.nlm.nih.gov/medlineplus/healthtopics.html)

●National Heart, Lung, and Blood Institute

     (www.nhlbi.nih.gov/)

●American Lung Association

     (https://www.lung.org/)

●American Academy of Allergy, Asthma, and Immunology

     (www.aaaai.org/patients.stm)

●American College of Allergy, Asthma, and Immunology

     (https://acaai.org/asthma/treatment/)

ACKNOWLEDGMENT — 

The UpToDate editorial staff acknowledges Christopher H Fanta, MD, and Nora Barrett, MD, who contributed to earlier versions of this topic review.