Maintain Control - Managing Your Asthma: Asthma

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Maintain control

The ultimate goal of treatment is to keep your asthma well controlled with the least amount of medication necessary. At first, you may need more intensive therapy to achieve rapid control over symptoms. Then, as you gain control over your asthma, your medications can be reduced (or "stepped down"). This is particularly important when it comes to inhaled steroids. In collaboration with your doctor, find the lowest dose of inhaled steroids that will maintain good control in order to avoid the potential side effects associated with long-term use of high-dose inhaled steroids (see "Inhaled corticosteroids").

There are some caveats to consider when stepping down your asthma therapy. The obvious one is that your asthma could get worse. If you find that your symptoms return and you are relying more frequently on your quick-acting bronchodilator inhaler, it may be necessary to "step back up" to the treatment program you were using before. With a little trial and error, and by paying attention to your symptoms and peak flow, you can usually find the right balance of therapy without suffering adverse effects.

More troublesome, however, is the possibility that stepping down the intensity of your asthma treatment will put you at increased risk for an asthma attack. It is entirely possible that you can reduce your medications to the point where you become vulnerable to a severe flare-up, even though you feel good and your peak flow remains normal. One study found, for instance, that people who had good control of their asthma and stopped their inhaled steroid, while continuing with the long-acting inhaled bronchodilator, had breathing capacities that were near normal but experienced asthma attacks more often. As this study showed, without any treatment of asthmatic inflammation, your bronchial tubes remain twitchy and you are at risk for asthma attacks. Continuing some anti-inflammatory therapy every day is therefore a good idea for all but the mildest form of asthma.

But how small a dose keeps you protected? It's not easy to answer this question. There is no direct way of measuring asthmatic inflammation of the bronchial tubes to determine whether inflammation is being adequately suppressed, although researchers are exploring experimental techniques such as measurement of nitric oxide levels in exhaled breath. However, one currently available indicator — variation in your peak flow — provides an indirect measure of inflammation and enables you to keep an eye on possible deterioration that could lead to an asthma attack. As an example, imagine that when your asthma is under good control, your peak flow is consistently 350 to 400 liters per minute (L/min). When you reduce your medications, you may start noticing greater fluctuations in your peak flow readings: Some mornings you hit 400; other mornings it's only 280, but when you check your peak flow later, it's back up to 400. This variability of peak flow is a warning that an asthma flare-up may be coming. It would be best to increase your medications again, until the peak flow readings are once again steady in the 350 to 400 range.

Last updated:	September 27, 2007