What is the First Choice Treatment for Asthma?

Best Initial Treatments for Asthma: Inhalers, Medications & More

Asthma is a chronic respiratory disease characterised by airway inflammation and constriction, resulting in symptoms such as wheezing, shortness of breath, chest tightness, and coughing. Asthma treatment aims to manage symptoms, prevent attacks, and enhance quality of life.

However, it is important to understand the first-line treatments for asthma in order to manage it more effectively. Read ahead to learn about the first-line treatments, management strategies, and key considerations for asthma care.

What are the First-Line Treatments for Asthma?

Listed below are several first-line treatments that can help manage asthma: 

1. Role of Inhaled Corticosteroids (ICS)

Inhaled corticosteroids (ICS) are considered the gold standard for long-term asthma control, particularly in managing chronic symptoms. ICS suppresses airway inflammation, preventing attacks, improving lung function, and decreasing emergency visits. 

Medications such as beclometasone, fluticasone, and budesonide are typically administered in low doses for daily management of asthma. The ICS are preferred due to their local action, which minimises systemic side effects compared to oral corticosteroids.

2. Use of Short-Acting Beta-Agonists (SABA)

Short-acting beta-agonists (SABA), such as salbutamol (albuterol), are utilised for rapid relief during an asthma attack. SABAs alleviate wheezing and breathlessness by relaxing airway muscles but do not address the underlying inflammation. 

SABAs are administered as needed and are not intended for long-term control. An over-reliance on SABAs indicates poor asthma management; therefore, they should be incorporated into ICS therapy.

3. Recent Updates: ICS-Formoterol as Needed

Recent GINA 2024 revisions now suggest using ICS-formoterol combinations as both a controller and a reliever. ICS-formoterol (e.g., fluticasone/salmeterol) has anti-inflammatory and bronchodilator actions. 

The combination may be used as needed for symptom relief, thereby eliminating the necessity for concomitant use of separate SABAs. This is ideal for mild asthmatics, simplifying their treatment.

How is Asthma Treatment Personalized Based on Severity?

The following discusses certain treatment approaches that depend upon the severity of asthma:

Stepwise Approach (Step 1 to Step 5)

Asthma treatment typically follows a stepwise approach to determine the most appropriate level of intervention. This system allows for individualised care and adjustments based on the severity of symptoms and the patient's response to treatment.

• Step 1: Intermittent asthma – The initial treatment involves using a short-acting beta-agonist (SABA) as needed for infrequent symptoms.
• Step 2: Mild persistent asthma – Low-dose ICS is added to the treatment to control inflammation.
• Step 3: Moderate persistent asthma – A low-dose inhaled corticosteroid (ICS) plus a long-acting beta-agonist (LABA) is employed for increased control.'
• Step 4: Severe persistent asthma – Increased doses of ICS or combination therapy with LABA and other controllers such as leukotriene modifiers or theophylline are considered.
• Step 5: Severe, uncontrolled asthma – Add-on therapies, such as biologics (e.g., omalizumab, mepolizumab), may be necessary for severe asthma. 

Adjusting Treatment (Step Up/Down)

One of the main principles of asthma control is titrating treatment as needed. When asthma worsens, the intensity of therapy can be increased. When symptoms improve or remain well-controlled for an extended period, the treatment can be adjusted.

This titration is performed in consultation with a prescriber to ensure that the asthma remains controlled and is not over-treated.

Why is the Proper Inhaler Technique So Important?

Proper inhaler technique is crucial as it ensures the medication reaches deep into the lungs, where it can be most effective. Many asthma patients unknowingly misuse their inhalers, leading to poor symptom control and frequent flare-ups. 

Common mistakes include failing to shake the inhaler, incorrect positioning, poor timing between actuation and inhalation, and not holding the breath after inhalation. Even the best medications won't be effective if not delivered correctly. Healthcare providers must routinely check and correct a patient’s inhaler technique. 

Demonstrations, visual aids, and hands-on training during follow-ups can significantly enhance technique, resulting in improved asthma control and a reduction in emergency department visits.

What Lifestyle Changes and Trigger Management Strategies Work?

A few crucial changes in lifestyle can significantly change the severity of asthma, and some of them include:

1. Allergen Avoidance

Avoiding asthma triggers, such as allergens (dust, pollen, and pet dander), smoke, and pollutants, is crucial for managing asthma effectively. Patients should be educated on environmental modifications to reduce exposure to known triggers.

2. Exercise, Stress, and Smoking Cessation

Regular exercise can help strengthen the respiratory system, but it must be controlled for asthmatic patients. Stress management techniques, such as relaxation or mindfulness, are also essential, as stress can exacerbate asthma symptoms. Finally, smoking cessation is crucial, as smoking is a significant trigger that worsens asthma control.

Effective asthma management involves the appropriate medications, proper inhaler technique, regular monitoring, and lifestyle modifications. Adopting a stepwise treatment approach, adjusting medications as necessary, and emphasising patient education helps ensure asthma control.

At Star Health, we offer coverage for asthma under our Star Health Assure Insurance Policy. We also provide hassle-free claim settlements with a reduced turnaround time across over 14,000 network hospitals in India.