How to Manage Long-Standing Asthma


Most acute asthma episodes will resolve completely with the program. The wheezing stops and, of equal importance, the bronchospasm is relieved. The peak flow meter reading, rate and depth of breathing will normalize and all will seem to be well. Despite appearances, relief may be less than 100% complete.

An acute episode of asthma that appears much improved may nevertheless persist in mild form. Something triggered the episode of asthma, and that something may still be in the picture. For example, allergy-induced asthma may persist in a low-grade state until the end of a pollen season. Or a chronic sinus infection may persist despite much lessening of signs and symptoms. Home management of asthma requires continuing the peak flow determinations regularly for at least a week or until you have other reasons to believe the danger is over. Although our target is 80% of normal peak flow, you may want to continue your medicines until the peak flow reading is above 90%. Measuring your chest size (circumference) is also helpful for deciding if an episode of asthma has subsided. Of course, when in doubt, it is prudent to consult with a doctor about whatever signs and symptoms persist.

Long-Standing Asthma

Suppose you wake up one morning a few days after finishing treatment for your acute episode and have that heavy, tight “load on the chest” feeling again. That is a warning that the episode is not over. The process that led to inflammation and spasm of the bronchial muscles has not yet been put to rest. A single course of treatment with inhaled and oral bronchodilators did not suffice. Further medical management is needed.

Rechecking your peak flow meter reading is useful at this time. A reading of more than 25% below your reading when you are well (baseline reading) means that asthma has recurred. Count the number of breaths you take each minute (respiratory rate). Better still, have someone else count for you. Normally, a respiratory rate is about 20 breaths per minute. The respiratory rate may double or triple with asthma. Obviously, the faster the rate of breathing, the more severe the asthma. Treatment is needed again, this time more intensively than last time and perhaps longer.

Begin again with the spray bronchodilator. At the same time, start your oral theophylline medicine immediately. When you feel a little lightening of the load on your chest, resume your breathing exercises. Remember to stay hydrated. If you are not urinating every 2 or 3 hours, you aren’t drinking enough to keep your chest secretions loose. Dehydration makes for thicker mucus that is more difficult to cough up.

Oral medicines come in different forms (formulations). Some are designed for use every 4 hours, others for use every 6, 8, or 12 hours. Consult the label on the medicine you will use, and take the medicine as directed. Take the recommended dosage as soon as you can swallow comfortably

You should feel better in 3 or 4 hours on a program consisting of spray bronchodilator, oral bronchodilator, fluids, and breathing exercises. Improvement will appear in the peak flow readings. Your respiratory rate will slow. When you are feeling more comfortable, look for changes that might have occurred in your environment, your diet, your work, and your life in general. Are you sure you don’t have a viral infection of your respiratory tract, or a hidden infection elsewhere?

While improvement expands, continue the oral bronchodilator for a whole week. Stop the spray after 2 or 3 days of comfort. Use peak flow readings to ensure that you are really back to normal. Check to see that your respiratory rate is back to its normal level.

There is additional treatment available for recurring or continuing asthma. Steroid medicines by mouth are at the next level of treatment. These hormones reduce the inflammatory process in the lungs, reduce the release of harmful (noxious) mediator substances, and turn off the process that leads to asthma. Steroids are very effective in management of asthma, but have the potential for serious side effects, such as suppression of the feedback mechanism between the pituitary and adrenal glands, accumulation of salt and fluids, high blood pressure, stomach ulcer, and muscle weakness, so they must be used thoughtfully and carefully Recurrent asthma is adequate reason to use oral steroids, in dosage sufficient to interrupt the asthma process. Steroids can also be used by inhalation. Various steroid sprays are available that deliver the medicine directly to the places in the lung where it is needed. This enables the patient to use less medicine than would be taken by mouth to relieve asthma. That, in turn, means that the undesirable side effects will be less. Many doctors suggest that inhaled steroids should be used for continuing treatment to prevent longstanding asthma. Indeed, medical studies have shown that continual treatment with cortisone-containing sprays is as good or better than ongoing treatment with bronchodilator drugs that are used by inhalation. As an aside, using medicines by direct application to the surface of skin or mucous membranes is called “topical” treatment; thus, inhaled steroids are topical steroids.

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About the Author: Andrew Reinert is a health care professional who loves to share different tips on health and personal care. He is a regular contributor to MegaHowTo and lives in Canada.

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