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Your Asthma Control is Our Mission

How I Will Use the 2020 Asthma Treatment Guidelines

These new guidelines have few practical implications.

 

 

 

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Indoor Allergens

Many patients with asthma get shortness-of-breath, coughing, runny  nose, watery eyes, and congestion when exposed to indoor allergens (dust mites, cockroaches, wood smoke, cigarette smoke, or molds.  These substances are considered triggers for asthma attacks.

If your asthma gets worse with exposure to these allergens, I will recommend mattress and pillow covers as part of several other strategies to reduce your exposure, including: a HEPA filter in your vacuum; carpet removal; air filters, mold removal or control, and pest management.

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Subcutaneous Allergy Shots

Some patients with asthma have wheezing that is triggered by environmental allergens like pollen.  When skin or lab testing shows confirmation of the allergen, subcutaneous allergy shots can be given to help with wheezing control.  New research confirms the value of such injections in certain situations.

If you have allergic asthma and aim to increase your asthma control, I will educate you about skin or lab testing and how allergy shots may be helpful.

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Inhaled Steroids - Short Course

Many children in the 0-4 age group have episodes of wheezing with their colds.  In the past, we weren’t sure how to treat this wheezing since it seems too early to call it asthma.  Yet, in quite of few of these children, asthma medicine makes them better.  This new recommendation gives more confidence for prescribing asthma medication for such children.

For children:

  • with a history of at least 3 episodes of wheezing
  • that seem triggered by a cold or upper respiratory infection (URI),
  • and new symptoms of cold or URI,

I’ll order a 7 day course of budesonide twice daily along with albuterol as needed for wheezing.

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Single Maintenance Meds

Most patients with moderate to severe persistent asthma are managed with daily use of an inhaler that contains corticosteroid (like fluticasone) ALONG WITH a rescue inhaler containing short-acting bronchodilator (like albuterol).  New studies show that a single inhaler containing both the steroid and a long-acting bronchodilator (formoterol) can keep these patients well controlled while simplifying their asthma action plan.

For my patient 4 years and older with moderate to severe asthma:

  • who get good control with an inhaled corticosteroid,
  • use a rescue inhaler such as albuterol 

I’ll offer a transition to this single inhaler approach, called SMART or Single Maintenance and Reliever Therapy.  

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Inhaled Steroids Daily

In the past, patients 12 years and older with mild persistent asthma were managed with daily use of an inhaler that contained a low-dose corticosteroid (like fluticasone) ALONG WITH a rescue inhaler containing short-acting bronchodilator (like albuterol).  New studies show that such patients can get control of worsening breathing by using the inhaled steroid intermittently (not daily), along with albuterol.

For my patient 12 years and older with mild persistent asthma:

  • who get good control with a low-dose inhaled corticosteroid,
  • use a rescue inhaler such as albuterol 

I’ll offer intermittent inhaled steroid treatment ALONG with Albuterol, as an alternative to daily inhaled steroid.  

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Long Acting Muscarinic Antagonist

Some patients with moderate to severe asthma who already use an inhaled steroid, still have break through wheezing.  In the past, I would have added a long-acting inhaler bronchodilator to get control.  New research shows that an alternative can be adding a different medicine called a long-acting muscarinic antagonist (LAMA). 

For my patients 12 years and older with moderate to severe asthma:

  • who are using an inhaled corticosteroid,
  • a short-acting rescue inhaler such as albuterol
  • but still have wheezing 

I’ll recommend adding a long-acting bronchodilator, along with their inhaled steroid.  In certain cases, I may offer a LAMA as well.  

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