Asthma Treatment: questions and answers

In detail

Asthma is a chronic immunological disease characterised by variable respiratory symptoms and airflow limitation. It involves complex gene-environment interactions and type 2 inflammation in many patients. Allergic rhinitis affects 10% to 40% of the population and reduces quality of life.

Our team evaluates specific phenotypes such as exercise-induced symptoms, occupational triggers, and severe asthma defined by frequent exacerbations despite high-dose inhaled glucocorticoids. Skin prick tests or serum IgE identify allergic triggers, while spirometry with reversibility confirms diagnosis and severity. FeNO measures airway inflammation for steroid titration.

In detail

Asthma symptoms include variable respiratory symptoms and airflow limitation. It is common for symptoms to worsen at night or early morning. Allergens such as pollens, dust mites, or mould can trigger breathing difficulty. Exercise-induced asthma causes symptoms during physical activity.

Occupational asthma develops or worsens with workplace sensitising agents. If you need a reliever inhaler often, or if symptoms limit your daily activities or sleep, your asthma may not be well controlled. Allergic rhinitis commonly coexists and reduces quality of life. A specialist can confirm the diagnosis with spirometry, assess severity, and create a written asthma action plan.

In detail

Clinically significant exacerbations are defined as acute asthma requiring oral corticosteroids, admission, or an emergency department visit. Severe exacerbations can progress rapidly. Warning signs include inability to complete sentences, no relief from short-acting beta2-agonists (SABAs), cyanosis, and altered consciousness.

SABAs can cause tremors and rapid heartbeat, but failure to respond is a red flag. Our emergency department operates 24×7 with ambulance service. Do not wait for a routine OPD appointment if these signs appear. Immediate treatment with oxygen, nebulised bronchodilators, and systemic corticosteroids is critical.

In detail

Diagnosis relies on demonstrating variable airflow limitation and identifying the inflammatory phenotype. Spirometry with reversibility confirms the diagnosis and assesses severity. FeNO measures airway inflammation and helps titrate inhaled corticosteroids.

Skin prick tests or serum IgE identify specific allergens such as dust mites, pollen, or mould. In studies, biologic eligibility requires blood eosinophil counts of at least 300 cells per microlitre and a history of exacerbations despite high-dose inhaled corticosteroids and long-acting beta2-agonists.

The doctor follows a cycle of assessment, treatment, and re-evaluation, using shared decision-making to choose the most appropriate investigations for your phenotype.

In detail

Treatment follows a cycle of assessment and re-evaluation. Spirometry with reversibility establishes variable airflow limitation and its severity, placing you on the appropriate step of controller therapy.

FeNO helps titrate inhaled corticosteroids — high FeNO suggests eosinophilic inflammation responsive to steroids; low FeNO may prompt a different approach. Skin prick or serum IgE results identify specific triggers: avoidance reduces flare-ups, and subcutaneous immunotherapy (allergy shots) can desensitise you over time.

For severe uncontrolled eosinophilic asthma (blood eosinophils ≥300 cells/μL, frequent exacerbations on high-dose inhaled corticosteroids plus long-acting beta2-agonists), biologics such as anti-IgE or anti-IL5 agents are considered. Studies show biologics reduce exacerbation rates and can spare oral steroid use. The goal is to minimise symptom burden and exacerbation risk through phenotype-specific treatment.

In detail

Quick-relief SABAs open airways during attacks but do not control inflammation. Controller medicines taken daily prevent attacks; inhaled corticosteroids are the mainstay. LABAs or LAMAs may be combined in one inhaler to prevent airway narrowing.

Leukotriene modifiers reduce swelling and keep airways open, used alone or with steroids. For exercise-induced asthma, a reliever before activity helps. In severe asthma with persistent eosinophilic inflammation despite high-dose inhaled corticosteroids, biologics like benralizumab, mepolizumab, or dupilumab target specific inflammatory pathways.

