Asthma (Part 3 of 3)

What are the treatments for asthma?

For most people with asthma, most of the symptoms can be prevented with treatment. So, you are able to get on with normal life, school, work, sport, etc.

Inhalers
Most people with asthma are treated with inhalers. Inhalers deliver a small dose of drug directly to the airways. The dose is enough to treat the airways. However, the amount of drug that gets into the rest of your body is small so side-effects are unlikely, or minor. There are various inhaler devices made by different companies. Different ones suit different people. A doctor or nurse will advise on the different types. See a separate leaflet called ‘Asthma - Inhalers‘.

Inhalers can be grouped into ‘relievers’, ‘preventers’ and ‘long acting bronchodilators’.

• A reliever inhaler is taken ‘as required’ to ease symptoms. The drug in a reliever inhaler relaxes the muscle in the airways. This makes the airways open wider, and symptoms usually quickly ease. These drugs are also called ‘bronchodilators’ as they dilate (widen) the bronchi (airways). There are several different reliever drugs. For example, salbutamol and terbutaline. These come in various brands made by different companies. If you only have symptoms every ‘now and then’, then the occasional use of a reliever inhaler may be all that you need. However, if you need a reliever inhaler three times a week or more to ease symptoms, a preventer inhaler is usually advised.
  
• A preventer inhaler is taken every day to prevent symptoms from developing. The drug commonly used in preventer inhalers is a steroid. There are various brands. Steroids work by reducing the inflammation in the airways. When the inflammation has gone, the airways are much less likely to become narrow and cause symptoms. It takes 7-14 days for the steroid in a preventer inhaler to build up it’s effect. Therefore, it will not give any immediate relief of symptoms. However, after a week or so of treatment, the symptoms have often gone, or are much reduced. It can take up to six weeks for maximum benefit. You should then not need to use a reliever inhaler very often, (if at all).
  
• A long acting bronchodilator may be advised in addition to a steroid inhaler. One may be needed if symptoms are not fully controlled by the steroid inhaler alone. The drugs in these inhalers work in a similar way to ‘relievers’, but work for up to 12 hours after taking each dose. They include salmeterol and formoterol. (Some brands of inhaler contain a steroid plus a long acting bronchodilator for convenience.)

Tablets to open up the airways
Most people do not need tablets as inhalers usually work well. However, in some cases a tablet (or in liquid form for children) is prescribed in addition to inhalers if symptoms are not fully eased by inhalers alone. Some young children use liquid medication instead of inhalers.

Steroid tablets
A short course of steroid tablets (such as prednisolone) is sometimes needed to ease a severe or prolonged attack of asthma. Steroid tablets are good at reducing the inflammation in the airways. For example, a severe attack may occur if you have a cold or chest infection.

Some people worry about taking steroid tablets. However, a short course of steroid tablets (for a week or so) usually works very well, and is unlikely to cause side-effects. Most of the side-effects caused by steroid tablets occur if you take them for a long time (more than several months), or if you take frequent short courses of high doses.

What are the dosages of treatment?

Everyone is different. The correct dose of a preventer inhaler is the lowest dose that prevents symptoms. A doctor may prescribe a high dose of a preventer inhaler at first, to quickly “get on top of symptoms”. When symptoms have gone, the dose may then be reduced by a little every few weeks. The aim is to find the lowest regular dose that keeps symptoms away.

Some people with asthma put up with symptoms. They may think that it is normal to still have some symptoms even when they are on treatment. A common example is a night time cough which can cause disturbed sleep. But if this occurs and your symptoms are not fully controlled - tell your doctor or nurse. Symptoms can often be prevented. For example, by adjusting the dose of your preventer inhaler, or by adding in a long acting bronchodilator.

A ‘typical’ treatment plan

A common treatment plan for a ‘typical’ person with moderate asthma is:

• A preventer inhaler (usually a steroid inhaler), taken each morning and at bedtime. This usually prevents symptoms throughout the day and night.
• A reliever inhaler may be needed now and then if breakthrough symptoms occur. For example, if symptoms flare up when you have a cough or cold.
• If exercise or sport causes symptoms, then a dose of a reliever inhaler just before the exercise usually prevents symptoms.
• The dose of the preventer inhaler may need to be increased for a while if you have a cough or cold, or during the hay fever season.
• Some people may need to add in a long acting bronchodilator, or tablets, if symptoms are not controlled with the above.

At first, adjusting doses of inhalers is usually done on the advice of a doctor or nurse. In time, you may agree an ‘asthma action plan’ with your doctor or nurse. This means that you make adjustments to the dose of your inhalers, depending on your symptoms and/or peak flow readings.

Does asthma go away?

There is no once-and-for-all cure. However, about half of the children who develop asthma ‘grow out of it’ by the time they are adults. For many adults, asthma is variable with some good spells and some spells that are not so good. Some people are worse in the winter months, and some worse in the hay fever season. Although not curable, asthma is treatable. Stepping up the treatment for a while during bad spells will often control symptoms.

Some other general points about asthma

• It is vital that you learn how to use your inhalers correctly. In some people, symptoms persist simply because they do not use their inhaler properly, and the drug from the inhaler does not get into the airways properly. See your practice nurse or doctor if you are not sure if you are using your inhaler properly.
• See a doctor or nurse if symptoms are not fully controlled, or if they are getting worse. For example, if:
  • a night time cough or wheeze is troublesome.
  • sport is being affected by symptoms.
  • your peak flow readings are lower than normal.
  • you need a reliever inhaler more often than usual.

  An adjustment in inhaler timings or doses may control these symptoms.

• See a doctor urgently if you develop severe symptoms that are not eased by a reliever inhaler. In particular, if you have difficulty talking due to shortness of breath. You may need emergency treatment with high dose reliever drugs and other treatments, sometimes in hospital. A severe asthma attack can be life-threatening.
• You should have an influenza immunisation every autumn (the annual ‘flu jab’) if you require regular treatment for asthma or if you have had a previous severe episode of asthma. Flu tends to be more serious if you have asthma.

Source www.patient.co.uk