Medicines & Treatments
470,000 people in Ireland have asthma and
the majority of these do not have their symptoms under control.
Ensure you take medication properly, particularly preventer
medication.
Relievers
- Everyone with asthma should have
a reliever.
- Relievers are medicines that you
can take immediately when asthma symptoms appear. They
quickly relax the muscles surrounding the narrowed airways.
This allows the airways to open wider making it easier
to breathe again. However relievers do not reduce swelling
in the airways.
- They are essential in treating asthma
attacks.
- If taken before exercise they reduce
your chances of getting asthma symptoms.
- Relievers usually come in blue inhalers.
Salbutamol (e.g. Ventolin) and terbutaline (Bricanyl) are
two examples of relievers. They work almost immediately
to relieve the symptoms of asthma. That is why they are
sometimes called rescue relievers. Ipratropium bromide
(Atrovent) is a different type of reliever and is most
commonly used by children under two or in older people.
Atrovent takes around 45 minutes to work.
- If you are using your reliever inhaler
two or more times a week, your asthma may not be fully
controlled and you should go back to your doctor or asthma
nurse for review.
- Relievers are a very safe and effective
medicine and have very few side effects. Some relievers
can slightly increase your heartbeat or give you mild muscle
shakes. These effects are more common when taking high
doses. These side effects generally wear off within a few minutes, or
a few hours at most.
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Preventers
/ Controllers
- Preventers control the swelling and inflammation
in the airways, stopping them from being so sensitive and
reducing the risk of severe attacks.
- Their effects build up over a period of
time so they need to be taken every day, usually morning
and evening, even when you are feeling well.
- You will be started on an appropriate
level of treatment to get your symptoms under control; once
this has been achieved the treatment will be reduced to the
lowest possible dose.
- Preventer inhalers usually contain a low
dose of steroid medication. There are several kinds of inhaled
steroids, but they all work in the same way to reduce the inflammation in your airways.
- Combination inhalers contain an inhaled steroid and a long acting reliever medication in one device. Your doctor may prescribe a combination inhaler if your asthma is not controlled on an inhaled steroid alone.
When are preventers prescribed?
You should be prescribed a preventer if you:
- are breathless, cough or have a tight
chest during everyday activities more than twice a week
- need to use your reliever inhaler more
than twice a week
- have sleep disturbed by cough or chest
tightness more
than twice a month
- have bad attacks of breathlessness when
you have a chest infection or are in a smoky atmosphere.
What will my preventer do for me?
As the protective effect of the steroid builds up, you will
be less likely to have asthma attacks. You will be less likely
to be breathless during the day and at night and you will not
need to use your reliever inhaler as often.
Why is my reliever inhaler not enough?
Reliever inhalers relax your airways, which help breathlessness,
but they do not treat airway inflammation. As well as the
relaxing effect of a reliever inhaler, you need the anti-inflammatory
effect of a preventer. Once airways are less inflamed they
are less sensitive to triggers such as cigarette smoke and
viral infections.
How long will it take to work?
It may take up to 14 days for your preventer medicine to reduce
inflammation and mucus in your airways. For children, it could
take 1-2 months.
Don't stop taking your preventer if you do not notice an improvement in the first few days. it if nothing much happens
for a few days. Gradually, chest tightness, night cough and
wheeze should become less. You should also notice that you need
to use less reliever inhaler. You should continue to take your preventer every day, morning and evening even when you are feeling well. This is how you keep your asthma symptoms under control.
When should I see my doctor or asthma
nurse again?
Your doctor or asthma nurse will probably want to see you within
a month after you start using a preventer to review your symptoms. They will be able
to adjust your medicines if your symptoms have not improved.
Do I really need to take my preventer
every day?
Yes. To work properly, preventers need to be taken every day,
usually morning and evening, even if you are feeling well.
The protective effect of the preventer medicine builds up gradually.
