Stephen J. Schueler, M.D.

Allergic Asthma Treatment

Treatment for asthma is most successful when a person follows a treatment plan that is designed by his or her doctor. The plan should include a strategy for long-term and short-term treatment of mild, moderate and severe asthma attacks. Long-term treatment of asthma may include inhaled corticosteroid medications and additional oral medications. For short-term treatment of mild to moderate symptoms, most people with asthma respond well to treatment with bronchodilator medication and oral corticosteroid medication. A person with a moderate to severe asthma attack may require hospitalization, and a severe asthma attack may require admission to the intensive care unit.

If an allergy is the cause for asthma symptoms, then allergy shots may help train the body to tolerate the allergic substance that triggers symptoms. This may help reduce the severity of asthma symptoms when a person is exposed to the trigger.

Treatment for asthma may include:

  • Inhaled medications:
  • Oral corticosteroids
  • Nebulizer therapy for asthma
  • Oral medications for asthma:
  • Mechanical ventilation:
    • Use of a ventilator to support breathing in severe acute asthma
  • Immunotherapy:
  • Bronchial thermoplasty:
    • Used to treat severe chronic asthma that does not respond to medications
    • Performed in 3 outpatient visits
    • Bronchial thermoplasty heats the inside of the air passageways with an electrode, destroying some of the smooth muscle in the wall of the airways. This prevents the muscle from narrowing the airway.

Important tips for treating an acute asthma attack:
  • Relax and remain calm.
  • Remain in a sitting position: do not lie down.
  • Measure peak expiratory flow rate before treatment.
  • Use an inhaler or nebulizer as directed.
  • Measure peak expiratory flow rate after treatment.
  • Seek medical care if:
    • Symptoms worsen
    • Symptoms do not improve with treatment
    • Peak expiratory flow rate is in the red zone.

Allergic Asthma Acute Mild Attack

Treatment for a mild asthma attack includes:

  • Monitor the peak expiratory flow rate (PEFR).
  • Follow your treatment plan.
  • Short-acting inhaled bronchodilator, such as:
  • Continue additional medications as directed.

Allergic Asthma Acute Moderate Attack

Treatment for a moderate asthma attack includes:

  • Monitor the peak expiratory flow rate (PEFR).
  • Follow your treatment plan.
  • Short-acting inhaler, such as albuterol:
    • 2 puffs, every 20 minutes
    • Continue inhaler use every 20 minutes for 1 hour
  • If symptoms improve, continue the short-acting inhaler every 4 hours, for 24 to 48 hours.
  • If symptoms do not improve within 2 hours, call your doctor.
  • Consider taking an oral corticosteroid, such as prednisone or Medrol, according to your treatment plan.
  • Continue additional medications as directed.

Allergic Asthma Acute Severe Attack

Initial treatment for a severe asthma attack includes:

  • Monitor the peak expiratory flow rate (PEFR)
  • Follow your treatment plan
  • Short-acting inhaler, such as albuterol:
    • 4-6 puffs every 10 minutes
    • Continue at this dose for 30 minutes
  • Contact your doctor immediately
  • Seek emergency care if symptoms do not improve

Treatment for a severe asthma attack in the emergency room includes:

Allergic Asthma Chronic Mild Asthma

A long term strategy to control mild asthma includes:

Allergic Asthma Chronic Moderate Asthma

A long term strategy to control moderate asthma includes:

Allergic Asthma Chronic Severe Asthma

A long term strategy to control severe asthma includes:

Allergic Asthma Devices

Devices are used to deliver medication directly to the lungs. This reduces the side effects that occur when medications are ingested and enter the bloodstream.

Devices include:

Allergic Asthma Hand-Held Inhaler

A metered dose inhaler, usually called an inhaler, is a canister of medication that is under pressure. The canister is attached to a mouthpiece. The inhaler releases a mist of medication in a preset dose.

The medication reaches the small bronchioles more effectively if it is used correctly.

Inhalers contain:

Allergic Asthma Proper Use

Directions for the proper use of an inhaler with a spacer:

  • Remove the cap from the inhaler.
  • Hold the inhaler with the mouthpiece at the bottom.
  • Shake the inhaler.
  • Insert the spacer if you have one, and place your mouth around the spacer.
  • Tilt your head back slightly.
  • Gently exhale.
  • Begin a slow, deep breath and activate the inhaler.
  • Continue to inhale slowly and deeply over 3 - 5 seconds.
  • Hold your breath for 5-10 seconds.
  • Repeat steps 3 through 10 if you require more than one puff.

Directions for the proper use of an inhaler without a spacer:
  • Remove the cap from the inhaler.
  • Hold the inhaler with the mouthpiece at the bottom.
  • Shake the inhaler.
  • Hold the mouthpiece 1.5 inches (4 cm) in front of your mouth. Your mouth should not touch the mouthpiece.
  • Tilt your head back slightly and open your mouth widely.
  • Gently exhale.
  • Begin a slow, deep breath and activate the inhaler.
  • Continue to inhale slowly and deeply over 3 - 5 seconds.
  • Hold your breath for 5-10 seconds.
  • Repeat steps 3 through 10 if you require more than one puff.

Tips on using an inhaler:
  • Keep your inhaler with you at all times. Use it at the first sign of wheezing.
  • Learn to use a spacer with the inhaler.
  • Use the inhaler every 20 minutes for the first hour of an attack. Continue the medication every 4 hours until symptoms are gone.

