Personalized asthma treatment planning using spirometry, allergy testing, and ICS-LABA-based therapy in patients with recurrent wheezing, cough, and shortness of breath.
Indication
- Recurrent wheezing, chest tightness, and shortness of breath
- Cough triggered by exercise or allergens
- Seasonal or nocturnal worsening of respiratory symptoms
- History of atopy or eczema in childhood
- Reassessment of control status in known asthma patients
- Need for frequent inhaler prescriptions (more than 3 SABA canisters per year)
- Respiratory symptoms developing due to occupational triggers
Preparation
- Notes on attacks, triggers, and medications used
- Two-week peak flow (PEF) monitoring if possible
- Information on known allergens, pets, and mold exposure
- Discontinuation of bronchodilators before spirometry per physician instructions
How it's performed
- Detailed history and physical examination; control status is evaluated using ACT and GINA control questions
- FEV1, FVC, and bronchodilator reversibility are measured with spirometry
- Methacholine challenge testing or FeNO measurement is performed if needed
- Allergy skin tests or specific IgE are checked
- Treatment is initiated according to the GINA stepwise approach: low-dose ICS-formoterol combination is recommended from the first step
- Inhaler technique and an attack management plan (written asthma action plan) are shared with the patient
Post-procedure
- Follow-up within 2-6 weeks after starting treatment
- Reassessment every 3-6 months in stable, controlled patients
- Treatment step is increased or decreased based on symptom control
- Annual influenza vaccination is recommended; pneumococcal vaccine when indicated
- Biologic therapy options (anti-IgE, anti-IL5) are considered in severe asthma
Risks
- Oral thrush and hoarseness due to inhaled corticosteroids
- LABA monotherapy (without ICS) is not recommended in asthma and carries risks
- Acute attacks, hospitalization, and rarely death due to treatment non-adherence
- Frequent SABA use (more than 3 times per week) is a marker of uncontrolled asthma
- Side effects associated with long-term use of systemic corticosteroids
FAQ
Does asthma fully resolve?
Asthma is a chronic disease, but with proper treatment most patients can lead a normal life with no or minimal symptoms. In some children, symptoms may decrease during the transition to adulthood.
Are corticosteroid inhalers harmful?
Inhaled corticosteroids act locally at low doses delivered to the airway. Systemic side effects are rare; rinsing the mouth reduces the risk of thrush. Uncontrolled asthma is far riskier than the side effects of treatment.
Can I exercise?
Yes. Regular exercise is recommended in well-controlled asthma. For exercise-induced asthma, a bronchodilator or ICS-formoterol may be used before sessions.
What should I do during an attack?
Follow the steps in your written asthma action plan: use the rescue inhaler, repeat if you do not improve, and oral corticosteroids or an emergency department visit may be needed. Regular controller therapy provides the most effective protection against attacks.
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