There's More To Treating Asthma Than Albuterol!

I am so surprised by the number of people who think if they have asthma, all they need is Albuterol.

Well, maybe for some people, that's enough.

But how do you know is you need something else?

There are a couple of things you can do:

Take a 5 question Asthma Control test (a score of 19 or below means your Asthma is not in control )

Or read the "Rules of Two"

Either of those can help you know if your asthma is in control or not. I meet so many families who think it's normal to cough all the time - even when they aren't sick. They use their Albuterol inhaler every day, and frequently wake up coughing at night. They can't participate during gym class or recess and struggle with shortness of breath, coughing and wheezing.

If your asthma is not controlled, then what?

Well, there are national guidelines from that National Asthma Education and Prevention Program (NAEPP) Third Expert Panel on the Diagnosis and Management of Asthma (quite the mouthful, I know!) But they have a chart that shows how to control asthma  (it's basically a staircase - you can go up or down the staircase, depending on your control.) You can see what it looks like here

Asthma treatment guidelines

There are 6 steps, and the treatment plans involve more than just using Albuterol. If that's all you need, you are on Step 1.

On Step 2, you add a low dose ICS (Inhaled Corticosteroid). What's that? It's a daily inhaler that keeps the swelling down in your lungs, and there are a lot of different brands and strengths.

Step 3: Low dose ICS + LABA (Long Acting Beta Agonist) - which stimulate the muscles surrounding the bronchial tubes to relax, which opens the airways wider. These are combination medications like Dulera, Advair, etc.

OR Step 3 also includes going up to a medium dose ICS.

Step 4: Medium dose ICS + LABA. There are different strengths of asthma inhalers, the Minnesota Department of Health has a great poster that shows different inhalers.

Step 5: High dose ICS + LABA (you keep getting a little bit stronger inhaler until it keeps your asthma in control.)

Step 6: High dose ICS + LABA and an oral systemic corticosteroid (Prednisone.) A systemic steroid means that you usually take it by mouth as a pill or liquid (or sometimes get a shot.) Systemic means it goes through your whole body. Inhaled corticosteroids just go to your lungs since they are inhaled. Patients on the Step 6 can also be considered for a biologic (injections for asthma.) My Middle Son was hospitalized 8 times for asthma, and two of those were ICU. He was one of those kids that had severe asthma and it was really hard to control.

We had gone through all of 6 steps, and carefully watched to make sure that he took his inhaler every morning and every night. And I made sure that he used a spacer so he had proper inhaler technique. But we just couldn't control his asthma.

That's why it's important to have a good relationship with your doctor, so you can check back with him or her and let them know that you are still struggling to control your asthma. Middle Son was on injections for 7 years, and it finally helped stabilize his asthma. When he would get sick, I wouldn't have to worry that he would end up in the hospital again.

He's in college now and healthy and happy.

What's the take away message here? There are a LOT of asthma medications on the market, so finding the best one for you can take some time. In our family, there are 4 of us with asthma, and we all have different inhalers and different strengths of inhalers. Sometimes, it was a little trial and error to try to find the best inhaler and strength. We had to carefully monitor or symptoms and let our doctor know how we were doing.

Remember, there are a lot of options for asthma medications other than Albuterol! Talk to your doctor and find out what is right for you.

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