Asthma medical treatment
Questions
Answers to your questions
What are “controllers”?Controllers are medicines that prevent asthma attacks from starting. There are two types of controller medicines – anti-inflammatory medicines and airway openers.
Anti-inflammatory medicines work by reducing the inflammation in the airways that occurs in asthma. The most effective and most commonly used anti-inflammatory medicines are inhaled glucocorticosteroids, such as budesonide, beclomethasone and fluticasone. These medicines help to prevent periods of greater severity of asthma if you take them regularly as instructed by your doctor (usually once or twice every day), and they may relieve you of your symptoms completely for most of the time. If your doctor gives you an inhaled glucocorticosteroid you must take it regularly, even if you are not wheezing.
If the inflammation is not controlled, the airways become red, swollen, narrower and extra-sensitive. Some degree of inflammation is usually present in your lungs, even when you are unaware of symptoms, and worsening of the inflammation may lead you to feel an attack coming on.
Airway openers, which are also known as bronchodilators, are medicines that help to prevent attacks progressing by quickly opening up the narrowed airways. They do this by relaxing the muscles surrounding the airways. Most airway openers only have a short-term effect and should not be used regularly as controllers. Long-acting airway openers, including formoterol and salmeterol, are effective as controllers when they are used regularly with an inhaled glucocorticosteroid. However, they should not be used regularly on their own as they do not treat the underlying inflammation and their effect on the symptoms of asthma could even hide the fact that it is getting worse.
What are “relievers”?
Relievers – or airway openers –
are medicines that provide rapid relief from an asthma attack by quickly opening up the narrowed airways (dilating the bronchi). They do this by relaxing the muscles surrounding the airways, and are known to doctors and other asthma professionals as bronchodilators.
There are two types of airway openers – short-acting bronchodilators and long-acting bronchodilators. The most widely used short- and quick-acting airway openers are salbutamol (also known as albuterol) and terbutaline. Salmeterol is a long-acting airway opener that has a slower action, so it is used for longer-term control, but not for the quick relief of symptoms. Formoterol is a long-acting airway opener that is also quick-acting, so it can be used both for the immediate relief of symptoms and for longer-term control.
What are combination medications?
Combination medications contain a reliever and a controller in the same inhaler. So this type of inhaler opens up the airways (preventing the feeling of chest tightening and the worsening of an attack) and also reduces the underlying inflammation that causes asthma. As a result, combination inhalers provide better control of asthma symptoms and reduce the number of inhalers you have to use.
With conventional combination inhalers, you take the same amount of medication all the time. But because every person with asthma has good days and bad days, this means that sometimes you will take a bit more of the medication than you really need, and at other times you will not be getting enough and you may have to use doses from a second inhaler containing an airway opener (bronchodilator).
Recently, a combination inhaler has become available that lets you safely adjust the dosage of your combined medication to match the changes in your asthma. This makes it possible for you to take the right level of medication at the right time and means that you use less medication overall.
What effects do anti-inflammatory medications have?
Asthma is caused by inflammation of the airways, which makes them become red, swollen, narrower and extra-sensitive to irritants. Anti-inflammatory medicines (controllers) relieve this inflammation, so that the swelling goes down and further swelling is prevented, the narrowing due to muscle tightening is reduced, and the airways become less sensitive to asthma triggers.
Anti-inflammatory medications are very effective and can control asthma in most people. The most effective anti-inflammatory medicines are the inhaled glucocorticosteroids, such as budesonide, beclomethasone and fluticasone.
What effects do airway opener medications have?
Airway openers work by opening up the narrowed airways.
They do this by relaxing the muscles surrounding the airways. This makes it easier to get air in and out of the lungs. Most airway openers work quickly and can be used to treat an asthma attack. They are sometimes called relievers or ‘rescue’ bronchodilators.
What are glucocorticosteroids?
Glucocorticosteroids, which are also known as corticosteroids, are anti-inflammatory medicines. They are used to relieve and prevent inflammation of the airways, which is the cause of asthma. In asthma,
glucocorticosteroids are usually inhaled and referred to as inhaled corticosteroids or inhaled steroids. The most effective and commonly used are budesonide, beclomethasone and fluticasone.
Why are glucocorticosteriod medications inhaled?
In asthma, glucocorticosteroids are usually inhaled so that the medicine goes straight to the lining of the airways affected by inflammation. This also greatly reduces the risk of any possible harmful effects on the rest of the body. The small amount of medicine that goes into the bloodstream is rapidly removed from the body, so that normally there are none of the side effects that may occur with other types of steroid treatment.This is exemplified by pregnancy. Long-term treatment with glucocorticosteroid tablets puts both mother and unborn baby at significant risk of various complications. However, the inhaled steroid budesonide has been investigated in large studies of pregnant women, which did not show any increased risk for the mother or unborn baby.
When and why are corticosteroid tablets or injections used?
Corticosteroid tablets (usually prednisolone or prednisone) or injections can be helpful to treat a severe attack of asthma when inhaled corticosteroids have not had enough effect or are not available.
Treatment with corticosteroid tablets or injections for short periods has few side effects. High doses can, however, temporarily affect your mood, either positively or negatively. Long-term treatment with corticosteroid tablets or injections can cause side effects, including osteoporosis, thinning of the skin, weight gain, high blood pressure and high blood-sugar levels. These risks are avoided if you switch back to inhaled corticosteroids as soon as possible (in consultation with your doctor) and avoid the long-term use of corticosteroid tablets or injections.
What is the difference between a corticosteroid and an anabolic steroid?
