Treating asthma

April 2017

Asthma is a chronic but reversible disease which requires some form of treatment most of the time. Regular monitoring and review of treatment is necessary even when patients are symptom free.
Asthma is like any condition, it requires long term treatment and monitoring.

Blue Inhalers or Relievers (Bronchodilator drugs)


Short acting bronchodilator are prescribed to relieve asthma attacks, wheezing or coughing episodes, exercise induced asthma, asthma symptoms caused by allergic reactions for example hay-fever. They dilate the bronchi preventing constriction and narrowing of the airways. Breathing and symptoms improve within 5 to 10 minutes.

Their acting duration is four to six hours. Bronchodilatorsare also used before doing exercise. In asthmatics the airways can react to exercise causing constriction of the bronchi. To prevent this from occurring 2 puffs of a bronchodilator drug are used prophylactically to widen the airway.

Bronchodilator medicine can sometimes cause the heart rate to accelerate. This is usually when multiple and repeated doses are taken, it is temporary and settles back to normal quickly.


Advice on the use of your Blue inhaler (fast acting bronchodilator)


Check that the inhaler is not empty . Some newer inhalers have dose counters and tell you when you are running low. The older MDI (metered dose inhalers) become light and float in water when empty.

Check the expiry date of all you medication and do not use if out of date.

If you have a MDI inhaler and have not used it for over a week, then the device needs to be primed or fired once into the air. All MDI inhaler devices MUST be shaken before and in between doses.

Always have spare inhalers and keep them within easy reach, at home or work, exercise gym bag for example, in case of needing them urgently.

If you are using your blue inhaler more than once a day for symptom relief, then this is a sign of poor control and a review of your asthma and medication is needed.

Blue inhalers are meant for occasional use to relieve occasional symptoms. In an emergency you can use your blue inhaler up to 15 to 20 times repeatedly . You should be on your way to hospital or have called an ambulance by this stage though.

Long acting bronchodilators


Long acting bronchodilators are more frequently prescribed. Their use is for maintenance and prevention of asthma symptoms and are sometimes called a 'protector'. They can come as a separate inhaler or more often combined with a steroid inhaler. They are not meant for symptom relief as with a short acting blue bronchodilator.

They are prescribed when a steroid inhaler on it's own is not quite enough and are helpful in those patients who regularly exercise or prone to many allergies..

Different medication is sometimes used


Anticholinergic medicine and theophyllines, are not as popular anymore and used more for chronic and severe lung conditions other than asthma. There is one anticholinergic inhaler - Ipratropium Bromide that is very effective in very young children under the age of 2 years and it's mode of action is to dilate the bronchi.

Advice on using inhalers


There are many different sorts of inhaler devices ranging from Metered Dose aerosols inhalers, to Dry Powdered inhalers and breath actuated inhalers. They will all have different and unique instructions of how to use them and your asthma nurse should explain and demonstrate their use. The most common inhaler device prescribed is the Metered Dose Inhaler (MDI). It is an aerosol and delivers a spray that is breathed in directly to the lungs.
  • MDI devices must always be shaken before use and in between doses.
  • The plastic housing unit needs to be rinsed under a hot tap weekly. This cleans any debris off the mouth piece and flushes any particles and dust away.
  • MDI devices can be used with a chamber device, which delivers the drug even more effectively to the lungs. It also slows down the process and the co-ordination of activating the aerosol and breathing in. Chambers are particularly good for use in babies and children.
  • Many MDI inhalers do not have a dose counters and it can be difficult to know exactly when they will run out. They become very light and will float in water when little medication is left.
  • Always replace the cap after using your inhaler to prevent dust and debris from blocking the mouthpiece and you breathing in debris that could irritate you lung and cause a coughing episode.
  • Always have a supply of spare inhalers ready to use for when you do run out.

Steroid inhalers (anti-inflamatory)


For many asthmatics when symptoms occur daily and a blue inhaler is not enough a steroid inhaler is vital. It is used for varying durations; short term is for a few weeks throughout coughs and colds. During the hay-fever season and or winter they are used for months at a time. Finally for those whose symptoms are triggered by so many things and symptoms are severe daily use for life is essential.


Asthma and it's symptoms are reversible but only when appropriately treated. If inflammation becomes chronic due to lack of treatment, permanent remodelling of the airways can take place.

Steroid inhalers are used in small low doses that are breathed in directly to the lungs. It treats the inflammation and prevents asthma attacks and worsening of their condition.

The dose that you require will depend on the severity of your condition, but the aim is to be symptom free day and night.

Steroid treatment is required if you are having symptoms day or night and needing your blue reliever medication more than once a day.

Unfortunately many asthmatics do not take their prescribed medication properly. For some it is denial and for some a lack information and knowledge of their condition, which can be as a result of healthcare professionals not explaining the disease and treatment correctly. .

Another sad fact is that many patients are never taught correctly how to use their inhalers and therefore are not getting the medication they need.

Steroid medicine controls the inflammation of the bronchi as well as the progresion of the disease. It reduces the number and intensity of asthma attacks.

Steroid inhalers have a slow onset of action taking several days before a person starts to feel the effects and benefits. This applies to when you stop the steroid inhaler and a gradual decline occurs. Asthmatic are not usually aware of this and don't associate stopping their inhaler with a decline in control and return of symptoms.

Steroid inhalers comes in many devices and seeing your asthma nurse is crucial to learning properly how to use it.