Once this protection is working, occasionally
forgetting to take your inhaler will usually not have bad
effects. But forgetting or stopping for several days at a
time will mean your protection begins to disappear.
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Other treatments and 'add-on therapies'
If your asthma is not well controlled by using your preventer/controller
medicine regularly, you should go and see your doctor. Before
increasing the dose of your preventer/controller, your doctor
may suggest other treatments or 'add-on therapies' to help
you.
The first 'add-on therapy' to be tried is
usually a leukotriene receptor antagonist (LRA) which blocks
the action of naturally occurring chemicals in the lungs, called
leukotrienes, which lead to inflammation in both upper and
lower airways. If asthma treatment remains suboptimal after
the addition of an LRA, a long acting reliever may be prescribed,
in addition to your steroid preventer/controller. Long acting reliever should always be taken with an inhaled steroid. Your doctor may prescribe these separately or in a combined inhaler.
Long-acting
relievers go on working for a longer time than normal relievers
and are usually taken twice a day to have an effect. Another
treatment which may be prescribed by your doctor is a slow-releasing
theophylline.
- Before changing any medicines or offering
you new ones, your doctor or nurse should speak to you about
how you take your medicines, if you are taking them regularly and whether you are taking the
prescribed dose
- If you are taking an 'add-on therapy'
that is not helping to control your asthma symptoms, your
doctor may stop it before you start a different treatment.
When are steroid tablets used in
asthma?
If your asthma gets really bad, your doctor may give you a
short course of steroid tablets. They work quickly and powerfully
to help calm down your inflamed airways. Short courses of tablets,
anything from 3-14 days, will not give any long-term side effects.
Steroid tablets can lower the body's resistance to chickenpox,
so you should contact your doctor if you are taking steroids
and come into contact with chickenpox. A small minority of
people with severe asthma need to take steroid tablets for
a longer period. These people are more at risk of experiencing
side effects. Always talk to your doctor or practice nurse
about any concerns you have about the side effects of your
asthma treatment.
Concerns about steroids
Many people are anxious about the side effects of steroids
used in preventer treatment.
Here are some points to remember:
- The steroids used to treat asthma
are called corticosteroids
- Corticosteroids are a copy of those
produced naturally in our bodies
- They are completely different to
the anabolic steroids used by body builders and athletes.
Most people with asthma use low dose inhaled steroids, which go straight down
to the airways, so very little is absorbed into the rest
of the body.
- Your doctor will prescribe the lowest
possible dose to get your asthma under control
- There is a small risk of a mouth
infection called thrush and hoarseness of the voice. You
can avoid this by using your inhaler before brushing your
teeth, and by rinsing out your mouth well afterwards. Using
a spacer will also help reduce the possibility of thrush.
Top Tip: Leave your preventer inhaler beside your toothbrush to remind you to take it morning and evening before you brush your teeth.
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Managing Adult Asthma in Steps
When doctors decide how best to treat your asthma, they use
a 'stepwise' approach.
Each step shows what treatment is needed to control your asthma.
If the treatment on one step is not working, your doctor may
recommend moving up to the next step. More importantly, if
your asthma is well controlled your doctor may recommend moving
down a step.
Step 1
Using your reliever twice or less per week. If
you are using it more than twice a week you
should go to step 2.
Step 2
In addition to your reliever, you will now need to take regular
preventer/controller treatment to reduce the inflammation
in your airways. This will almost always be a low-dose steroid
inhaler and/or LRA (leukotriene receptor antagonist).
Step 3
If your asthma is not fully controlled, before increasing preventer/controller
treatment, your doctor should offer you a trial of 'add-on
therapy', such as a long-acting reliever. Symptoms should
then be assessed to see if there has been an improvement.
There are other 'add-on' treatments available and if the
long-acting reliever medicine has no effect, your doctor
should stop this treatment before introducing other medicines.
Patients who are not controlled on Step 3 medications should
be referred to a respiratory specialist for further investigation.
