such as chest X-RAYand complete BLOODcount
(CBC), to rule out other causes of symptoms. The
pulmonologist will conduct pulmonary function
tests to measure the flow and volume of air, typi-
cally before and after administration of a bron-
chodilator medication that relaxes and opens the
airways. People who have asthma generally have
much improved pulmonary function test results
after the bronchodilator, even when they are hav-
ing no symptoms of asthma at the time of testing.
However, the reverse can also be true and the per-
son has normal breathing tests during a time of no
symptoms. In such cases, the pulmonologist may
conduct a test called a methacholine challenge,
administering the DRUG methacholine to see
whether it initiates a mild hypersensitivity reac-
tion. A positive response (symptoms appear) is
fairly conclusive of an asthma diagnosis.
Treatment Options and OutlookTreatment for many people who have asthma is a
combination of medications to prevent symptoms
(long-acting, controller medications) and to pro-
vide immediate relief from symptoms that occur
(short-acting, rescue medications). Medication
regimens vary with the step (classification) and
nature of symptoms. Commonly prescribed med-
ications include
- inhaled (and occasionally oral) CORTICOSTEROID
MEDICATIONS, which are anti-inflammatory and
serve as long-term controller medications - inhaled and oral beta-2 agonists, which are
bronchodilators and may provide short-acting
or long-acting relief- leukotriene modifiers, which are IMMUNE
RESPONSE mediators that provide long-term
control
- leukotriene modifiers, which are IMMUNE
The mainstay of asthma treatment is baseline
control of the inflammation with long-acting med-
ications. For some people, ALLERGY DESENSITIZATION
(when allergy reaction is the clear cause of the
asthma) provides further control. Other important
steps for managing asthma long-term include
monitoring asthma symptoms (such as with peak
flow monitoring) and developing an action plan
for asthma control. When there is an acute exac-
erbation of symptoms (an asthma attack), treat-
ment is most likely to succeed when it begins in
advance of or immediately on recognition of
symptoms. Once an asthma attack is under way,
even rescue medications may take time to bring
the situation under control.
Lifestyle factors for managing asthma include
avoiding known triggers and allergens. Three of
the most common triggers are allergic RHINITIS,
chronic SINUSITIS, and GASTROESOPHAGEAL REFLUX DIS-
ORDER(GERD). Regular physical exercise, though
for some people a trigger for asthma attacks, gen-
erally improves lung capacity, pulmonary effi-
ciency, and AEROBIC FITNESS. Air-conditioning helps
reduce humidity in the air and filter the air of par-
ticulates that may cause irritation or exacerbate
asthma symptoms. It is important to regularly
change the air filters for central heating and cool-
ing systems. ACUPUNCTUREtreatments are helpful
for reducing the frequency and severity of asthma
attacks in some people.188 The Pulmonary System
ASTHMA CLASSIFICATIONClassification Severity Frequency of Symptoms Without Treatment
step 1 mild intermittent symptoms occur two days or less each week and two nights or less each month
step 2 mild persistent symptoms occur up to five days each week and up to five nights in a month
step 3 moderate persistent symptoms occur at least once during every day and several nights a week
step 4 severe persistent symptoms occur throughout the day, every day, and most nights