How can I Treat my Asthma

How can I treat my asthma?

Although there is no cure for asthma, there are some excellent medicines available to help you to control your asthma so that is does not interfere with your daily life.
It is important that you take your asthma medicine properly and that your doctor or asthma nurse has explained how to use inhalers properly so that every dose you take gives you the most benefit.
Relievers

Everyone with asthma should have a reliever inhaler. Reliever inhalers are usually blue.

Relievers are medicines that are taken immediately to relieve asthma symptoms. They quickly relax the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again.

Relievers are essential in treating asthma attacks. You should take a dose of reliever inhaler when you are having asthma symptoms. If you are using your reliever inhaler three or more times a week, your asthma may not be well controlled and you should go back to your doctor or asthma nurse and have your symptoms reviewed.

Preventer inhalers
Preventers control the swelling and inflammation in the airways, stopping them from being so sensitive and reducing the risk of severe attacks.

Not everyone with asthma will be prescribed preventer medicine.

The protective effect builds up over a period of time so they need to be taken every day (usually morning and evening) even when you are feeling well.

Preventers do not give immediate or quick relief when you are breathless but instead they reduce long-term inflammation. Preventer inhalers usually contain a low dose of steroid medicine.

There are several kinds of preventers, but they all work in the same way. 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.

Preventers are usually brown, red or orange inhalers.

When are preventers prescribed?

You should be prescribed a preventer if you:

* are breathless, cough or have a tight chest during everyday activities three or more times a week
* need to use your reliever inhaler three times a week or more
* have sleep disturbed by cough or chest tightness each week
* 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 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 remove 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.

Don't stop taking it if nothing much happens for a few days. Gradually, chest tightness, night cough and wheeze should become less. You should notice that you need to use less reliever inhaler.
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. They will be able to adjust your medicines if your symptoms are not decreasing. Or, if your preventer works well for you, you may be able to cut down on the number of puffs you take each day, or the strength of the medicine.
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. If you stop using your preventer, chest infections are more likely to bring on an asthma attack.
Will my preventer medicines change?
Yes. It is likely that you will have to change your medicines from time to time.

If your asthma gets really bad, you may need to increase the dose you take. Or you may need a short course of steroid tablets as well as your regular preventer.

When you begin taking preventer medicine, your doctor or asthma nurse may want you to take a higher dose each day. This will get your asthma under control quickly. As your symptoms improve, you may be able to take fewer daily puffs or move to a lower strength inhaler.
Using your inhalers
Using an inhaler is the most common way of taking asthma medicines. It is also a very effective way because inhaling the medicine takes it straight into your lungs.

It is important that you take the medicine properly. Your doctor or asthma nurse should explain how to use your inhaler so that every dose you take gives you the most benefit.

It is very common to experience problems using inhalers. Talk to your doctor or asthma nurse specialist and they will be able to check your inhaler technique or may give you a different inhaler.

They may also suggest that you try one of the following options:

* Large volume spacers are available on prescription. These make aerosol inhalers easier to use and more effective. 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. Ask your doctor, nurse or pharmacist for details.

* If you have arthritis in your hand, or have difficulty holding the inhaler, a device like the Haleraid or Turboaid might be useful. The Haleraid fits onto some spray-type inhalers. It allows you to release medicines by applying pressure with the palm of your hand. This can be easier than pressing the canister down. Your doctor or asthma nurse will be able to advise you. The Haleraid is not available on prescription, but your pharmacist can order it direct from the manufacturers, Allen & Hanburys. Your pharmacist can also order the Turboaid from the manufacturers, Astra Zenec

Steroid tablets
If your asthma symptoms become severe, your doctor or asthma nurse may give you a short course (3-14 days) of steroid tablets. Steroid tablets work quickly and powerfully to help to calm your inflamed airways. Short courses of steroid tablets are also used to treat acute asthma attacks and are used for essential emergency treatment of asthma attacks.

If you finish a short course of steroids but are not back to normal, you should visit your doctor. You may need to continue the course for more days to get your asthma back under control.

A small number of people with severe asthma find that their preventer medicine and short courses of steroid tablets are not enough to control their asthma. They need to take steroid tablets for a longer period.
Why do I need to keep taking preventer medicine when I am taking steroid tablets?
The main reason why you should continue taking preventer medicines is because that means your steroid tablet dose can be as low as possible.
Stopping regular steroid tablets: A warning

When you are taking regular tablet steroids your adrenal gland becomes lazy, and makes less of its own natural steroids. This means you have less ability to cope with infections or deal with physical stress.

Long courses of steroid tablets (three weeks or more) can be stopped only by gradual reduction and under the guidance of your doctor or asthma nurse. If they are stopped suddenly you will be very vulnerable to infection and less able to cope with any crisis such as an operation. For this reason the doses should be reduced slowly over weeks or months.
Spacers

A spacer is a large plastic or metal container, with a mouthpiece at one end and a hole for the aerosol inhaler at the other. Spacers only work with an aerosol inhaler.

Why are spacers important?

Spacers are important because they help to deliver the medicine to your lungs. They also make the inhaler easier to use and reduce the risk of side effects.

