Overview

Managing Asthma

An emerging goal in asthma management is to achieve a very high level of symptom control over a long period of time. People with asthma will have their own goals for asthma management. Treatment should start with an empathic discussion between the clinician and individual with asthma about goals, attitudes and concerns about asthma and its treatment. For more information see Living with Severe Asthma.

The introduction of monoclonal antibodies (biologics) has allowed for targeted treatment of specific molecular pathways in severe asthma. These therapies help control symptoms and significantly reduce asthma attacks , with fewer side effects compared to oral corticosteroids. Managing related allergic airway conditions, such as allergic rhinitis and nasal polyps, is also essential as they can contribute to asthma symptoms. Additionally, identifying and addressing modifiable lifestyle factors, such as physical activity, weight management, and sleep habits is crucial for a holistic, person-centered approach. These are considered treatable traits, where each individual trait is considered clinically relevant, identifiable and measurable. This can support the goal of achieving a state of low disease activity that is sustained over a long period of time.

Optimising a person’s asthma knowledge and self-management skills using a shared decision-making approach and discussing the factors that may be leading to poor adherence to prescribed medications, will improve asthma control and health outcomes.

Patients should be provided with information about  asthma attacks in combination with an individualised written asthma action plan, instruction on self-monitoring of symptoms, and regular medical review. Inhaler technique should be assessed and optimised regularly. Written asthma action plans are one of the most effective asthma interventions available for acute asthma attacks .

Some people may benefit from measuring PEF as a self-monitoring tool. Monitoring PEF measurements can help people who do not easily recognise symptoms. When using PEF, the action plan should be based on the person’s best recorded PEF, not predicted values. Treatment should not be increased based on lower PEF readings alone if there are no symptoms, as this may lead to over-treatment.

Patients should also be encouraged to engage in an active lifestyle, including physical activity and exercise, recognised to facilitate asthma control. In patients with impaired exercise capacity consider a supervised exercise program (Price et al. 2025 & McLoughlin et al. 2022). Address concerns that patients may have about undertaking physical activity. Emotional aspects should also be discussed, such as discussions of patient concerns and emotions when experiencing an asthma attack (Urroz Guerrero et al. 2023)

It is important that self-management skills are regularly reviewed, on an annual basis and anytime an asthma attack occurs. In addition to self-management approaches, it is also important to discuss the patient’s (non-medical) support network in managing their condition. It may be useful to discuss with patients what support they have available.