Both corticosteroids and anabolic steroids are sometimes just called
‘steroids’. However, corticosteroids are very different from anabolic steroids. Corticosteroids reduce the swelling in the airways that make breathing difficult and also reduce the amount of mucus produced in the lungs. Anabolic steroids have an effect similar to that of the male hormone testosterone, and are used illegally by some athletes to increase muscle mass, strength and endurance. Corticosteroids do not have these effects.
What are inhaled non-steroidal anti-inflammatory medications?
Inhaled non-steroidal anti-inflammatory medications, such as the cromones (sodium cromoglicate and nedocromil),
have weaker anti-inflammatory effects than corticosteroids. If your doctor gives you an inhaled non-steroidal anti-inflammatory medication, you must take it regularly, even if you are not wheezing – in the same way as you should take an inhaled corticosteroid. If you are being treated with one of these medications, you will need to take an airway opener from another inhaler to treat any asthma attacks.
Is there an effective alternative to using inhaled corticosteroids?
There are no alternative treatments that control asthma as effectively as inhaled corticosteroids. Inhaled non-steroidal anti-inflammatory medications, such the cromones, are not so effective and do not usually relieve the inflammation completely.
Anti-leukotrienes are tablets that are taken by mouth and are helpful to some people with asthma. Often they are not an effective alternative to inhaled corticosteroids for the long-term control of asthma and the prevention of attacks, but some patients benefit from their use.
Antihistamine tablets are not helpful in the treatment of asthma. However, patients who also have hay fever may find that their asthma improves when the hay fever is successfully controlled, and antihistamines may be successfully used to treat hay fever.
Some airway openers, such as theophylline, can be taken by mouth in ‘long-acting’ preparations. To select the safe and effective dose for an individual patient, and thus achieve the best effect, blood levels of the drug may need to be measured and the dose adjusted. In general, long-acting airway openers are not an alternative to inhaled corticosteroids, because these medications do not fully relieve the underlying inflammation of asthma. The inflammation tends to become worse over time, causing more frequent asthma attacks and more severe symptoms. Although some patients find that their asthma can be satisfactorily controlled by the regular use of theophylline tablets or capsules, these treatments have been largely replaced by inhaled medications. If you have been using theophylline for some time, you may want to discuss today’s alternative treatments with your doctor.
What are anti-leukotrienes?
Anti-leukotrienes are a relatively new type of medication for asthma that are taken as tablets once or twice a day. They work by relieving the part of the airway inflammation caused by chemical substances called leukotrienes, but do not reduce it completely. They may also help to protect against asthma attacks. Often they are not an effective alternative to inhaled corticosteroids for the long-term control of asthma and the prevention of attacks, but some patients benefit from their use.
Do I still need my inhaled corticosteroid if I feel OK?
Yes. Asthma is a long-term (chronic) disease that causes inflammation and narrowing of the airways. Your asthma does not stay the same, but changes over time, and some degree of inflammation is usually present, even when you are unaware of any symptoms.
People with asthma sometimes forget or choose not to take their anti-inflammatory medication, especially during periods when they are feeling well. When they start to get symptoms of asthma, they increase the dose of airway opener (bronchodilator). However, this will not treat the underlying inflammation. At the first sign of symptoms of asthma, you should re-start your anti-inflammatory medication if you have stopped it, in addition to using an airway opener.
You should not stop using your inhaled corticosteroid regularly at any time unless you have discussed this with your doctor first.
Inhaled corticosteroids are recommended for treating asthma because they are anti-inflammatory. Aspirin is also anti-inflammatory, but is not recommended for people with asthma. Why?
Corticosteroids and aspirin are both anti-inflammatory, but work in very different ways and relieve different types of inflammation. Aspirin has no effect on the inflammation of the airways that occurs in asthma. More seriously, in some patients with asthma, aspirin may provoke severe attacks of asthma. Any patient who is known to have such ‘aspirin sensitivity’
should avoid the use of aspirin at all times. Even in other patients,
aspirin has no beneficial effects on asthma.
What anti-inflammatory medication can I take for a strained muscle,
aching joints, severe back pain or rheumatism, for example?
If you have asthma and have used aspirin or a similar medicine (often called non-steroidal anti-inflammatory drugs or NSAIDs) without any worsening of your asthma, you can continue to use it. If, however, you have had asthma symptoms after using aspirin or an NSAID, you should avoid these drugs and use paracetamol or another medicine instead. You should discuss appropriate alternatives with your doctor if necessary.
What is hyposensitisation (vaccination)?
‘Hyposensitisation’ is often referred to as ‘allergy vaccination’. It usually involves having a series of injections of the allergen or allergens that are known to cause your asthma. The dose of the injections is gradually increased, with the aim that the body will learn to handle these allergens better and no longer develop asthma on exposure to them.
Hyposensitisation is sometimes suitable for the treatment of asthma provoked by pollen, some animals or dust mites. It is most likely to be successful if your asthma is caused by only one or a few allergens. If your asthma reacts to many different things, it will not usually get better with this treatment.
Hyposensitisation has been used for more than 80 years and is still the only treatment that can potentially reduce your reaction to a specific allergen. The method works for asthma that has been provoked by pollen, furry animals and dust mites, but not for mould. However, there is a risk of serious reactions to the injections, so they should only be given by a specialist, and usually only in a hospital clinic. The risks of these injections limit their availability in some countries, and the treatment is also relatively expensive.
I'm troubled by my asthma when outdoors in cold weather. What can I do?
First of all, be sure that you are using an effective anti-inflammatory treatment. If cold air causes asthma symptoms, inhaled corticosteroids are probably needed. If you are already taking them, ask your doctor whether you should increase the dose or take additional treatment. A long-acting bronchodilator, such as formoterol, may be the best choice.
A face mask may also help by heating and moisturising the inhaled air, because cold air dries and irritates the mucus membranes in the airways, especially in people with asthma. Your doctor or pharmacist will be able to advise you.
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