The Rundown on Asthma

Asthma can be a frustrating and sometimes frightening condition to live with.  It doesn’t have to be if you have it well managed.  If you are going to be running and have asthma, I highly recommend you meet with your doctor first!  You can discuss treatment with your primary care physician but may need to see an asthma specialist.

When I go to see a doctor, I like to know what to expect and have some background knowledge about what they are looking for and what treatment could be.  Asthma will be evaluated based on severity and level of control and then assigned treatment based on those two factors.

First up… severity

It can be classified as intermittent or persistent.  If it is persistent it can be mild, moderate or severe.  To figure out your classification the doctor will consider how frequently you experience symptoms, how often it causes you to wake up at night, how often you use a short-acting beta­2-agonist (SABA) for symptom control and if it interferes with your normal activity.  They will also look at lung function measures like your forced expiratory volume, forced vital capacity and peak expiratory flow. 

Next up… level of asthma control

It will either be well controlled, not well controlled, or very poorly controlled.  The same factors are considered for level of control as in severity.   An “Asthma Control Questionnaire,”  “Asthma Control Test,” and “Asthma Therapy Assessment Questionnaire” are also used to judge level of control.

Finally… stepwise treatment approach

You should be placed at a treatment level depending on your severity and level of control.  Then you can step up if needed or step down if possible and asthma has been well controlled.  The following treatments are the preferred treatments, although some alternatives are available.

  • Step 1: For intermittent asthma, you should be prescribed a SABA as needed.
  • Step 2: With persistent asthma, you should be prescribed daily medication to maintain proper control of your symptoms.  The first step for persistent asthma is a low-dose inhaled corticosteroid (ICS).
  • Step 3:  The next step up is a medium-dose ICS or a low-dose ICS with a long-acting beta­2-agonist (LABA).
  • Step 4:  The next step up is a medium-dose ICS with a LABA.  If you reach this level of care or higher, you need to see an asthma specialist.
  • Step 5: The next step is a high-dose ICS with a LABA.
  • Step 6:  The last step is a high-dose ICS with a LABA and an oral corticosteroid.
  • Rescue treatment for all: SABA as needed for symptoms, possibly short course of oral corticosteroids for exacerbations.  If you are using the SABA more often, you should let your doctor know because you may need to step up your treatment.

All this information (and more of the details) was found on a handy table prepared at the University of Michigan.  The full guidelines and more can be found at the National Heart, Lung, and Blood Institute.

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