Your Best Day With Allergic Asthma

Your Doctor Discussion Guide: Allergic Asthma

Will I have to use an inhaler?
For mild cases of allergic asthma, a bronchodilator such as albuterol may be enough of a treatment, says Dr. Dhanani.

These come in the form of a small inhaler you can carry in a purse or pocket. They work by opening the muscles of your airway and you use them as needed to manage symptoms.

But if you use bronchodilators too often—your doctor will be able to tell you what the guidelines are—then you need to bump up your treatment plan.

"If you start overusing albuterol, it's a sign things are not controlled," says Dr. Dhanani.

What are the other treatments?
If this happens, your doctor might put you on an inhaled corticosteroid. These also come in the form of portable inhalers and work by decreasing inflammation. Generally your doctor will tell you how often to use them, usually not more than once or twice a day.

What if the standard treatments don't work?
If your asthma still isn't controlled, the next step would be a combination of an inhaled steroid and a long-acting bronchodilator. Unlike products such as albuterol, long-acting bronchodilators are formulated to keep the lungs dilated for a longer period of time, perhaps 12 hours or more.

"You can get quite significant relief from that," said Dr. Dhanani.

With any drug, it's best to find the lowest effective dose.

"The goal is getting down to the lowest dose possible for control and do no more and no less than that," Dr. Dhanani said. "You don't want to keep having asthma exacerbations because over time it leads to deterioration in lung function but at the same time you don't want to overtreat people and give them doses which are unnecessarily high."

How often will I need to see the doctor?
Regardless of your treatment, your doctor will initially want to see you fairly often, perhaps at three-month intervals. If your condition is stabilized, you can go longer between visits.

What are allergy shots and will they work for me?
Allergy shots are also an option for people with allergic asthma. The purpose of the shots is to desensitize you to an allergen by giving you trace amounts of it.

"You're injecting (the allergen) in higher and higher doses hoping to change the immune system to accept it as normal," explains Dr. Dhanani.

The downside is convenience (you have to keeping going to your doctor's office to get the shots) and there can occasionally be severe anaphylactic reactions to the allergen.

Will my asthma ever go away?
The upside is that sometimes allergy shots can be discontinued without asthma symptoms returning. "You can gain long-term control and a lot of times (the patient) can come off medication entirely or go to a low dosage," says Dr. Dhanani.

An alternative to allergy shots is a treatment called sublingual therapy. This works on the same principle as a shot but instead of injecting the allergen, drops are placed under your tongue.

One analysis conducted by researchers at Johns Hopkins in Baltimore found that this type of therapy did improve symptoms in a large proportion of patients. It's also much more convenient than shots.

Unfortunately, the therapy is not yet approved in the U.S., although some doctors do offer it to patients "off label." And Dr. Dhanani thinks it will eventually be approved here."There's quite a bit of data that it is pretty effective," he says. "It's just a matter of time."

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