There are several different brands of spacer that fit different inhalers and are available on prescription (including Volumatic (pictured), Nebuhaler, AeroChamber and Able Spacer)

Spacers are very important because:

* they make aerosol inhalers easier to use and more effective
* you get more medicine into your lungs than when just using the inhaler on its own
* they are convenient and compact and work at least as well as nebulisers at treating most asthma attacks in children and adults
* they help to reduce the possibility of side effects from the higher doses of preventer medicines by reducing the amount of medicine that is swallowed and absorbed into the body

Handy hints for using a spacer

* Your doctor, asthma 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, breathing in and out of the mouthpiece several times 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

Nebulisers
A nebuliser is a machine that creates a mist of medicine, which is then breathed in through a mask or mouthpiece. They are more commonly used to give high doses of reliever medicine in an emergency situation, for example in hospital or a doctor's surgery, but are no more effective than an inhaler and spacer for treating most asthma attacks.
If you have your own nebuliser it is important to have it serviced regularly and keep it in good working order.

Read more about nebulisers, what they are, who needs one and how to get hold of one by downloading our factfile below.
Side effects of asthma medicines

Relievers are a safe and effective medicine and have very few side effects. You cannot overdose on reliever medicine. Some relievers can temporarily increase your heartbeat or give you mild muscle shakes. These effects are more common when taking high doses. However they generally wear off within a few minutes or a few hours at most.
Side effects of preventer medicines

The possibility of side effects from taking your inhaled preventer medicine is very low. Because the inhaled medicine goes straight down to the airways where it is needed, very little is absorbed into the rest of the body.

If you use preventer medicine there is a small risk of having a sore tongue, sore throat, hoarseness of the voice and a mouth infection called thrush. To help prevent these side effects, rinse your mouth out and brush your teeth after using your preventer inhaler. Using a spacer will also help reduce the possibility of thrush.

Children should be monitored closely if they are taking preventer medicines - especially for growth.

It is possible that long-term and high-dose use of preventer medicines (inhaled steroids) may cause some other side effects (See 'Side effects of long-term use of steroid tablets', below). That is why your doctor and asthma nurse will try to keep you on the lowest dose to control your symptoms.

Several studies have suggested the possibility of a very slight increased risk of the development of cataracts in elderly people who have used inhaled steroids. As with use of all medicines, careful attention needs to be paid to the risk versus benefit argument and it's as likely that any risk can be reduced by always using the lowest possible dose of medication to control the condition.
Side effects of steroid tablets
Short term use
For a small number of people, a short-term course of steroid tablets, can lower the body's resistance to chickenpox, so you should contact your doctor if you or your child are taking steroid tablets and you/they come into contact with chickenpox. If your doctor thinks you are at risk they can give you an injection to protect you.

Other possible side effects from taking a short course of steroid tablets are mood swings (especially in children) and increased hunger.

There are very few other side effects from taking occasional (three to four) short courses of steroids per year. However it is important to keep the number of courses to a minimum by making sure you are using enough of your other regular inhaled medicines.
Long term use
A small minority of people with severe asthma need to take steroid tablets for a longer period. However, taking steroid tablets regularly, for long periods of time (months or years) can have serious side effects for some people.

For these reasons your doctor and asthma nurse will always try to prescribe the smallest possible dose of daily steroid tablets. It is very important that you continue to take your other asthma treatments regularly to keep the need for steroid tablets to a minimum.

If you have severe asthma and you have been prescribed long-term steroid tablets your doctor and asthma nurse should discuss and consult with you about the risk of side effects against the benefits of controlling your asthma symptoms (if untreated, severe asthma can lead to permanent lung damage).

The possible side effects of long-term use of steroid tablets are:

* Fattened face (moon face)

* Feeling hungry and wanting to eat more (this extra eating can lead to weight gain)

* Feeling 'hyped up' and over active with difficulty sleeping

* Feeling depressed or having sudden mood swings

* Heartburn and indigestion

* Bruising easily

* Brittle bones (osteoporosis)

* Altering diabetic control or uncovering a tendency to diabetes

* Chickenpox may be more serious

* Risk of cataract increases

Steroid tablets do not have any side effects that damage the heart.
What can I do about side effects of steroid tablets?

* Most importantly, don't smoke. If you smoke, bone thinning side effects are worse. Your general asthma control will also be helped if no one in your household smokes. If your partner gives up smoking, it may mean you can cut down on your dose of steroid tablet.

* Taking steroid tablets first thing in the morning may have some benefit in decreasing side effects.

* People who need to take regular steroid tablets can use daily calcium supplements, although there is no clear scientific evidence to prove that these are useful.

* Weight-bearing exercise, such as walking for 20 minutes each day will help protect against the bone thinning effect of long-term steroids.

Complementary therapies
Many people with asthma are interested in trying treatments and therapies that do not use prescribed medicines. These treatments and therapies such as yoga, acupuncture, homeopathy, hypnosis and Buteyko and other breathing techniques, are usually referred to as complementary therapies.

However there is little scientific evidence that complementary therapies are effective especially used on their own. That is why it is better to see them as 'complementary' and working alongside conventional medicines - rather than 'alternative'. If you are interested in trying one of the many complementary therapies available, you should speak to your doctor or asthma nurse first.

Complementary therapies and treatments should only ever be used alongside your prescribed medicines. (It is very important that you never stop taking your normal asthma medicines unless your doctor advises you otherwise).

Please call us about our advice on Powerbreather and Oxygen systems. See website
http://www.friendsofasthama.com