Allergic Asthma Nebulizer

A nebulizer is a small plastic bowl with a lid and a mouthpiece. The bowl is connected to a tube that supplies compressed air from a pump. Liquid medication is placed in the bowl. The compressed air flows through the liquid, forming a mist. The medication enters the lungs when the mist is inhaled through the mouthpiece.

Allergic Asthma Proper Use

Directions for using a nebulizer with a mouthpiece:

  • Put the mouthpiece in your mouth and close your lips around it.
  • Hold the nebulizer in an upright position. This prevents spilling.
  • Gently exhale.
  • If there is a hole on the top of the nebulizer, cover the hole with your finger. The nebulizer will mist continually if the hole is absent.
  • When the mist starts, inhale slowly and deeply, while you keep your finger over the hole.
  • At the end of a deep breath, take your finger off of the hole to stop the mist.
  • Hold your breath for a few seconds. This allows the medication or be absorbed by the air passages.
  • Take a few breaths before you inhale the mist again.
  • Tap the side of the nebulizer occasionally, in order to keep the medication at the bottom of the bowl.
  • Continue these steps until the medication is gone.

Directions for using a nebulizer with a mask:
  • Hold the mask to your face so that your nose and mouth is covered. The mask may be secured to your head with an elastic band.
  • Hold the nebulizer in an upright position. This prevents spilling.
  • Breathe slowly and deeply until the medication is gone.
  • Tap the side of the nebulizer occasionally, in order to keep the medication at the bottom of the bowl.
  • Continue these steps until the medication is gone.

Allergic Asthma Drugs

Medications for asthma include:

Allergic Asthma Anti-IgE Therapy

Anti-IgE therapy with omalizumab works by binding to (and thereby blocking) the IgE receptors located on the surface of all mast cells and basophils. Omalizumab interrupts IgE's signal to trigger the inflammatory response responsible for the symptoms of allergic asthma.

Anti-IgE therapy has been shown to reduce asthma attacks and lessen symptoms in some people with allergic asthma.

Facts about omalizumab (Xolair):

  • Used only in those with elevated IgE in the bloodstream and a positive skin test to an allergen.
  • Used in those with allergic asthma who cannot be controlled with corticosteroids.
  • Administered as a weekly subcutaneous injection at the doctor's office.

Your doctor can determine if you are a candidate for treatment with omalizumab.

Allergic Asthma Anti-Leukotrienes

Anti-leukotrienes, or leukotriene inhibitors, prevent the swelling and inflammation of the air passages. Anti-leukotrienes are used to prevent asthma attacks, but are not useful for the treatment of an asthma attack.

Allergic Asthma Bronchodilators

Bronchodilators open up the air passages making breathing easier. Narrowing of the air passages causes wheezing, commonly seen in people with asthma and chronic obstructive pulmonary disease. Inhaled bronchodilator medications can more quickly open narrowed air passages since they are inhaled directly into the lungs.

Bronchodilator medications come in two types:


Most of these bronchodilator medications come in a variety of forms:
  • Liquid form for addition to a nebulizer device (pumps compressed air through the liquid, in order to create a mist of medication that can be inhaled)
  • Metered dose inhaler
    • With and without spacers
  • Powder inhaler:
    • No need to coordinate the pumping with the breathing
  • Breath activated metered dose inhaler:
    • Helps out people who have problems using the standard metered dose inhaler

Short-acting inhaled bronchodilators include:

Long-acting inhaled bronchodilator and corticosteroid mixtures include:

Allergic Asthma Corticosteroids

Corticosteroid medications treat swelling and inflammation of the air passages in those who have asthma. Corticosteroids may be given by inhaler, orally or by injection.

Oral corticosteroids:


Inhaled corticosteroids:

Long-term use of oral corticosteroids can result in side effects. However, side effects are uncommon in those who use a corticosteroid inhaler, and in those who only receive short courses of therapy with corticosteroids.

Side effects include:

Allergic Asthma Mast Cell Stabilizer

Mast cell stabilizers are used to treat asthma that is caused by allergies or exercise.

These drugs work by blocking a calcium channel that is essential for mast cell degranulation, the process that releases histamine into the bloodstream.

Mast cell stabilizers:

Allergic Asthma Theophylline

Theophylline medications open narrowed air passages in those who have asthma. This medication was used routinely for the treatment of asthma; however, other medications have largely replaced theophylline because if its side effects and toxicity. Theophylline blood levels must be maintained in a particular range, in order to avoid toxicity.

Medications that contain theophylline:

Allergic Asthma Questions For Doctor

The following are some important questions to ask before and after the treatment of asthma.

Questions to ask before treatment:

  • What are my treatment options?
  • What are the risks associated with treatment?
  • Do I need to stay in the hospital?
    • How long will I be in the hospital?
  • What are the complications I should watch for?
  • How long will I be on medication?
  • What are the potential side effects of my medication?
  • Does my medication interact with nonprescription medicines or supplements?
  • Should I take my medication with food?

Questions to ask after treatment:
  • Do I need to change my diet?
  • When can I resume my normal activities?
  • When can I return to work?
  • Do I need a special exercise program?
  • Will I need physical therapy?
  • Will I need occupational therapy?
  • What else can I do to reduce my risk for having this problem again?
  • How often will I need to see my doctor for checkups?
  • What local support and other resources are available?

Allergic Asthma Specialist

Physicians from the following specialties evaluate and treat asthma:

Continue to Allergic Asthma Home Care

Last Updated: Jun 2, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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  6. Vallance G, Thomson NC. Asthma: ten myths debunked. Practitioner. 2004 Nov;248(1664):844-7. [15543882]
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