Studies show biologics reduce exacerbation rates significantly and can lower oral steroid dependence. Allergy shots (subcutaneous immunotherapy) turn down the body's response to identified allergens. Bronchial thermoplasty is a procedure for serious asthma unresponsive to medicines, applying heat to airway muscles via bronchoscope.

In detail

Inhaled corticosteroids and bronchodilators remain the mainstay of therapy. Leukotriene modifiers and mast cell stabilisers are alternatives or add-ons. For exercise-induced asthma, a reliever before activity and regular warm-up help. Allergic rhinitis treatment with intranasal corticosteroids improves asthma control.

Allergy shots (subcutaneous immunotherapy) can reduce sensitivity to specific allergens over time. In studies, regular training and warming up before exercise prevent symptoms. Occupational asthma requires removal of the sensitising agent. Weight loss in overweight patients improves lung function and symptom control.

Annual influenza and pneumococcal vaccinations reduce exacerbation risk. The written asthma action plan integrates all these elements into daily self-management.

In detail

Bronchial thermoplasty delivers controlled heat to airway smooth muscle via a bronchoscope inserted through the mouth, reducing the muscle's ability to constrict. In studies, it is reserved for serious asthma when other treatments are not working.

Risks include temporary worsening of asthma, airway or lung infections, and bronchiectasis. Biologic therapies (anti-IgE, anti-IL5, anti-IL4 receptor) are usually tried before thermoplasty for severe eosinophilic or allergic phenotypes.

Eligibility in trials required age 12 to 75, physician-diagnosed asthma for at least one year, at least two exacerbations on high-dose therapy, and often blood eosinophils of at least 300 cells per microlitre. The decision involves shared discussion of risks, benefits, and alternatives.

In detail

Evidence shows that inhaled short-acting beta2-agonists open the airways quickly to relieve acute symptoms. Inhaled corticosteroids reduce airway inflammation, but their full effect builds over weeks of regular use.

For severe eosinophilic or allergic asthma, biologic medicines such as anti-IL5 or anti-IgE antibodies are given by injection every few weeks; studies report significant reductions in exacerbation rates and improvements in FEV1 by week 12 to 48. Your response also depends on trigger avoidance, correct inhaler technique, and treating co-existing allergic rhinitis.

In detail

An asthma action plan is a written document that describes how to recognise an attack, what medicines to take, and when to seek urgent care. Guidelines stress a cycle of assessment and re-evaluation; if control is not achieved, treatment is stepped up.

Worsening asthma is the most common adverse event noted in studies of both standard and biologic therapies. Persistent symptoms despite high-dose inhaled corticosteroids and long-acting bronchodilators may indicate severe asthma that needs specialist review for biologic eligibility.

In detail

Uncontrolled asthma leads to larger avoidable costs from lost work productivity than direct medical costs. Allergic rhinitis, which often coexists, reduces quality of life and work or school performance.

Exercise-induced asthma causes symptoms during or after physical activity; guidelines recommend a reliever inhaler before exercise and good background control with inhaled corticosteroids. Occupational asthma can develop or worsen from workplace allergens or sensitisers; avoiding the trigger is essential. For travel, carry medicines in hand luggage, keep a copy of your action plan, and know local emergency numbers.

In detail

Symptoms such as wheeze, cough, and breathlessness can also occur in other conditions, so guidelines recommend objective confirmation before long-term treatment.

Spirometry measures forced expiratory volume in one second (FEV1) and forced vital capacity (FVC); an increase in FEV1 of more than 12% and 200 ml after a bronchodilator confirms reversible obstruction.

FeNO levels above 25 parts per billion in adults suggest eosinophilic inflammation responsive to inhaled corticosteroids. Allergy testing helps define phenotype and avoid specific triggers. These tests together distinguish asthma from COPD, vocal cord dysfunction, or cardiac causes.

In detail

Relievers are for as-needed use during an attack or before a known trigger such as exercise. They do not treat the underlying inflammation. Preventers must be used every day even when you feel well; stopping early allows inflammation to return.

