How to Live Better with Asthma: Expert Recommendations and Answers to Important Patient Questions

 This article is entirely based on the guidelines and conclusions presented in the review article “Guidelines for the management of asthma in adults: Evidence and recommendations,” published in the Asian Pacific Journal of Allergy and Immunology. The publication was developed by a multidisciplinary team of leading physicians and scientists in pulmonary medicine, allergology, and emergency medicine in Thailand, with contributions from specialists affiliated with major university and clinical centers (Ramathibodi Hospital, Mahidol University; Chulalongkorn University; Siriraj Hospital; Thammasat University, and others), as well as members of the Thai Asthma Council (TAC).

The article summarizes the most up-to-date scientific data, clinical standards, and practical recommendations for the diagnosis, treatment, and long-term management of asthma in adults, with special attention given to adapting the recommendations to the needs and capacities of various healthcare systems, including those in resource-limited settings. The following questions and answers have been selected based solely on the information in this publication and reflect the most common practical dilemmas and concerns of asthma patients.

“An informed patient is a safer patient—active participation in treatment and asthma control leads to a better life and fewer complications.” Experts Speak

Asthma is a chronic inflammatory disease of the airways that affects millions of people worldwide and has a significant impact on quality of life, work capacity, and overall health. Modern approaches to diagnosis and treatment are based on accumulated scientific evidence while also taking into account local healthcare system characteristics and treatment accessibility. Proper information and coordination between patients, doctors, and caregivers are key to achieving optimal disease control and preventing complications.

Below are key scientific insights and expert perspectives that will guide you through the most important aspects of current asthma treatment and management.

1. What does “asthma control” mean and why is it more important than assessing severity?

Expert opinion:

“All current guidelines focus on asthma control assessment rather than asthma severity assessment... Asthma control is defined by the patient’s clinical characteristics that are improved by treatment and consists of two components:

• Current asthma control – evaluated by symptoms and limitations to physical activity that impact quality of life.

• Risk of future adverse events – includes loss of asthma control, asthma exacerbation, accelerated decline in lung function, and treatment side effects.”

Explanation: The key to modern asthma management is evaluating and achieving good control over both symptoms and the risk of exacerbations. This means that care isn't only focused on how severe your current symptoms are but also on the likelihood of future complications. Patients should be mindful of both their current condition and long-term risk.

2. How is asthma diagnosed and what are the main tests?

Expert opinion:

“Diagnosis of asthma is based on the following two items:

• Asthma symptoms: wheezing, dyspnea, cough, or chest tightness...

• Evidence of variable expiratory airflow limitation based on a pulmonary function test... Spirometry & bronchodilator response test: FEV₁ increases ≥ 12% and 200 mL after inhalation of salbutamol... Peak expiratory flow rate (PEFR): PEFR variability > 10%...”

Explanation: Diagnosis isn’t made solely based on symptoms—confirmation through functional tests (most often spirometry) is essential to show variable airflow limitation. This ensures the treatment targets the correct condition and not another cause of shortness of breath.

3. What are the main treatment steps for asthma in adults?

Expert opinion:

“Inhaled corticosteroids (ICS) are a mainstay treatment to control asthma. The patient should start with a low dose, which can be adjusted based on severity... If low-dose ICS treatment is not effective, the dosage can be increased (high dose) or other medications can be used such as long-acting β₂-agonists, LABA, or leukotriene receptor antagonists (LTRA). An inhaled ICS/LABA in the same device is recommended as it has the highest efficacy.”

Explanation: Inhaled corticosteroids (ICS) are the cornerstone of modern asthma treatment. If symptoms persist despite ICS use, additional medications like long-acting bronchodilators (LABA) or leukotriene receptor antagonists may be added. Combination inhalers (ICS + LABA) typically offer the best results.

4. What are the specifics and risks of severe and uncontrolled asthma? When should I see a specialist?

Expert opinion:

“Severe asthma is different from uncontrolled asthma. Severe asthma is asthma that is difficult to control even with high-dose medications and control of risk factors. Despite treatment, asthma symptoms are still frequent and severe... Uncontrolled asthma, however, is defined by symptoms that are unable to be controlled by medication or severe symptoms with triggers such as exercise, allergens, or upper respiratory tract infection... The percentage of asthma patients with severe and uncontrolled asthma is 3.7% and 17%, respectively.”

“Situations in which the patient should be referred to a specialist for severe asthma: • Inability to diagnose or differentially diagnose the condition • Frequent emergency room visits • Frequent or regular oral corticosteroid use • Suspected occupational asthma • Suspected severe food allergy or anaphylaxis • Suspected heart disease or infection • Suspected COPD • Symptoms of or suspected comorbid disease causing difficulty in diagnosis”

Explanation: Severe and uncontrolled asthma is relatively rare but requires a specialized approach and often a multidisciplinary team. If your symptoms persist despite proper treatment, or if you need frequent ER visits, it's essential to see a pulmonologist or allergist experienced in managing complex asthma cases.

5. What is the role of biologic therapies in asthma?

Expert opinion:

“The majority of severe asthma patients have been found to have the type-2 phenotype... The indication for type 2 biologics for severe asthma have been addressed. Firstly, omalizumab as anti-IgE is indicated in patients with allergic asthma by evidence of allergen sensitization with high serum IgE... Anti-IL5 (mepolizumab and reslizumab) and anti-IL5R (benralizumab) are indicated in severe eosinophilic asthma with high blood eosinophilia and history of asthma exacerbation. Lastly, anti-IL4R (dupilumab) is indicated in corticosteroid-dependent asthma with high blood eosinophilia or high FeNO... For patients with the non-type-2 phenotype, non-pharmacological treatment, such as bronchial thermoplasty, should be given.”

