To rule out other possible conditions — such as a respiratory infection or chronic obstructive pulmonary disease (COPD) — your doctor will do a physical exam and ask you questions about your signs and symptoms and about any other health problems.
You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe. These tests may include:
Lung function tests often are done before and after taking a medication called a bronchodilator (brong-koh-DIE-lay-tur), such as albuterol, to open your airways. If your lung function improves with use of a bronchodilator, it's likely you have asthma.
Other tests to diagnose asthma include:
To classify your asthma severity, your doctor considers your answers to questions about symptoms (such as how often you have asthma attacks and how bad they are), along with the results of your physical exam and diagnostic tests.
Determining your asthma severity helps your doctor choose the best treatment. Asthma severity often changes over time, requiring treatment adjustments.
Asthma is classified into four general categories:
|Asthma classification||Signs and symptoms|
|Mild intermittent||Mild symptoms up to two days a week and up to two nights a month|
|Mild persistent||Symptoms more than twice a week, but no more than once in a single day|
|Moderate persistent||Symptoms once a day and more than one night a week|
|Severe persistent||Symptoms throughout the day on most days and frequently at night|
Prevention and long-term control are key in stopping asthma attacks before they start. Treatment usually involves learning to recognize your triggers, taking steps to avoid them and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler, such as albuterol.
The right medications for you depend on a number of things — your age, symptoms, asthma triggers and what works best to keep your asthma under control.
Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, allergy medications are necessary.
Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an asthma attack. Types of long-term control medications include:
Inhaled corticosteroids. These anti-inflammatory drugs include fluticasone (Flonase, Flovent HFA), budesonide (Pulmicort Flexhaler, Rhinocort), flunisolide (Aerospan HFA), ciclesonide (Alvesco, Omnaris, Zetonna), beclomethasone (Qnasl, Qvar), mometasone (Asmanex) and fluticasone furoate (Arnuity Ellipta).
You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a relatively low risk of side effects and are generally safe for long-term use.
Leukotriene modifiers. These oral medications — including montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) — help relieve asthma symptoms for up to 24 hours.
In rare cases, these medications have been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any unusual reaction.
Long-acting beta agonists. These inhaled medications, which include salmeterol (Serevent) and formoterol (Foradil, Perforomist), open the airways.
Some research shows that they may increase the risk of a severe asthma attack, so take them only in combination with an inhaled corticosteroid. And because these drugs can mask asthma deterioration, don't use them for an acute asthma attack.
Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your doctor recommends it. Types of quick-relief medications include:
Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex).
Short-acting beta agonists can be taken using a portable, hand-held inhaler or a nebulizer — a machine that converts asthma medications to a fine mist — so that they can be inhaled through a face mask or a mouthpiece.
If you have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your long-term control medications are working properly, you shouldn't need to use your quick-relief inhaler very often.
Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more often than your doctor recommends, see your doctor. You probably need to adjust your long-term control medication.
Allergy medications may help if your asthma is triggered or worsened by allergies. These include:
This treatment — which isn't widely available nor right for everyone — is used for severe asthma that doesn't improve with inhaled corticosteroids or other long-term asthma medications.
Generally, over the span of three outpatient visits, bronchial thermoplasty heats the insides of the airways in the lungs with an electrode, reducing the smooth muscle inside the airways. This limits the ability of the airways to tighten, making breathing easier and possibly reducing asthma attacks.
Your treatment should be flexible and based on changes in your symptoms, which should be assessed thoroughly each time you see your doctor. Then your doctor can adjust your treatment accordingly.
For example, if your asthma is well-controlled, your doctor may prescribe less medicine. If your asthma isn't well-controlled or is getting worse, your doctor may increase your medication and recommend more-frequent visits.
Work with your doctor to create an asthma action plan that outlines in writing when to take certain medications or when to increase or decrease the dose of your medications based on your symptoms. Also include a list of your triggers and the steps you need to take to avoid them.
Your doctor may also recommend tracking your asthma symptoms or using a peak flow meter on a regular basis to monitor how well your treatment is controlling your asthma.
Although many people with asthma rely on medications to prevent and relieve symptoms, you can do several things on your own to maintain your health and lessen the possibility of asthma attacks.
Taking steps to reduce your exposure asthma triggers is a key part of asthma control, including:
Taking care of yourself can help keep your symptoms under control, including:
Get regular exercise. Having asthma doesn't mean you have to be less active. Treatment can prevent asthma attacks and control symptoms during activity.
Regular exercise can strengthen your heart and lungs, which helps relieve asthma symptoms. If you exercise in cold temperatures, wear a face mask to warm the air you breathe.
Certain alternative treatments may help with asthma symptoms. However, keep in mind that these treatments are not a replacement for medical treatment — especially if you have severe asthma. Talk to your doctor before taking any herbs or supplements, as some may interact with medications you take.
While some alternative remedies are used for asthma, in most cases more research is needed to see how well they work and to measure the extent of possible side effects. Alternative asthma treatments include:
Asthma can be challenging and stressful. You may sometimes become frustrated, angry or depressed because you need to cut back on your usual activities to avoid environmental triggers. You may also feel limited or embarrassed by the symptoms of the disease and by complicated management routines.
But asthma doesn't have to be a limiting condition. The best way to overcome anxiety and a feeling of helplessness is to understand your condition and take control of your treatment. Here are some suggestions that may help:
You're likely to start by seeing your family doctor or a general practitioner. However, when you call to set up an appointment, you may be referred to an allergist or a pulmonologist.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready for your appointment, as well as what to expect from your doctor.
These steps can help you make the most of your appointment:
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For asthma, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask: