Asthma treatment

Le traitement de l'asthme

Asthma treatment must follow a comprehensive plan, agreed between doctor and patient. The aim of treatment is to improve symptoms, maintain normal or near-normal lung function, prevent flare-ups and maintain a good quality of life.

Non-pharmacological treatment

Avoid smoking. Asthma patients who smoke have poorer disease control and respond less well to medication. All asthma patients are advised to stop smoking and avoid passive smoking.

Running; regular exercise
Physical activity. Regular physical activity improves patients' cardiovascular fitness and exercise tolerance.

Sun, wind, rain and waves are environmental factors.
Avoid environmental pollution. Do not exercise outdoors on days when air pollution is high.

Vaccination. Vaccination against influenza and pneumococcus is recommended for patients with moderate-to-severe asthma.

Avoid contact with various allergens:

Allergic patients should avoid dust mites as much as possible. Reduce the use of carpets, rugs, curtains and objects that accumulate dust. Clean household dust with a damp cloth, wash bed linen at least once a week at high temperature, use anti-dust mite anti-dust mite covers for mattresses and pillows.

Patient allergic to bee stings, insect bites and pollen.

Avoid staying outdoors for long periods on days of heavy pollination. You need to be aware of the type of pollen you are sensitive to and the seasons in which they predominate.

Allergy sufferers should avoid animals.

Pets. Remove the animal from the house and clean it thoroughly; if this is not possible, avoid all contact with the animal in the bedroom and on the sofa.

Allergy sufferers should avoid humidity.

Avoid dampness in the home, and air dark, damp rooms frequently.

Pharmacological treatment

Pharmacological treatment of asthma aims to improve symptoms and prevent asthma attacks. It should be adjusted periodically, in stages, according to the severity and control of symptoms.

Most asthma treatments are administered by inhalation, which provides a local effect on the airways, with fewer side effects.

Correct inhalation technique is essential for a good response to treatment.

There are two groups of inhaled medications:

Bronchodilators. These are drugs that open or dilate the airways; they may be short- or long-acting.

Glucocorticoids. These are anti-inflammatory drugs that reduce airway inflammation.

There are two treatment strategies:

Rescue" treatment. This provides rapid relief of symptoms by administering a short-acting bronchodilator, which starts to work within a few minutes.

Maintenance treatment. This helps to control the disease and prevent future attacks. The cornerstone of this treatment is inhaled glucocorticoids, which can be administered alone or in combination with long-acting bronchodilators.

Other treatments help control the disease:

Leukotriene receptor antagonists. Taken orally, they also have an anti-inflammatory action.

Antihistamines. They help control allergy symptoms.
Immunotherapy with allergen injections. In the case of allergic asthma, when exposure to the allergenic agent cannot be avoided, this treatment is used to desensitize the patient.

Inhalation therapy

Most asthma treatments are administered by inhalation, i.e. the medication is inhaled through the mouth to reach the airways. Correct inhalation technique is essential to ensure that the medication reaches the area where it is intended to act, otherwise insufficient medication will reach the airways and the desired effect will not be achieved.

In general, there are two main groups of inhalers: pressurized-cartridge inhalers and dry-powder inhalers. Within these two groups, there are different types of device. It's up to the patient and doctor to find the most suitable option for the patient, and to ensure that the inhalation technique is carried out correctly.

New therapies

In recent years, new asthma treatments have been developed. They are indicated in cases of severe asthma that remains uncontrolled despite optimal conventional treatment.

Biological drugs. These are monoclonal antibodies directed against certain proteins involved in the inflammatory mechanisms of asthma. They are generally administered subcutaneously. The following medications are available in Canada:

Omalizumab. It acts by blocking immunoglobulin E, a protein involved in allergic inflammation. It is indicated for patients with severe allergic asthma.

Mepolizumab. Acts by blocking interleukin 5, which is involved in the inflammatory pathways of asthma. It is indicated for patients suffering from severe asthma with a type of inflammation called eosinophilia.

Bronchial thermoplasty is an endoscopic procedure, performed by flexible fibrobronchoscopy, which involves applying controlled heat to the airway walls to reduce the thickness of bronchial smooth muscle and decrease bronchial hyperreactivity. It is indicated only in very select cases of severe asthma, which are not controlled by conventional treatment.

Treatment complications

Inhaled treatment is generally safe, as the drug acts locally in the airways and systemic side effects are rare. The most common side effects are as follows

Local effects. Such as throat irritation, voice alteration (dysphonia) and oral thrush. These effects are generally due to the presence of traces of the drug in the oral cavity and larynx; it is therefore advisable to rinse the mouth after each inhalation.

Systemic side effects are generally associated with high doses and prolonged periods of treatment. Glucocorticoids can cause osteoporosis, glaucoma, increased blood sugar levels, adrenal insufficiency and an increased risk of pneumonia. Bronchodilators may cause tachycardia, tremors, feelings of anxiety or nervousness.

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