Asthma Treatment: Simple & Fast Medication

What is Asthma? Symptoms, Triggers, and Warning Signs in Everyday Life

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

Typical asthma symptoms include:

• Wheezing or rattling 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
• Drop in performance during exertion (stairs, sports, faster walking)

Asthma can vary greatly. Some people rarely experience symptoms, while others feel it almost daily. Often there are phases where you are symptom-free, and phases where it worsens.

Common triggers include, for example, tobacco smoke, pollen, mites, mold, infections (viruses/bacteria), car exhaust or generally poor air, but also cold air or fog. Dry indoor air or physical exertion or stress can also irritate.

Warning signs at which you should have your asthma therapy checked:

• You have asthma symptoms during the day and/or need your emergency inhaler more than twice a week (excluding on-demand medication before physical exertion).
• You wake up at night due to coughing or shortness of breath.
• You avoid daily activities because you become short of breath or other asthma symptoms occur.
• You recently had a severe attack or had to be treated as an emergency.

These signs often mean that the asthma is not sufficiently controlled and the treatment needs to be adjusted to prevent long-term consequences.

Diagnosis of Asthma: How it is determined whether your symptoms are caused by asthma

With asthma, it's not just about the symptoms «somehow fitting». Doctors specifically clarify whether asthma is actually the cause or if another disease causes similar symptoms (for example, COPD, infections, reflux, functional breathing disorders, or even heart problems).

Conversation and Medical History (Anamnesis)
You describe when the symptoms occur: for example, at night, during physical exertion, during pollen season, in cold weather, under stress, or after a cold. Allergies, smoking, and cases of asthma or allergies in the family are also important indicators.

Physical Examination
Breathing and lungs are examined. Between attacks, the examination may be unremarkable. This is normal with asthma, as it is a chronic disease that occurs in attacks, similar to, for example, migraines.

Lung Function (Spirometry)
A breathing test measures how well your lungs are working. If the values are normal, a provocation test is performed, where you inhale a substance (usually methacholine) to see if your bronchi narrow in response. If the bronchi are already narrowed during the breathing test or after the provocation test, it is then checked whether the values improve after a bronchodilating medication. If breathing is significantly eased or normalized as a result, this indicates asthma.

Peak Flow Measurement at Home
A small measuring device can help visualize fluctuations in everyday life, for example, whether your values are worse with pollen, cold, or at night. This supports the assessment and shows how stably controlled the asthma is. In addition, the effectiveness of the on-demand medication you use can also be checked.

Allergy Clarification
If allergic asthma is suspected, allergy diagnostics can be useful to identify triggers such as pollen, house dust mites, or animal dander. If an allergy exists, it can be causally treated with desensitization so that you react less or no longer at all to the allergen. This eliminates this trigger and you have less frequent phases with asthma attacks.

Asthma Treatment: What helps in everyday life and when more is needed

The treatment of asthma has two goals:

1. Reduce everyday symptoms
2. Avoid asthma attacks and protect the lungs long-term

What you can do yourself in everyday life:

Identify and reduce triggers
If smoke, pollen, dust, or mold aggravate your symptoms, it is worthwhile to deal with them consistently. Regular ventilation, appropriate humidity, and quitting smoking are also powerful levers.

Take infections seriously
Colds are a common trigger for asthma exacerbations. If you notice that your symptoms worsen quickly with infections, talk to a doctor in good time about your personal action plan.

Exercise yes, but with a plan
Sports are generally possible and even helpful. What is important is a therapy that keeps your asthma stable. If you regularly experience symptoms during exertion, this is a sign that the treatment should be optimized.

When are everyday tips no longer enough?
Sometimes your symptoms indicate that your asthma is not optimally managed and everyday tips are no longer sufficient. 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 severe asthma attacks occur
• If you need your emergency inhaler more than twice a week
• If your daily activities are limited by asthma symptoms

Then your asthma therapy should be reviewed and adjusted as quickly as possible. Because asthma is not just «cramped bronchi», but above all an inflammation of the airways. And this inflammation must be well controlled in the long term so that symptoms and attacks become less frequent and your lungs remain protected.

Asthma Therapy: How to get your asthma well under control long-term?

Good asthma therapy means: You can live your everyday life normally, sleep peacefully, have very rare to no attacks, and only rarely need your emergency inhaler.

This usually involves three things:

1. A clear treatment plan
   Many therapies follow a step-wise principle: medications are adjusted depending on symptoms and risk. The goal is always the lowest effective step that keeps your asthma stable. According to this step plan, it is normal for therapy to be intensified or de-escalated depending on the activity level of your asthma. If there is insufficient symptom control, the therapy is intensified, meaning one or more steps in the step-wise scheme are «moved up». And if your asthma remains controlled with the therapy of one step for usually over 3 months, an attempt can be made to see if the therapy can be reduced to the step below. Asthma therapy is therefore not a «static» therapy with always the same medication and dose, but a dynamic one that adapts to the frequency of your asthma attacks to always optimally control it and prevent long-term damage to your lungs and heart.
2. Regular check-ups
   Even if you are feeling well, periodic check-ups are worthwhile (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 are unsure whether your asthma is fully controlled or not.
4. Correct role of «emergency» vs. «long-term»
   Many affected individuals automatically reach for the emergency inhaler when symptoms occur. This can help in the short term, but it does not resolve the inflammation. Frequent need is a warning sign of insufficient control. International recommendations, based on new studies, have found and emphasize that pure SABA use (use of a classic emergency inhaler, such as Salbutamol) without an appropriate anti-inflammatory strategy can increase risks.