Explanation: Biologic therapies (injection-based treatments targeting specific inflammation pathways) are the most advanced approach for severe asthma that does not respond to standard therapies. They are suitable only for specific phenotypes (e.g., eosinophilic or allergic asthma) and must be prescribed after thorough evaluation by a specialist.

6. How are comorbidities treated, and how do they affect asthma?

Expert opinion:

“Respiratory and non-respiratory diseases/disorders are known to be associated with asthma and may affect asthma control. Common diseases/disorders include chronic rhinitis or chronic sinusitis, gastroesophageal reflux disease, obesity, obstructive sleep apnea, and depression and anxiety disorders... Clinical studies have shown that the pharmacologic treatment of rhinitis is capable of improving the outcomes of asthma and vice versa... Weight reduction by more than 10% of baseline is recommended, as it can improve both asthma control and pulmonary function... There is evidence supporting the use of CPAP in asthmatic patients with coexisting OSA, as it may reduce days of asthma, nocturnal asthma attacks, and nighttime symptom scores, as well as improve ACT score, mean PEFR, %FEV₁, and quality of life.”

Explanation: Managing comorbid conditions (allergic rhinitis, sinusitis, GERD, sleep apnea, obesity, depression) is just as important as treating asthma itself. Poor control of these related issues often leads to worse asthma symptoms.

Q&A Section

1. How do I know if I’m using my inhaler correctly, and why is that important? Answer: Correct inhaler technique is crucial for achieving good asthma control. The article recommends:

“Use of the appropriate inhaling device provides better medication administration, which improves asthma control. The choice of inhaling device should be individualized based on simplicity, inhalation force, price, and efficacy of medication delivery... Physicians should intermittently confirm that the patient is using the device correctly.”

Incorrect technique can make treatment ineffective, even if the medication is right. Patients should regularly demonstrate their inhaler use to their doctor and watch training videos or read the instructions provided.

2. Should I stop or reduce my treatment if I have no symptoms? Answer: Discontinuing treatment is not recommended, even when symptoms are absent:

“Discontinue treatment is NOT recommended when any of exacerbation risk is present... The importance of regular hospital visits and good medication compliance according to their treatment plan whether or not they are experiencing symptoms.”

Asthma often involves hidden inflammation that can cause sudden flare-ups if treatment is stopped. Always consult your doctor before making changes to your medication.

3. How can I recognize an asthma attack is coming, and what should I do first? Answer: The article emphasizes self-monitoring and early action:

“Self-monitoring of exacerbation warning signs and symptoms that require medical attention... Initial treatment in the event of an asthma attack according to the patient’s individual asthma action plan.”

Signs may include increased shortness of breath, more wheezing, chest tightness, or needing to use your rescue inhaler more often. If these appear, follow your asthma action plan immediately.

4. What role do vaccines play if I have asthma? Answer: Vaccination is a key part of non-pharmacological care:

“Influenza vaccination is recommended annually in asthma patients. The 13 serotype pneumococcal vaccine may be considered in these individuals due to no obvious benefits.”

Flu and pneumonia can trigger severe asthma flare-ups. Annual flu vaccination is strongly recommended, and pneumococcal vaccination may be appropriate for some patients.

5. Can I exercise, and what kinds of physical activity are recommended? Answer: Yes! Exercise is not only allowed but recommended for people with asthma. The article highlights its many benefits:

“There is evidence that exercise can improve asthma control, increase maximum exercise ability, increase endurance, improve pulmonary function, reduce dyspnea symptoms, improve quality of life, and reduce dependence on healthcare services by reducing asthma exacerbation, antibiotic use, oral corticosteroid use, and emergency room visits.”

Aerobic activities like swimming, biking, running, or Tai Chi are recommended.

“Recommended exercises include swimming, running, biking, or Tai Chi. Patients with severe, uncontrolled asthma should engage in an appropriate exercise 5-7 times/week for 20-30 minutes/time, for at least 6-8 weeks.”

Always tailor your exercise to your individual condition. For those with more severe asthma or frequent attacks, using a rescue inhaler beforehand (e.g., SABA or salbutamol) may be advised by your doctor. High-intensity or competitive sports should be avoided unless approved by a specialist, but light to moderate activity is beneficial for most.

Conclusion 

Asthma is a chronic disease that requires active involvement from patients, caregivers, and medical professionals at every stage of diagnosis, treatment, and management. The information presented in this article reflects best practices and recommendations from leading experts and researchers in respiratory medicine, as compiled and analyzed in the scientific publication “Guidelines for the management of asthma in adults: Evidence and recommendations.” The credibility of the source and the multidisciplinary approach ensure that the shared answers are up-to-date, evidence-based, and practically useful for patients and their families.

An informed patient is a safer patient—these guidelines are intended not just as theoretical advice but as a working tool for improving asthma control and enhancing quality of life.

Source: Theerasuk Kawamatawong et al., “Guidelines for the management of asthma in adults: Evidence and recommendations,” Asian Pacific Journal of Allergy and Immunology DOI: 10.12932/AP-210421-1118