Evidence shows that regular preventer use lowers exacerbation risk and improves lung function. Overusing a reliever without a preventer signals poor control and increases the risk of severe flare-ups.

Side effects differ: relievers may cause tremor or rapid heartbeat; preventers can cause hoarse voice or oral thrush, reduced by rinsing the mouth and using a spacer.

In detail

Studies show that up to 70% of patients make at least one critical error that reduces drug delivery to the lungs.

Proper technique: shake the inhaler, exhale fully, seal lips around the mouthpiece, press the canister while breathing in slowly and deeply over 3 to 5 seconds, hold breath for 10 seconds, then exhale gently.

With a spacer, press the inhaler once into the chamber, then take 5 to 6 slow tidal breaths or one slow deep breath and hold. Rinsing the mouth after corticosteroid inhalers reduces thrush risk. The team may use a placebo inhaler or a flow-check device to give feedback.

In detail

Guidelines define an asthma action plan as a written treatment plan that describes how to know if you are having an attack and what to do, when to call your provider or go to the emergency room, and your daily controller and reliever doses.

The plan is based on your symptom pattern, peak flow or FEV1, and known triggers. It supports the cycle of assessment and re-evaluation recommended in guidelines. Having a plan reduces emergency visits and improves confidence in self-management.

In detail

Identifying triggers starts with a symptom diary noting time, place, activity, and exposures. Skin prick testing or serum IgE confirms specific allergic sensitivities. Evidence shows that avoiding confirmed allergens improves control and reduces medication need.

For occupational asthma, removal from exposure is the most effective step. Exercise-induced symptoms are managed with a reliever inhaler 15 minutes before activity and good baseline control. Night-time worsening may point to bedroom allergens or reflux. Seasonal patterns suggest pollen allergy.

In detail

Asthma is a chronic inflammatory airway disease with variable symptoms and airflow limitation. Diagnosis relies on demonstrating variable obstruction that improves with bronchodilator, which spirometry with reversibility provides. FeNO measures eosinophilic airway inflammation and helps decide if inhaled corticosteroids are needed and at what dose.

Evidence shows treatment follows a cycle of assessment, adjustment and shared decision-making to minimise symptom burden and exacerbation risk. Identifying triggers such as allergens, smoke or exercise allows targeted avoidance.

An asthma action plan tells you how to recognise worsening control, when to increase reliever use, when to start oral steroids and when to seek emergency care.

In detail

Severe asthma is defined as asthma that requires high-intensity treatment to stay controlled or remains uncontrolled despite high-dose inhaled corticosteroids plus long-acting bronchodilators. Patients often have persistent eosinophilic airway inflammation and experience recurrent exacerbations needing oral corticosteroids or emergency visits.

Evidence shows these patients benefit from systematic phenotyping: blood eosinophil count, FeNO and IgE levels identify those who may respond to biologic therapies such as anti-IL5, anti-IgE or anti-IL4 receptor agents. Studies demonstrate significant reductions in exacerbation rates and oral steroid doses with targeted biologics.

Comorbidities like allergic rhinitis, sinusitis or reflux are also addressed. Regular multidisciplinary review is essential to balance control against medication side effects such as osteoporosis, cataract or adrenal suppression from prolonged steroid exposure.

In detail

Biologic medicines such as anti‑IgE, anti‑IL5, or anti‑IL4 receptor antibodies are used for severe uncontrolled eosinophilic or allergic asthma.

In studies, mepolizumab reduced exacerbation rates by 47% and had a glucocorticoid‑sparing effect; dupilumab increased FEV1 by 0.32 litres and lowered severe exacerbation rates; benralizumab cut annual exacerbation rates by up to 45%.

Eligibility typically requires a physician‑based diagnosis for at least one year, blood eosinophils of at least 300 cells per μL, and two or more exacerbations on high‑dose therapy. The choice of biologic depends on your specific phenotype and comorbidities.

