So why aren’t you seeing results when you use your controller and rescue therapies? Your doctor may need to do additional tests to determine the answer and the right strategies to provide you relief. And it’s important that you do. Not only can uncontrolled asthma accelerate loss of lung function and lead to more frequent hospitalizations, it can be life-threatening. A couple signs to watch for: If you have daily symptoms that limit work or school attendance, interfere with daily activities, or disrupt sleep, or if you’re using your rescue inhaler more than usual. “It’s also important for patients with asthma to have regular visits with their doctors [even when they’re feeling well] because sometimes changes in asthma activity can be relatively silent and only detected by physical examination or lung function testing,” says Bruce Levy, MD, the Parker B. Francis Professor of Medicine and the division chief of the pulmonary and critical care division at Brigham and Women’s Hospital in Boston. Here are seven things your doctor might do if your current treatment plan isn’t keeping your asthma symptoms under control.
1. Adjust or change your medication
Treatment for asthma generally consists of quick-relief (or rescue) inhalers, taken when your symptoms flare up, and long-term controller medications, which are taken daily to help reduce inflammation and prevent symptoms. If you’re already taking these medications but still having shortness of breath, wheezing, and coughing, a first step may be to make sure you’re using them correctly. “Some of the inhaled medications can be difficult for patients to use correctly, so doctors often spend time teaching patients how to get the most out of their medications,” explains Dr. Levy. Your doctor may also increase the dose of your current medications. “In all but the most severe asthma patients, this usually provides relief,” says Levy. The next step is to try an add-on medication or explore other treatment options altogether. “Asthma therapies come in a wide array of options,” says Levy. “They are formulated as inhalers, nebulized solutions, pills, and injections. For the most severe asthma, there are even therapies that target the bronchial smooth muscle — they are administered directly through the airway by a specialized bronchoscopy procedure called thermoplasty. Patients can explore these different treatment options with their healthcare provider.” If your doctor changes your medication dose or prescribes a new treatment, you should schedule a follow-up appointment to discuss how the treatment is working, according to Asthma UK. Together, you can continue monitoring your condition to optimize the treatment plan for your needs.
2. Test for airflow obstruction and inflammation
A variety of tests can help your doctor tailor your treatment to your specific asthma. For example, your doctor might ask you to breathe into a machine for a lung function test known as spirometry. You might then be asked to repeat the test, possibly after taking a puff from an inhaler, so that your doctor can compare results and check whether the inhaler helped improve your airflow. Additional tests look for signs consistent with inflammation, in particular allergic inflammation, says Levy. These tests might include a peripheral blood eosinophil count, serum immunoglobulin E (IgE) level, and exhaled nitric oxide level.
3. Determine if you have a more severe form of asthma
If your asthma is uncontrolled or partially controlled despite taking high-dose inhaled steroids plus a second controller medication, or taking oral corticosteroids, you may have severe asthma, according to guidelines from the American Thoracic Society and European Respiratory Society. Severe asthma doesn’t respond to standard treatments, but there may be other options for you. For instance, nearly half of people with severe asthma have high levels of eosinophils in their lungs and blood, according to the NHLBI. These white blood cells can build up and cause inflammation and swelling in your airways, and today, medications called biologics can be prescribed to target those eosinophils. To diagnose eosinophilic asthma, your doctor will perform a blood test, a sputum induction test, or a bronchial biopsy to measure your level of eosinophils.
4. Identify hidden triggers
Does your asthma get worse in certain situations? Many people have triggers — often allergies. To figure out your triggers and where they’re lurking, your doctor might ask detailed questions, help you recognize patterns, and even order a blood test. If we identify asthma triggers, we can develop strategies to help you avoid those triggers, says Levy. “This can be challenging and is a bit like detective work,” he says. Here’s how you can help: Keep an asthma diary that tracks your symptoms, where you were and what you were doing when you experienced an asthma attack, and any factors that may have triggered it.
5. Diagnose conditions that make asthma worse
Sometimes the problem isn’t just your asthma; something else may be aggravating your symptoms. For example, chronic sinusitis with post-nasal drip, gastroesophageal reflux disease, and obesity can all aggravate asthma or make it more difficult to control, says Levy.
6. Provide tips for healthy habits
While lifestyle changes won’t cure asthma, people tend to manage their symptoms better when they eat a healthy, well-balanced diet, exercise regularly, and sleep well, says Levy. Stress-reduction techniques like mindfulness, meditation, and deep breathing can also be beneficial: Stress and anxiety can lead to shortness of breath, too, so keep them in check to better manage asthma.
7. Help you develop an emergency plan
Asthma attacks can sometimes become emergencies, and during severe symptoms you may not be able to speak up and ask for help. Be prepared: “It’s very important for patients with severe asthma to develop plans for seeking urgent help from friends and family members, which might include assisting with a home treatment or transporting you for an emergency evaluation and treatment,” says Levy. Your emergency plan should also include a list of all your medications, allergies to medications, healthcare providers’ names and contact information, and your preferred urgent care center or hospital, says Levy. Make it digital to easily share with family, friends, or coworkers. “I also suggest that patients with severe asthma keep an updated record of their most recent pulmonary function tests and blood test results to share with providers who may be unfamiliar with their history,” he says.
