In short: Asthma is a chronic inflammatory disease of the airways. With an accurate diagnosis and tailored treatment, most patients can live without attacks, without waking at night, and without giving up sport. When that isn't happening, the treatment is worth reassessing.
What is asthma
Asthma is a chronic disease in which the airways of the lungs are sensitive and inflamed. In response to triggers such as a viral infection, allergens, smoke, exercise or cold air, the muscles around the airways tighten, the lining swells, mucus is produced, and air flows with difficulty.
The disease is common in both children and adults, and can appear for the first time at any age. It has different types, such as allergic asthma and eosinophilic asthma, and identifying the type is important for choosing treatment.
Symptoms
Cough (sometimes at night or after exercise), wheezing, chest tightness and shortness of breath. Symptoms vary and come in waves, and are often triggered by a viral infection, exposure to allergens, smoke, strong smells or cold air.
How asthma is diagnosed
The foundation is spirometry, sometimes with testing before and after a bronchodilator in a pulmonary function lab. Where needed, we add FeNO measurement (exhaled nitric oxide, a marker of airway inflammation), a bronchial challenge test, blood tests for eosinophils and IgE, and allergy testing. It is also important to identify conditions that mimic asthma or make it worse.
Where needed, spirometry can also be performed at the clinic during your visit.
Treatment
The cornerstone of treatment is an inhaled corticosteroid, which treats the inflammation. According to the international GINA guidelines, adults and adolescents should not rely on a reliever inhaler (such as salbutamol, known as Ventolin) alone. A combination inhaler of a corticosteroid and formoterol is usually appropriate, either as needed only or as both maintenance and reliever treatment.
- Checking inhaler technique and adherence: problems with either are common reasons for asthma that "doesn't respond"
- Treating related conditions: rhinitis and sinusitis, reflux, sleep-disordered breathing
- A written action plan for flare-ups
Types of inhalers
- Reliever inhaler (fast-acting bronchodilator), such as Ventolin (salbutamol)
- A combination inhaler of a corticosteroid and a bronchodilator that acts both quickly and over a long period, such as Symbicort (budesonide-formoterol) or Foster/Fostair (beclometasone-formoterol), suitable both as regular treatment and as needed
- Other combination inhalers for regular treatment, such as Seretide/Advair (fluticasone-salmeterol) or Relvar/Breo (fluticasone-vilanterol)
- Adding a different type of long-acting bronchodilator, such as Spiriva (tiotropium), or a triple inhaler
The choice of inhaler, dose and device is tailored to each patient. During the visit we check that the inhaler suits you and that you are using it correctly, and we teach you how to use it, including a demonstration.
Severe asthma and biologic therapies
Severe asthma is asthma that is not controlled even with high-dose inhalers used correctly and consistently, or that is controlled only at a high dose or with oral steroids. For these patients there are now biologic therapies: injections that block a specific mechanism in the inflammatory cascade (for example IgE, IL-5, IL-4/IL-13 or TSLP).
Available treatments include Xolair (omalizumab), Nucala (mepolizumab), Fasenra (benralizumab), Dupixent (dupilumab) and Tezspire (tezepelumab). The choice between them is individual, based on markers such as blood eosinophils, FeNO, allergies and related conditions such as nasal polyps. Before starting, we make sure there is no other condition mimicking or complicating the asthma, such as ABPA or EGPA. The goal is remission: no symptoms, no attacks and no oral steroids.
Frequently asked questions
Ventolin isn't enough for me. What should I do?
"Ventolin is not the recommended treatment as a sole inhaler in asthma" (Dr. Shafran, quoted on the Israeli news site Walla). Ventolin (salbutamol) opens the airways quickly but does not treat the inflammation. Using it more than twice a week is a sign that the asthma is not under control and that treatment including an inhaled corticosteroid should be considered.
Exercise-induced asthma: can I keep doing sport?
Yes. Shortness of breath or cough during exercise is often a sign of asthma that is not well controlled. With appropriate treatment you can train as usual. Sometimes it is worth ruling out other causes, for example with a cardiopulmonary exercise test (CPET), which we interpret.
Asthma in pregnancy: should I stop my inhalers?
Not on your own. Uncontrolled asthma poses a greater risk to mother and baby than standard inhalers do. It is important to continue treatment and to seek medical advice.
How do I know which biologic treatment is right for me?
It depends on the type of inflammation. For example, elevated IgE and allergic sensitisation point towards Xolair (omalizumab); high eosinophils towards Nucala (mepolizumab) or Fasenra (benralizumab); high FeNO and nasal polyps towards Dupixent (dupilumab); and Tezspire (tezepelumab) is suitable for a wide range of asthma types. The decision is made after a structured work-up.
Can asthma go away?
Today the goal is remission: living without symptoms and without attacks, with stable lung function. With the right treatment many patients get there, including those with severe asthma.
Further reading: Think it’s just asthma? You may have a rare disease (ynet, in Hebrew, Dr. Inbal Shafran) · Why Ventolin vanished from Israeli pharmacies (ynetnews, Dr. Inbal Shafran)
Related topics
General information only; it does not replace a medical consultation. עברית