If you have asthma, the airways in your lungs are usually inflamed. During an asthma flare-up these airways get even more swollen, and the muscles around the airways can tighten. This can trigger wheezing, cough, chest tightness and shortness of breath.
An allergist / immunologist, often referred to as an allergist, has specialized expertise to clearly identify your asthma triggers and to develop a treatment plan that can minimize flare-ups and improve your quality of life.
Common Asthma Triggers
• Many people with asthma have allergies, which can trigger asthma symptoms. Common allergens include house dust mites, animal dander, molds, pollen and cockroach droppings. Your allergist can identify what you are allergic to and recommend ways to avoid exposure to your triggers.
• Tobacco smoke is an irritant that often aggravates asthma. Your asthma may also be irritated by air pollution, strong odors or fumes.
• Many patients with asthma develop asthma symptoms when exercising. This is called exercise-induced bronchoconstriction (EIB).
• Some medications can cause or worsen asthma symptoms. These include aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and beta-blockers, which are used to treat heart disease, high blood pressure, migraine headaches or glaucoma.
• Emotional anxiety and stress may also increase asthma symptoms and trigger an attack. Proper rest, diet and exercise are important for your overall health and can help in managing asthma.
• Viral and bacterial infections such as the common cold and sinusitis.
• Exposure to cold, dry air or weather changes.
• Acid reflux, with or without heartburn.
Asthma is a chronic disease, so it requires ongoing management. This includes using proper medications to prevent and control symptoms and to reduce airway inflammation.
There are two general classes of asthma medications, quick-relief and long-term controller medications. Your allergist may recommend one or a combination of two or more of these medications.
Quick-relief medications are used to provide temporary relief of symptoms and, at times, used before exercise. These rescue medicines are bronchodilators, which help to open up the airways so that more air can flow through. Bronchodilators are primarily short-acting beta-agonists administered by an inhaler or a nebulizer machine. Another type of medicine called an anticholinergic may be used at times.
Long-term controller medications are important for many people with asthma, and are taken on a daily basis to control airway inflammation and treat symptoms in people who have frequent asthma symptoms.
Inhaled corticosteroids and leukotriene modifiers can help control the inflammation that occurs in the airways of most people who have asthma. One medication may work better for you than another. Your allergist can help guide you.
Inhaled long-acting beta-agonists are symptom controllers that open your airways.
Current recommendations are for them to be used only along with inhaled corticosteroids.
Long acting inhaled anticholinergic medications may also be added to long-term controller therapy.
Methylxanthines can help open the airways and may have a mild anti-inflammatory effect. Theophylline is the most frequently used methylxanthine. Blood levels of theophylline need to be monitored.
Omalizumab is an injectable drug that helps reduce allergic inflammation. It is used in certain patients with severe persistent allergic asthma.
Mepolizumab, reslizumab, benralizumab and dupilumab are injectable medications that reduce inflammation by targeting cells called eosinophils and other allergic pathways. They are indicated in the treatment of eosinophilic or oral-steroid dependent asthma.
Bronchial Thermoplasty is an outpatient procedure that reduces the smooth muscle around the airways. It may be considered in patients with severe asthma.
Asthma Management Plan
The better informed you are about your condition, the better control you will have over your asthma symptoms. To assist, you and your allergist will develop a personalized management plan. This plan includes:
• Ways to avoid your asthma triggers.
• Medications to prevent symptoms as well as medications to use for quick relief of flare-ups.
• An asthma action plan to identify when you are doing well and when you need to seek help.
• A partnership between you, your family, your allergist and other healthcare providers.
Together, you and your allergist can work to ensure that asthma interferes with your daily life as little as possible. If you need a plan you can find one here.
• Asthma triggers vary from person to person and so do strategies to reduce asthma flare-ups.
• Many people with asthma also have allergies, which can trigger asthma symptoms. Your allergist can identify what, if any, allergens you should avoid.
• Quick-relief rescue medications provide temporary relief of asthma symptoms, while long-term controller medications are taken on a regular basis to control airway inflammation or prevent frequent asthma symptoms.
• Your asthma medications may need to be adjusted as you and your asthma change, so stay in close touch with your allergist.
Feel Better. Live Better.
An allergist / immunologist, often referred to as an allergist, is a pediatrician or internist with at least two additional years of specialized training in the diagnosis and treatment of allergies, asthma, immune deficiencies and other immunologic diseases.
By visiting the office of an allergist, you can expect an accurate diagnosis, a treatment plan that works and educational information to help you manage your disease and feel better.
The AAAAI's Find an Allergist / Immunologist service is a trusted resource to help you find a specialist close to home.
Learn more about asthma.
This article has been reviewed by Andrew Moore, MD, FAAAAI