Asthma treatments

Main asthma treatments

There are two main treatments for asthma: preventers and relievers. These come in a variety of delivery devices called inhalers, which enable you to breathe the medicine in through your mouth, directly into your lungs. The addition of a spacer device increases the medication delivered to the lungs.

Asthma preventers

Preventers are designed to quell swelling and inflammation in the airways and reduce mucus. This also reduces the sensitivity of the airways and so minimises potential damage.

The protective effect is built up gradually over a period of about a fortnight. Your medication must be taken daily to maintain protection, even if you are not experiencing symptoms.

Most preventers are based on corticosteroids, usually known as steroids. These are completely different from the anabolic steroids sometimes used by bodybuilders and athletes.

Most common types of preventer are inhaled steroids. These can include beclomethasone, budesonide, fluticasone. Occasionally, if your asthma is acute and severe, you may be given a short course of steroids taken as tablets, or even an injection. There are other non-steroid preventers, usually used for children, such as sodium cromoglycate and nedocromil sodium. They are usually taken three to four times a day and are not generally as effective as steroids.

Many people worry about the side-effects of steroids. High doses taken over a long period can have significant side-effects. For this reason, doctors will be careful to prescribe the lowest possible dose needed to control your asthma.

Potential side effects of asthma preventers

The main side effects are hoarseness and an increased risk of mouth and throat infections caused by thrush, a yeast that lives normally on the body's mucous membranes.

Using the inhaler before brushing your teeth and rinsing your mouth out afterwards helps to avoid this. Using a 'spacer' makes it easier to inhale the drug, and so helps reduce the risks of steroids being absorbed into your body.

Asthma relievers

Relievers are drugs that relax and open up the airways - medically known as bronchodilators - making it easier to breath. These are prescribed for the relief of asthma symptoms during an actual asthma attack, when peak flow readings are low and before exercise or activity to reduce the risk of an attack.

Because these drugs do not reduce swelling and inflammation of airways, you may also need to take a preventer.

Some relievers alleviate symptoms almost instantly (rescue relievers). Others have a longer lasting action (long-lasting relievers). The latter may be prescribed if wheezing, breathing difficulties and coughing persist despite using a preventer and a rescue reliever - or if symptoms come on in the night - nocturnal asthma.

Common rescue relievers are salbutamol and terbutaline. Another type of reliever (most often prescribed for babies under two and for older people) is called ipratropium bromide.

Long-acting relievers include oxitropium, salmeterol, and eformoterol, all of which are inhaled. Occasionally, theophylline-based drugs are taken by mouth, so tablets may be prescribed.

Potential side effects of asthma relievers

Side effects are usually mild and pass away quickly. The main ones are a slightly increased heartbeat, and muscle trembling, especially in the hands. Some oral relievers may cause dry mouth, blurred vision, difficulties passing urine, or constipation. Theophylline-based drugs, which relax the muscles in the walls of the airways, can occasionally cause nausea, more rapid heart rate, a nettle-like rash, dizziness, nervousness, headaches, irritability or restlessness.

Always report any unusual symptoms to your doctor.

Inhaled asthma medication

Most asthma treatments are inhaled. There are several different types of inhalers, but the main ones are aerosol-based (often called puffers) and dry powder inhalers.

• Puffers - the medication is mixed into a liquid and forced under pressure into a small aerosol canister. Once activated (usually by pushing down the canister, although breath activated devices are increasingly available) the liquid evaporates, leaving the active ingredient that you inhale. A measured dose of the drug is released every time the canister is pushed down. Both relievers and preventers can be given via a puffer.
• Dry powder inhalers - the drug that comes in dry powder form is contained in a capsule. When the device is activated, the capsule breaks and the powder may be inhaled. In some inhalers the powder is contained inside a disk or compartment.
• Spacers - because it can be hard to coordinate your breathing with an inhaler, you may be prescribed a spacer. This device allows more medication to enter your lungs than would be possible using an inhaler alone. It's usually a large plastic chamber in two halves, which click together, with a mouthpiece at one end and a hole at the other end where the inhaler is attached. The drug is released into the spacer chamber from the inhaler device, and then enters your body as you breathe in through the mouthpiece.
• Nebulisers - a machine in which air or oxygen is forced through the liquid form of a drug, creating a mist, which is then inhaled through a mask or mouthpiece. It's used to administer high doses of reliever in an emergency and sometimes for children who are too young to use an inhaler.

Other asthma medication

There are a number of medicines that are taken in pill form, including eukotriene receptor antagonists, theophyllines and steroids . Your doctor will be able to advise you when and why these may be necessary for you.

If your asthma is really bad, your doctor may also prescribe a short course of steroid tables to calm down your inflamed airways.

New anti-inflammatory tablet-form medication for asthma includes the leukotriene receptor antagonists. These are particularly useful for brittle asthma and those with aspirin-sensitive asthma.

Omalizumab is a new injection treatment for asthma that works by dampening down the allergic reaction in those with severe persistent allergic asthma.

Dealing with an asthma attack

• Remove yourself from any conditions or situations that trigger your asthma. Treatment is not as effective in the presence of a trigger.
• Take a couple of puffs of your reliever (usually the blue inhaler) , using a spacer if you have one. Stay calm and relaxed and breathe slowly to reduce fatigue.
• Rest sitting up. It's harder to breathe lying down. Loosen any tight clothing. Rest your hands on your knees to help support your back.
• If you have no immediate improvement, take another puff of your reliever inhaler every minute for 5 minutes or until symptoms improve.
• Wait five to ten minutes to see if the attack eases. Measure your peak flow to see if your reading is improving. If it does, you can resume what you were doing. If the reliever has not taken effect within 15 minutes, call your doctor or call an ambulance on 999. Carry on using the reliever every minute until help arrives.

Never put off seeking medical help because of fear of making a fuss or being a nuisance.

Hospital treatment for asthma

If you need hospital treatment, take your medication (and your asthma management plan, if you have one) with you. The doctor will need to know what steroids you have taken, whether you used a nebuliser and if you are taking the drug theophylline.

On arrival, the doctor will examine you and check your pulse, oxygen saturation blood pressure and peak flow, and listen to your chest. You may also have a test to check blood levels of oxygen and carbon dioxide.

Treatment will usually begin with a nebuliser to improve your peak flow reading. If you have to be admitted, a chest x-ray may be done to check for damage to your lungs. On the ward, you'll probably have nebulised bronchodilator treatment and steroid injections. Oxygen may be needed and, in severe cases, artificial ventilation.

Helping someone having an asthma attack

If you're with someone who is having an asthma attack, try to stay calm. Make sure they take their reliever medicine. Listen to them, reassure them and encourage them to breathe slowly and deeply. If the person has a peak flow meter use this to monitor their condition.

Don't try to lie them down as this constricts the breathing passages. If the reliever has no effect after five -ten minutes, or if the peak flow meter falls to less than 50 per cent of the expected reading, you should call a doctor or ambulance immediately. You should also do this if the person becomes distressed or unable to speak properly.

Call for medical help immediately if the person's:

• Symptoms worsen even after taking medication.
• Peak flow number decreases or doesn't improve after treatment.
• Breathing becomes increasingly difficult and the chest and neck are depressed with each breath.
• Having difficulty walking or talking and has to stop what they're doing.
• Lips, tongue or fingernails take on a blue or grey tinge.

Thanks to Royal Brompton & Harefield NHS Trust for allowing BBC Health to take photos.