My Current Treatment Regimen for Severe Asthma
I developed asthma when I was about 16 years old, following a few rounds of severe sinus infections. What started as occasional shortness of breath evolved into more severe asthma as time went on. It seems that each year my symptoms are a little bit worse than the year before.
I met my current pulmonologist about 10 years ago. He is genuinely the best doctor I have ever had, and I affectionately refer to him as The Good Doctor. He has worked very closely with me over the last few years to get my asthma in check. It has taken a lot of trial and error, but we finally found a treatment regimen that works pretty well for my asthma.
Finding the right regimen for my asthma
We have tried many different maintenance inhalers. I am pretty sure I have been on all of them at some point in my life, and every combination of them. Last summer my doctor switched me to Trelegy. It is a combination inhaler that uses a steroid, a long-acting bronchodilator, and an anticholinergic. Apart from simplifying my maintenance inhaler to once a day, this particular combination has worked wonders for me. I have been on it for about a year now and it has been a complete game-changer for my asthma control.
Antibiotics are not something typically prescribed for asthma, but a medicine called azithromycin has anti-inflammatory properties that somehow work in the lungs. I am not sure of the specifics of it, but I know that it is also a medicine commonly used in people with cystic fibrosis for the same reason. My doctor added it a few years ago, kind of as a “hail mary” when I was having trouble recovering from a particularly nasty asthma exacerbation.
Rescue medications
Everyone with asthma has some type of rescue inhaler. Albuterol is common, but it causes some pretty bad side effects for me, namely shaking and a severe increase in my heart rate. I have something called idiopathic sinus tachycardia, basically, my heart always beats too fast and they do not know why. And this poses a particular issue when I need rescue medication for my asthma, as it increases my already fast heart rate.
So I take a medication called Xopenex. Xopenex is very similar to albuterol but has less of the nasty side effects. (I would love to nerd out about the specifics of albuterol and Xopenex because it is pretty fascinating, but perhaps beyond the scope of this article). Xopenex comes in an inhaler and solution for my nebulizer.
A new-to-me biologic
A couple of winters ago I was doing some research on emerging asthma treatments and came across a medicine called Dupixent. It is in the class of medications called biologics. I am not 100% sure how it works, but I think it has something to do with one or two of the inflammatory pathways in the lungs. I mentioned it to my doctor and he was up for giving it a try. I am glad he was, because it has been a super helpful medicine for me and keeping my asthma under control.
Steroids
I always keep steroids on hand. And I mean always. I have a bottle at home and always make sure I have some on my person when I am out of the house. My doctor and I have found that if I start steroids as soon as any asthma symptoms start, my chance of having a severe exacerbation goes down significantly. In fact, starting steroids is the main focus of my asthma action plan, which we revised last summer. My doctor and I have discussed the indications for starting steroids extensively, so I am very comfortable with knowing when to use them and how much.
My current treatment regimen for asthma may change
I still have bouts of severe exacerbations, but they are much less frequent. I know my treatment plan will change and evolve as time goes on, but this is what is working for me now. It may sound like a lot, but it is definitely worth it to me.
Share your experience
What kind of asthma regimen are you on? I would love to hear what you and your doctor have tried to help with your asthma. Let me know in the comments!
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