Asthma Treatment: Quick and Easy Access to Medication

If medically necessary, our team of doctors will write a prescription for the medication you need. This allows you to obtain your medication quickly and easily.

Asthma is a chronic respiratory disease. In this condition, the bronchi are inflamed and very sensitive. They react to triggers more quickly than usual. The bronchi narrow, the mucous membrane swells, and thick mucus forms. This makes breathing difficult.

Typical asthma symptoms include:

• Wheezing or a rattling sound when breathing (especially when exhaling)
• Coughing (often at night or early in the morning)
• Shortness of breath, difficulty breathing, “not getting enough air”
• Tightness in the chest
• Decreased stamina during physical activity (climbing stairs, exercising, walking briskly)

Asthma can vary greatly. Some people rarely experience symptoms, while others feel them almost daily. There are often periods when symptoms are absent and periods when they worsen.

Common triggers include tobacco smoke, pollen, dust mites, mold, infections (viruses/bacteria), car exhaust, or poor air quality in general, as well as cold air or fog. Dry indoor air, physical exertion, or stress can also cause irritation.

Warning signs that indicate you should have your asthma treatment reviewed:

• You have asthma symptoms during the day and/or need to use your rescue inhaler more than twice a week (excluding as-needed medication before physical activity).
• You wake up at night due to coughing or shortness of breath.
• You avoid everyday activities because they make you short of breath or trigger other asthma symptoms.
• You’ve recently had a severe attack or required emergency treatment.

These signs often indicate that your asthma is not adequately controlled and that your treatment needs to be adjusted to prevent long-term complications.

With asthma, it’s not just a matter of the symptoms “sort of fitting.” Doctors conduct a targeted evaluation to determine whether asthma is actually the cause or whether another condition is triggering similar symptoms (such as COPD, infections, reflux, functional respiratory disorders, or even heart problems).

Describe when the symptoms occur: for example, at night, during physical activity, during pollen season, in cold weather, during times of stress, or after a cold. Allergies, smoking, and a family history of asthma or allergies are also important factors to consider.

Breathing and lung function are examined. Between attacks, the examination may show no abnormalities. This is normal for asthma, as it is a chronic condition that occurs in episodes, similar to migraines, for example.

A breathing test measures how well your lungs are functioning. If the results are normal, a provocation test is performed, during which you inhale a substance (usually methacholine) to see if your airways narrow in response. If your airways are already narrowed during the breathing test or after the provocation test, a check is performed to see if the results improve after taking a bronchodilator. If this significantly eases your breathing or brings it back to normal, this is indicative of asthma.

A small monitoring device can help you identify fluctuations in your daily life—for example, whether your symptoms worsen when there’s pollen in the air, in cold weather, or at night. This helps you assess your condition and shows how well your asthma is under control. It can also help you monitor the effectiveness of the rescue medication you’re using.

If allergic asthma is suspected, allergy testing may be helpful in identifying triggers such as pollen, dust mites, or pet dander. If an allergy is present, it can be treated with desensitization therapy, which reduces or even eliminates your reaction to the allergen. This eliminates the trigger, and you’ll experience fewer episodes of asthma attacks.

The treatment of asthma has two goals:

1. To reduce symptoms in daily life
2. Prevent asthma attacks and protect the lungs in the long term

What you can do on your own in everyday life:

• Identify and reduce triggers: If smoke, pollen, dust, or mold worsen your symptoms, it’s worth taking consistent action to manage them. Regular ventilation, maintaining appropriate humidity levels, and quitting smoking are also effective strategies.
• Take infections seriously: Colds are a common trigger for asthma flare-ups. If you notice that your symptoms worsen quickly when you have an infection, talk to a doctor in a timely manner about your personal treatment plan.
• Exercise—yes, but with a plan: Exercise is generally possible and can even be helpful. It’s important to have a treatment plan that keeps your asthma under control. If you regularly experience symptoms during physical activity, that’s a sign that your treatment regimen needs to be adjusted.

Sometimes your symptoms indicate that your asthma isn't well-managed and that everyday tips are no longer enough. Typical examples include:

• If you have symptoms more than twice a week
• If you wake up at night due to coughing or shortness of breath
• If you have a severe asthma attack
• If you need to use your rescue inhaler more than twice a week
• If your daily activities are limited by asthma symptoms

Then your asthma treatment should be reviewed and adjusted as soon as possible. This is because asthma isn’t just “tightened bronchial tubes,” but primarily an inflammation of the airways. And this inflammation must be well controlled over the long term so that symptoms and attacks become less frequent and your lungs remain protected.

Effective asthma treatment means you can go about your daily life normally, sleep soundly, have very few or no attacks, and rarely need to use your emergency inhaler.