Step 4
Selection of treatment at Step 4 depends on the response to
prior treatments at Step 2 and Step 3. Increase in preventer/controller
medication, in addition to further add-on therapies, may
be introduced to gain control at this stage.
Step 5
Your symptoms are still difficult to control, even on maximum
amounts of medicine. Your respiratory specialist may investigate
your condition further and also assess to see if you are
suitable for lgE treatment.
Stepping up and stepping down
You should be on the lowest dose of medicine to control
your asthma. Once your asthma is under control, your doctor
may consider 'stepping down' your medicines to see if your
symptoms will stay controlled on a lower dose. It is important
that your doctor or nurse reviews your symptoms after your
medicines have been 'stepped down' to see what effect it
has had.
Your asthma should be stable and well controlled for at least 3 months before your doctor will consider reducing your medication.
To Watch our video on "Creating an Asthma Management Plan" Click Here
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How do I take my asthma medicine?
Most asthma medicines are given by inhalers. There are a variety
of different types of inhaler. Tablets may also be given
as part of your treatment. Whichever inhaler you have,
it's important that you use it correctly. This helps send
the medicine straight to where it's needed, inside the
airways of your lungs. Your doctor, nurse or pharmacist
will help you choose the best device for you and show you
how to use it correctly.
What is a spacer?
A spacer is a large plastic container, usually in two halves
that click together. At one end there is a mouthpiece and
at the other a hole for the aerosol inhaler to fit in.There
are several different brands of spacer, which fit inhalers
and are available on prescription (including Volumatic, Babyhaler and Aerochamber). The child's Aerochamber
is not currently available on prescription. All these devices are available to buy from the Asthma Society at cost price plus postage and packaging. Please call the Asthma Society office on 01 8788511 or email office@asthmasociety.ie.
Spacers are very important
because:
- They make aerosol inhalers easier
to use and more effective
- You get more medicine into your
lungs than you could using just the inhaler on its own
They trap the medicine inside the spacer so you don't have
to worry about pressing the inhaler and breathing in at exactly
the same time
- They are a convenient and
compact alternative to a nebuliser.
- Spacers work just as well as nebulisers
in acute attacks of Asthma
- They help reduce the possibility
of side effects from the higher doses of inhaled steroids
by reducing the amount of medicine which is swallowed and
absorbed into the body.
How to use a spacer device:
- Your doctor, nurse or pharmacist should
show you how to use your inhaler and spacer properly
- Make sure that the spacer you have been
given fits your inhaler
- Put one puff of your inhaler into the
spacer and breathe in deeply through the mouthpiece. Hold
your breath for ten seconds (or for as long as is comfortable)
then breathe out slowly. It is best to take at least two
deeply held breaths for each puff of your inhaler. If you
find it difficult to take deep breaths, taking ten smaller
breaths is just as good
- Repeat the step above for each dose/puff
needed
- Wash your spacer once a month - leave
it to drip-dry as this helps to prevent the medication sticking
to the sides
- Using metal or anti-static spacers can
help to make sure that most of the medicine gets into your
lungs
Spacers should be replaced at least every
year, especially if you use them daily.
Spacers work as well as nebulisers
in severe attacks of asthma.
For further information see our "How to use a Spacer Device" online video
When is a nebuliser used?
A nebuliser is a machine, which creates a mist of medicine
which is breathed in through a mask or mouthpiece. They are
most often used to give high doses of a reliever medicine
in an emergency. With so many improved inhaler devices and
spacers around, there is less and less need for nebulisers.
However, if you have very severe asthma, your hospital consultant
may prescribe one.
Complementary Medicines and Asthma
Many people find that complementary therapies, particularly
yoga, acupuncture and homeopathy, seem to improve their asthma
symptoms. However, there is little scientific evidence that
complementary treatments used on their own are effective.
That is why it is better to regard them as 'complementary'
rather than 'alternative'. If you want to try one of the
many complementary treatments available, tell your doctor
and do not stop taking your normal asthma medication.
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