If you feel your asthma is «gradually worsening», do not wait. Often, a brief medical check-up with small adjustments (e.g., technique, dosage, timing) is enough to regain stability.

Which medications and active ingredients are commonly considered for asthma?

With asthma, there isn't «one» medication that fits everyone. Asthma can vary greatly. Some people rarely experience symptoms, others almost daily. The triggers can also be different, such as pollen, house dust, infections, cold air, or physical exertion. Therefore, treatment is always individually adjusted. Decisive factors include your symptoms, lung function, how often you have attacks, and how well your asthma is controlled in everyday life.

Basically, asthma medications have two functions.

Relievers (On-demand medication)
Relievers are medications for the acute moment. They provide rapid relief when you feel breathing becoming heavier, you wheeze, or a tightness in the chest occurs. These medications widen the bronchi so that air can pass through more easily. Many call them «emergency inhalers». Relievers act quickly but do not resolve the inflammation that is often permanently present in the background with asthma.

Controllers (Long-term therapy)
Controllers are medications for long-term control. They treat the inflammation in the airways and help to reduce the frequency of symptoms and attacks. Controllers do not always work immediately. It often takes a few days to weeks to notice the full effect. However, they protect the airways long-term, provided they are used regularly. Even when things are going well.

Which active ingredient groups are commonly used for asthma?

Inhaled Corticosteroids (ICS)
These are anti-inflammatory medications, often as a spray or powder inhaler. They are considered the basis of treatment for many forms of asthma because they calm the inflammation in the airways. This makes the bronchi less sensitive and react less strongly to triggers.

Beta-2-sympathomimetics
These active ingredients widen the bronchi. They are available in two variants:

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

Combination medications (ICS/LABA)
If an inhaled corticosteroid alone is not sufficient, a combination preparation is often used. This combines an anti-inflammatory active ingredient (ICS) and a long-acting bronchodilator (LABA) in one medication. This can improve symptom control and prevent attacks.

Leukotriene receptor antagonists (e.g., Montelukast)
These medications also have anti-inflammatory effects, but through a different mechanism than cortisone. They are additionally used in certain situations, for example, when allergic components play a role or when the previous therapy is not yet sufficiently effective.

Add-on therapies for severe asthma (including biologics)
If asthma is not sufficiently controlled despite good inhalation technique and appropriate standard therapy, there are further options. These include special therapies such as biologics, which specifically intervene in certain inflammatory processes. These treatments are usually used after thorough clarification and by specialists.

Long-acting bronchodilators (LABA) are normally not used alone for asthma. While they open the bronchi, they do not treat the inflammation. In combination with an anti-inflammatory therapy (mostly ICS), the treatment is usually safer and more effective.

If your therapy is generally well adjusted, consistent and correct application makes a big difference in everyday life. Many supposed «therapy problems» are ultimately not due to the medication itself, but to the fact that it is not used regularly enough or does not reach the lungs optimally during inhalation. The cause is often small errors in application that one hardly notices oneself.

Using your asthma inhaler correctly: How the medication gets into the lungs

Even the best therapy helps little if the medication does not reach the lungs. This is where errors often occur. Asthma medications only work well if inhaled correctly. The medications are available in the form of metered-dose inhalers or various dry powder inhalers. Each inhaler therefore has its own specific features on how to use it correctly so that the medication safely reaches the lungs and can take effect.

A few basic principles for all inhaler forms:

1. Prepare the device
   Depending on the inhaler, you need to load, shake, or prepare a dose. Read your device's instructions, use the videos from the German Respiratory League (Inhalation - Deutsche Atemwegsliga e.V.) or have the technique demonstrated to you at the pharmacy or by your doctor.
2. Exhale before inhalation
   Exhale calmly (not into the device).
3. Inhale: slowly or forcefully depending on the device
   For some devices, a slow, deep inhalation is important, for others, a more forceful one. A short instruction is useful.
4. Hold your breath
   After inhaling, hold your breath briefly (a few seconds) so that the medication can settle.
5. Do not exhale immediately
   Then exhale slowly.

If you are unsure, have your technique regularly checked (e.g., at the pharmacy or by specialists). This is often the quickest «optimization» in asthma treatment. Sometimes it can also be helpful to use a spacer chamber with an inhaler. This significantly reduces the difficulties in using metered-dose inhalers.

Side effects of asthma medications: What you should know

Asthma medications are generally well tolerated. Nevertheless, side effects can occur.

Possible side effects of bronchodilating emergency medications
Some people experience trembling, heart palpitations, or restlessness after using the emergency inhaler. This is unpleasant but often subsides. If it is severe or happens frequently, the therapy should be reviewed.

Possible side effects of inhaled corticosteroids (ICS)
Hoarseness, irritated throat, or fungal infection in the mouth (oral thrush) can occur here. A simple routine often helps: After inhaling, rinse your mouth, drink something, eat something, or brush your teeth so that active ingredient residues do not remain in your mouth.

When should you seek medical advice?

• If side effects are new, severe, or bothersome
• If you repeatedly have infections/hoarseness and don't know if it's due to the spray
• If you feel your asthma medication is not helping as expected
• If you need your emergency inhaler more than twice a week than before (warning sign)

Please do not change your medication on your own, but always with a doctor. Especially with asthma, an incorrect adjustment can increase the risk of attacks.

Disclaimer

These articles are for informational purposes only and may not be used for diagnostic or therapeutic purposes. They are not a substitute for personal medical advice and treatment. Medgate has carefully compiled the information, but cannot guarantee the accuracy and completeness of the information. Medgate assumes no liability for damages that may arise from the use of this information. Are you sick and need help? Our doctors are available to you around the clock via the Medgate App.