Asthma Diagnosis and Treatment

Asthma Diagnosis

The Michigan Medicine Asthma Program is designed to provide personalized treatment for all asthma patients, but we are especially focused on those with severe asthma. We perform a detailed history, physical examination and obtain tests that help us to understand the type of asthma that you have, and more importantly, how asthma is affecting your life. The tests include pulmonary function testing, which is a series of procedures that measures both the capacity and effectiveness of your lungs, as well as the force of your breathing. These tests will help us to measure whether you have any obstruction in your lungs and if you so, whether or not albuterol improves your lung function.

We will also measure inflammation in your lungs using the fraction of exhaled nitric oxide (FeNO).  This is a test where you blow into a machine and we measure the level of nitric oxide that is in your lungs. A chest x-ray and allergy testing may be required. In select cases, we perform chest CT scanning and use special computer based algorithms to see how much air is trapped in your lungs. This will help us to understand how much your small airways are affected by asthma.

Coordinated Multidisciplinary Care

At Michigan Medicine we work in a multidisciplinary fashion and coordinate your care with allergy, gastroenterology, sleep medicine and ear nose and throat (ENT) based on your specific needs. We have providers in each of these specialties that will evaluate and help manage any of the comorbid conditions that may be making your asthma worse.

Once we have diagnosed the type of asthma, we will tailor a treatment specifically for you. Although types of asthma can range from mild to severe, our emphasis is on controlling your asthma, whatever the type.

Treatments

Regardless of the type or severity of your asthma, treatment should be focused on controlling it. There are many good treatments for asthma, and you should work with your doctor to find the one that works to control your type of asthma. Traditional asthma treatments include rescue medications, controller medications and inhalers.

Rescue Medications

• Rescue inhalers: These medications are meant to be used during times when you need emergency medications for asthma symptoms, for example if your chest is tight and you need immediate relief.
• The medications in this class include albuterol (comes in various formulations as an inhaler or in the liquid form that is administered via a nebulizer machine). Atrovent can also be used as a rescue medication when added to albuterol.

Controller Medications

Controller medications should be taken as prescribed, usually daily to twice a day. These medications are meant to control your asthma so that you rarely require the rescue medications described above.

• Leukotriene antagonists: Medications such as montelukast and zafirlukast that block leukotrienes that are produced in the lungs of some patients with asthma and allergies.
• Inhaled corticosteroid: Includes medications like flovent, asmanex and Qvar amongst others.
• Inhaled long-acting bronchodilators: These include beta agonists (salmeterol, vilanterol and formoterol) and long acting anti-muscarinic agents such as Spiriva.
• Combination therapies: Include inhaled steroids and long acting bronchodilators like Breo, Advair, Symbicort and Dulera.
• Methyxanthines: Theophylline falls in this category and is an oral medication that reduces inflammation and opens up your bronchial tubes.
• Zileuton: An oral medication that blocks 5-lipooxygenase and improves inflammation and airway spasms. Works well in those with eosinophilic asthma.

Inhalers

Many asthma patients use inhalers as part of their treatment. As you work with your doctor to find the best treatment for your type of asthma, be sure you understand how to use your inhaler properly to provide the best control of your asthma. If you are still having problems after confirming you are using the inhaler correctly, you may want to look into additional treatments.

Treatments for Difficult to Control Asthma

For patients with poorly controlled asthma that doesn’t respond to standard therapies, treatment may include:

Biologic therapies:

• Anti-IgE therapy targets the cells and pathways that cause allergic inflammation that has been linked to some types of asthma.
• Anti-Interleukin-5 therapy targets patients with eosinophilic asthma, a type of asthma characterized by increased levels of a type of white blood cell in the airways.

Bronchial thermoplasty: Bronchial thermoplasty is an endoscopic alternative that opens the airways using gentle heat (radiofrequency energy) delivered through a bronchoscope to shrink the smooth muscles in the lungs. During the minimally invasive procedure, a bronchoscope is guided through the nose or mouth, down the throat and into the lungs. A smaller tube is then inserted through the bronchoscope to warm the major airways of the lungs. The procedure reduces the presence of airway smooth muscle that narrows the airways in asthma patients. The treatment is typically given in three sessions to access different airways.

The U-M Asthma Program team is working in conjunction with Jose Luis Cardenas-Garcia, M.D., to offer an adult bronchial thermoplasty program.

Asthma Education and Treatment at the University of Michigan

The Michigan Medicine Asthma Program, led by Njira Lugogo, M.D. provides care to adult asthma patients with a wide range of asthma severities. The program is especially focused on the care of severe refractory asthma patients (those with persistent airway inflammation and poor asthma control associated with increased symptoms and poor quality of life) and provides asthma phenotyping, identification and management of disease-modifying risk factors.

Asthma Education

The Michigan Medicine Asthma Program will provide you with education about your asthma, how to measure your lung function at home and how to recognize when your asthma is not well controlled and what to do about it.  We’ll also provide you a thorough education about asthma, including recognizing symptoms, identifying and avoiding triggers, and properly administering your medication. In addition, we’ll help you develop an individualized asthma action plan so you know what to do at home, when you should call your doctor, and when you need to get to the emergency room.

Research shows educational programs that encourage more self-management on the part of patients can dramatically improve their health by reducing hospital admissions, emergency room visits, sleep disturbances, and absenteeism from work. When patients participate in educational programs, they are much more likely to use their medications correctly, they experience fewer severe asthma symptoms, and asthma is much less likely to interfere with their daily lives.

Asthma Research

A robust clinical research program has been developed in conjunction with the clinical program and is currently enrolling patients in trials aimed at developing state-of-the-art diagnostic strategies as well as new, targeted therapies for patients with severe asthma.

The Asthma Program also includes a registry used to track patient outcomes and enable informed decision-making about quality improvement initiatives and standardization of care protocols for patients with asthma, which will significantly improve patient-related outcomes.

For information about asthma clinical trials for which you may be eligible, visit UMHealthResearch.org and search for asthma studies.

Make an Appointment

To schedule an appointment to discuss yours or a patient’s need for asthma treatment:

For patients:  call our patient call center at 888-287-1084.

For referring physicians: call M-Line at 800-962-3555, 24 hours a day.