Only the medical professionals that monitor your asthma should decide what, when and how much medication you should take and if at all stopped.

The blue reliever inhalers do give instant relief of symptoms and often patients like and prefer this inhaler as they associate it with improving their symptoms. Patients often dismiss and avoid their steroid inhaler because they do not cause any immediate felling of improvement. It is because of this that they often stop taking their steroid inhaler.


Side-effects of inhaled Steroids


The side effects of steroid inhalers should not be confused with those in the form of tablets, syrup or injections.
  • This side effects are therefore minimal;-
  • The voice can in come sound a little hoarse and the tone is often lowered.
  • Thrush (Candidia) of the mouth can occur, but this is easily avoided if you clean your teeth of have a drink of water after taking your inhaler. If you do get a sore mouth then it is easily treated with a special mouth solution.
  • Many studies showed that with the usual prescribed doses, there is no effect or reduction in the growth curve of a child or of an adolescent. In fact it has been found that a poorly controlled child without the appropriate treatment of a steroid inhaler is more likely to have growth and development problems and an increased chance of more asthma attacks and infections. Such attacks and infections are likely to require oral steroids which can have more complicated side effects, not to mention loss of school days and inability to keep up with school work.

Steroids in tablet (ORAL) form




For severe attacks and infections, oral steroids are required to reduce and control the inflammation. All inhaler medication is continued throughout such severe attacks , but very close monitoring is required of these attacks to ensure improvement is made and symptoms controlled.
  • Oral steroids are normally prescribed from as little as 3 days to 14 days.
  • In certain situations, oral steroids maybe prescribed for longer, but this is not without weighing up the risks versus the benefits, however, in this case, there may be side-effects: appetite increase , putting on weight temporarily, mood swings...

Antileukotrienes


Antileukotrienes, are in tablet form and act by blocking the action of the leukotrienes, which are inflammatory mediators in the respiratory tract. They are very useful in exercise-induced asthma. They are not licensed for mono therapy and are prescribed in conjunction with steroid and blue reliever medications.

Anti - IgE


This is a new medication in the form of an injection. It is prescribed for severe allergy related asthma. Treatment is initiated by specialist respiratory and allergy doctors.

Other treatments


Respiratory physiotherapy


Respiratory physiotherapy is usually for more chronic lung conditions, but during severe asthma attacks and hospital admissions physiotherapy is effective at helping relieve secretions blocked in the lungs.

Thermal cures


There us no current evidence to suggest a stay in a thermal cure will help. However, people do find them relaxing and beneficial to their breathing. Asthmatics MUST still continue their regular medication and monitoring.

Allergy treatment


It is essential that all allergies are kept under control and are treated appropriately. For example rhinitis, hay-fever and pets, as these are well known allergens that can cause and worsen asthma.

Too many asthmatics stop their treatment



The figures are surprising
: more than half of asthmatics do not comply with their medical treatment.
  • Asthmatic people struggle with their diagnosis and to accept they have a chronic disease. Some are not interested or willing to learn about their asthma and dislike having to take medication and be monitored, which for some can be for life.
  • For some, they take their medication only when having an attack and once they feel better stop their treatment. The absence of symptoms does not encourage patients to take their medication. However attacks will be more frequent, the need for oral steroids more likely and permanent remodelling of the airways will take place over time.


Education is of paramount importance, as the more a person can learn about their condition the more likely they will feel empowered to monitor and control their condition.

Frequency of asthmatic follow-up appointments


The frequency of follow-up appointments depends on the severity of the asthmatic condition, what triggers a persons asthma and the capacity of the patient to respect the treatment and monitoring suggested to him.
  • The aim is for all asthmatics to be symptom free day and night. Depending on the person it can several appointments to convince asthmatics to take their basic treatment even when they are symptoms free.
  • It is usually when a patient becomes symptom free that they stop their treatment. However, they are symptom free due to their medication being effective and therefore MUST continue. It may be appropriate to step down on doses of treatment, all of which can be implemented by your asthma nurse or GP.
  • All asthmatics must have a review at least once year. The asthma nurse or GP normally carries out this review checking: your understanding of asthma, treatment, symptom control and inhaler technique, when to seek help, and control of other factors such as hay-fever, rhinitis etc.
  • Where understanding and compliance may be a problem regular reviews may be necessary.
  • When a new treatment is commenced or following an asthmatic attack, patients will require more frequent monitoring. The British Thoracic Society have published specific guidelines for the treatment and monitoring of asthma and included in this is that patients as well as having their treatment stepped up that it is also stepped back down when appropriate.



Further Information

Asthma UK
http://www.asthma.org.uk/

British Thoracic society (BTS)
http://www.brit-thoracic.org.uk/clinical-information/asthma/patient-information-asthma.aspx

BTS Asthma guidelines
http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Asthma/Guidelines/qrg101%20revised%202009.pdf

How to use your MDI inhaler
http://www.netdoctor.co.uk/health_advice/facts/howtousemeter.htm

Video Clips on how to use all types of inhaler
http://www.medicines.org.uk/guides/pages/how-to-use-your-inhaler-videos

Allergy
http://www.allergyuk.org/

Anti IgE therapy
http://www.nice.org.uk/nicemedia/pdf/TA133Guidance.pdf

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Latest update on November 12, 2013 at 04:48 AM by Jeff.
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