In detail

Allergic asthma is driven by type 2 inflammation triggered by specific allergens. Skin prick testing or serum specific IgE identifies sensitisation. Evidence shows allergic rhinitis affects 10 to 40 percent of the population and worsens asthma control. Avoiding identified allergens reduces symptoms and flare-ups.

Subcutaneous immunotherapy (allergy shots) gradually reduces the immune response to the allergen. It is a long-term treatment, typically three to five years, and can modify the disease course. It is most effective for single dominant allergens like house dust mite or specific pollens.

Biologic therapy such as anti-IgE may be an alternative for poly-sensitised patients. The decision balances symptom burden, medication use, allergen avoidability and patient preference.

In detail

Asthma affects people from childhood to old age. In children, diagnosis relies on symptom patterns, response to bronchodilators, and objective tests when the child is old enough to perform spirometry (usually after five to six years).

FeNO helps detect airway inflammation even when spirometry is normal. Allergy testing identifies triggers such as dust mites, pollen, or pet dander.

An asthma action plan written with the provider tells you how to recognise an attack, adjust reliever use, and when to seek emergency care. Regular follow‑ups monitor growth, inhaler technique, and medication side effects such as thrush or hoarse voice from inhaled corticosteroids.

In detail

Clinically significant asthma exacerbations are defined as episodes requiring oral corticosteroids, admission, or an emergency department visit.

Warning signs include worsening wheeze despite reliever use, inability to lie flat, use of accessory neck muscles, respiratory rate over 30 breaths per minute, silent chest (no wheeze because air movement is too low), and oxygen saturation below 92% on a home pulse oximeter.

Night‑time worsening is common; being around allergens while you sleep may worsen symptoms. An asthma action plan tells you exactly when to start oral steroids, increase reliever frequency, and call for help.

In detail

Asthma results from complex gene-environment interactions. Tobacco smoke directly irritates airways and reduces corticosteroid responsiveness. Outdoor pollutants (particulate matter, nitrogen dioxide, ozone) and indoor pollutants (biomass fuel, mould, dust mite) trigger inflammation.

Occupational asthma develops or worsens with workplace exposure to sensitisers like isocyanates, flour dust, latex or cleaning agents; once sensitised, even tiny amounts trigger symptoms. Evidence shows removing the sensitising agent is essential.

Comorbidities are common: allergic rhinitis affects 10 to 40 percent of the population and impairs asthma control; gastro-oesophageal reflux can trigger bronchospasm; obesity increases mechanical load and systemic inflammation. Treating these conditions improves asthma outcomes. A detailed environmental and occupational history guides targeted avoidance and informs whether workplace modification or job change is needed.

In detail

Asthma costs include direct medical expenses — consultations, lung function tests (spirometry, FeNO), allergy panels, inhalers, controller medications, and for severe disease, biologic injections — and indirect costs from lost work or school days. Evidence shows avoidable productivity losses exceed direct medical costs.

In India, a spirometry and allergy panel package typically falls between ₹8,000 and ₹20,000. Biologic agents such as anti-IgE, anti-IL5 or anti-IL4 receptor are given every two to eight weeks and represent the largest expense for severe asthma.

Insurance coverage varies: government schemes (RGHS, CGHS, MAA Yojana) and empanelled private TPAs may cover consultations, diagnostics and some medications. The hospital's in-house pharmacy and laboratory streamline billing. A detailed estimate is provided after the doctor defines the investigation and treatment plan.

In detail

The estimate covers the outpatient visit and the specific diagnostic package chosen. Spirometry with reversibility confirms the diagnosis and checks severity. Fractional Exhaled Nitric Oxide (FeNO) measures airway inflammation to guide steroid use. Skin prick tests or serum IgE identify allergic triggers.

If the pulmonologist advises biologic therapy such as anti-IgE or anti-IL5 for severe uncontrolled asthma, those drug costs and administration charges are extra. Hospitalisation, if ever needed for a severe flare, is also separate.