Asthma is characterized by periods of increased activity and of symptom remission, as explained in contemporary view of asthma. When your asthma is active (persistent, as per the NAEPP classification), you will need to use your asthma medication daily and continue to use it for some time after your asthma becomes better controlled, at which time you may find yourself taking medicine although you feel great!
If your asthma becomes quiescent, then you may not need to take daily medicine. That would be the case, if over the last 3 months (or more), you experienced no nocturnal awakenings, no interference with normal activities, and a minimal (or no) need for your inhaled, short-acting, quick-relief β2 bronchodilator (SABA).
No physician can predict whether or not treatment of your asthma will require indefinite (“forever”) medication. I counsel my patients to focus instead on the here and now, addressing right now symptoms rather than becoming caught up in a what-if mentality. The key point is that asthma medicines are highly effective and should be pre-scribed when necessary. It is wrong to decline appropriate treatment because of a fear of how long that treatment might take!
Medicine is indicated, in the context of an asthma treatment plan, to eliminate respiratory symptoms such as breathlessness, chest discomfort and tightness, cough, wheeze, and exercise limitation. Asthma medicine helps control asthma symptoms, and in doing so clearly improves day-to-day quality of life.
Successful asthma management not only includes prescribing the least amount of medicine required for adequate asthma control, but also mandates using medication that is well tolerated and free from undesirable or adverse effects. A basic principle of modern asthma care includes the step-ping up and stepping down of medication, reflecting the variable nature of the disease itself and an individual’s responsiveness to treatment.
Asthma medicine should always be stepped up until all symptoms become controlled. Current asthma guidelines define six treatment steps in asthma management. Asthma assessments can be obtained as often as weekly if necessary and should focus on the frequency and intensity of lung symptoms and of nocturnal awakenings; the need for inhaled, short-acting, β2 bronchodilators; any functional limitations; and lung function measurements.
The decision to increase the amount of prescribed asthma medicine is thus the result of an ongoing reevaluation targeting the adequacy and maintenance of control. If asthma symptoms are well controlled for at least 90 days in a row, then confirmatory lung function measurements (FEV1) should be considered along with a clinical assessment, and if control is indeed well established, then asthma medication can be reduced, or “stepped down.”
It goes without saying that patient and doctor should monitor asthma symptoms closely after a step-down to ensure continued control. If control is maintained, step-down can proceed until minimal or no medication is required.