This usually involves three things:

1. A clear treatment plan
   Many treatment plans follow a stepwise approach: Medications are adjusted based on your symptoms and risk. The goal is always the lowest effective level that keeps your asthma under control. In accordance with this stepwise plan, it’s normal for treatment to be intensified or de-escalated depending on the severity of your asthma. If symptoms aren’t adequately controlled, treatment is intensified—that is, you “move up” one or more steps in the stepwise scheme. And if your asthma generally remains under control with a particular step of treatment for more than 3 months, a attempt can be made to see if treatment can be reduced to the next lower step. Asthma treatment is therefore not a “static” regimen with the same medication and dose at all times, but rather a dynamic one that adapts to the frequency of your asthma attacks in order to maintain optimal control and prevent long-term damage to your lungs and heart.
2. Regular Checkups
   Even if you’re feeling well, it’s worth getting a periodic checkup (e.g., lung function, symptoms, inhalation technique). Asthma can change—seasonally, due to new triggers, stress, or infections.
3. Use the online Asthma Control Test (Welcome to the Asthma Control Test) if you’re unsure whether your asthma is fully controlled or not.
4. The Proper Role of “Emergency” vs. “Long-Term”
   Many people with asthma automatically reach for their rescue inhaler when they experience symptoms. This can provide short-term relief but does not resolve the inflammation. Frequent use is a warning sign of inadequate control. Based on new studies, international guidelines have found that relying solely on SABA (use of a classic rescue inhaler, such as salbutamol) without an appropriate anti-inflammatory strategy can increase risks.

If you feel like your asthma is “gradually getting worse,” don’t wait. Often, a brief medical evaluation with minor adjustments (e.g., technique, dosage, timing) is enough to restore stability.

When it comes to asthma, there is no “one” medication that works for everyone. Asthma can manifest in very different ways. Some people experience symptoms only rarely, while others have them almost every day. Triggers can also vary—for example, pollen, house dust, infections, cold air, or physical exertion. That’s why treatment is always tailored to the individual. Key factors include your symptoms, your lung function, how often you have attacks, and how well your asthma is controlled in your daily life.

Generally speaking, asthma medications serve two purposes.

Relievers are medications for acute episodes. In everyday language, they are often referred to as “emergency sprays.” They provide quick relief when you feel your breathing becoming more difficult, wheezing occurs, or you experience a tightness in your chest. These medications widen the airways so that air can flow more easily again. Relievers work quickly but do not resolve the inflammation that is often present in the background of asthma on a chronic basis.

Controllers are medications used for long-term management. They treat inflammation in the airways and help reduce the frequency of symptoms and attacks. Controllers do not always work immediately. It often takes a few days to weeks before you notice their full effect. However, they provide long-term protection for the airways as long as they are used regularly—even when you aren’t experiencing any symptoms.

Inhaled corticosteroids (ICS)>br> These are anti-inflammatory medications that are often administered as a spray or powder inhaler. They are considered the cornerstone of treatment for many forms of asthma because they reduce inflammation in the airways. This makes the bronchi less sensitive and less likely to react strongly to triggers.

These active ingredients dilate the bronchi. They come in two forms:

• Short-acting (SABA): for quick relief of acute symptoms (traditional emergency inhaler)
• Long-acting (LABA): for longer-lasting bronchodilation, usually as part of long-term therapy

If inhaled corticosteroids alone are not sufficient, a combination medication is often used. This medication combines an anti-inflammatory agent (ICS) with a long-acting bronchodilator (LABA). This can improve symptom control and help prevent attacks.

These medications also have anti-inflammatory effects, but they work differently than cortisone. They are used as a supplement in certain situations, such as when allergic factors are involved or when the current treatment has not yet been effective enough.

If asthma is not adequately controlled despite proper inhalation technique and appropriate standard therapy, there are other options. These include specialized therapies such as biologics, which specifically target certain inflammatory processes. These treatments are generally prescribed by specialists following a thorough evaluation.

Long-acting bronchodilators (LABAs) are not normally used alone for asthma. While they open the airways, they do not treat the inflammation. When combined with anti-inflammatory therapy (usually ICS), the treatment is generally safer and more effective.

If your treatment is generally well-adjusted, consistent and correct use in everyday life makes a big difference. Many so-called “treatment problems” ultimately aren’t due to the medication itself, but rather to the fact that it isn’t used regularly enough or doesn’t reach the lungs optimally during inhalation. These issues are often caused by minor errors in administration that you may hardly notice yourself.

Even the best treatment is of little help if the medication doesn’t reach the lungs. This is exactly where mistakes are often made. Asthma medications are only effective when inhaled correctly. These medications are available as metered-dose inhalers or various types of dry powder inhalers. Each inhaler therefore has its own specific instructions on how to use it correctly so that the medication reaches the lungs safely and can take effect.

A few basic principles for all types of inhalers:

1. Prepare the device
   Depending on the inhaler, you may need to prime it, shake it, or prepare a dose. Read the instructions for your device, watch the videos from the German Respiratory League (Inhalation - Deutsche Atemwegsliga e.V.), or have a pharmacist or your doctor show you the proper technique.
2. Exhale before inhaling
   Exhale calmly (not into the device).
3. Inhaling: slowly or forcefully, depending on the device
   With some devices, a slow, deep inhalation is important; with others, a forceful one is better. A brief instruction is helpful.
4. Hold your breath
   After inhaling, hold your breath briefly (for a few seconds) to allow the medication to settle.
5. Do not exhale immediately
   Then exhale slowly.

If you’re unsure, have your technique checked regularly (e.g., at a pharmacy or by a healthcare professional). This is often the quickest way to “optimize” asthma treatment. Sometimes it can also be helpful to use a spacer with an inhaler. This significantly reduces the difficulties associated with using metered-dose inhalers.