Medicines are just one part of managing asthma

Asthma medicine - key points

• carry your reliever with you always
• keep asthma under control by using your preventer medicine daily
• use reliever medicine to deal with acute symptoms
• make sure you have a good supply of both preventer and reliever medicines - don't run out
• you will need to check with the doctor or nurse regularly that you are using your inhaler correctly so enough medicine is delivered to your lungs and breathing tubes
• using a spacer device with your aerosol inhaler increases the amount of medicine getting to your lungs by up to 50%
• ask the doctor to tell you when you can increase and decrease your medicines - get a written self management plan or child asthma plan
• most asthma medicines are safe, including during pregnancy. However if you are taking these and are pregnant - talk to your doctor
• asthma medicines are not addictive.

What are preventers?

These medicines soothe the inflamed (swollen) breathing tubes, resulting in less cough and mucus and fewer episodes of wheezing. They have to be taken daily. They work slowly, which means that you don't notice any change at the time you take the medicine.

Steroid inhalers

Preventer medicines are usually steroids, and are like the steroid we produce naturally in our bodies every day. You do not become addicted to them and they don't lose their effect if you have to take them long-term.

Side effects

Husky voice occurs sometimes, and a few people may have a sore throat or fungal growth in the mouth (thrush). This is less likely if a spacer is used with an inhaler. You should always gargle and spit out after using the inhaler.

Very little of this medicine gets into the rest of the body to cause the sort of side effects seen with steroid tablets. The lowest possible dose needed to get good control should be used. Higher doses may be necessary on the advice of a respiratory specialist (paediatrician for children).

Non steroid preventers

These medicines are useful in mild asthma, especially in children. An extra dose can be taken before exercise, if needed, to prevent cough and wheeze. They are free of most side effects, apart from throat irritation.

What are relievers?

These medicines relax the muscle in the breathing tube when it has tightened. They don't have a lasting effect like preventers. Their effect wears off in a few hours and they don't change the swelling in the breathing tube. They are only taken when you need them - when you feel tight in the chest or are coughing and wheezy. People who find exercise brings on asthma may also use a reliever before exercising.

These medicines work very quickly. They can be taken more often during an asthma attack - follow the instructions on your self management plan or child asthma plan. The medicine relaxes the tightened muscles and you can breathe freely again.

If you use your reliever more than three or four times a week you should see a doctor, as preventer medicine is probably needed (or, if you are already taking a preventer, it should be increased).

Side effects

Their side effects, though not common, include shakiness and a fast heartbeat, lasting half an hour or so.

What are symptom controllers - long-acting inhaled relievers?

These are taken twice a day to keep the muscle relaxed, and they last 12 hours. They don't have the same effect as the preventer inhalers, and a preventer is always prescribed at the same time. They are likely to help those who wake with symptoms at night and those who have bad asthma with exercise. The need to use a reliever should decrease when a symptom controller is prescribed. A reliever may still have to be used occasionally.

Symptom controllers should not be used for immediate or emergency relief; a reliever should still be used in these circumstances.

What other forms do these medications come in?

Tablets and liquids

In tablet form relievers act more slowly. They are used for children who can't manage inhalers and spacers or when inhaled treatment does not seem to work. There are mixtures/suspensions, short-acting tablets, and long-acting tablets.

Side effects such as fast heartbeat, tremor, headache, hyperactivity are more likely, because the medicine affects more parts of the body and the dose is higher.

Theophyllines

These are a separate group of swallowed relievers. They come as long-acting tablets or sprinkles (little granules that are sprinkled on food). They do need a bit of care and an occasional blood test is needed to check the dose.

Side effects can be experienced, even if the dose is not high. These may include: tummy upsets, headache, shakiness, wakefulness. Because of this, theophyllines are not popular.

Steroid tablets

Steroid treatment is very effective for an attack of asthma that is not clearing with inhaled medicines. It helps get rid of the build-up of swelling and mucus in the breathing tubes so the usual medicines then start to work again.

Steroid tablets are taken in short courses for a number of days - your doctor or self management plan will tell you how many. Except at the start of treatment, the total daily dose is taken in the morning. They take four to six hours to start working.

Temporary side effects while on a short course may include indigestion, mood changes, increased appetite and weight gain. These only last while on this medicine. For small children and those who cannot take tablets, a liquid form of prednisolone is most suitable.

A small number of people with severe asthma will need to take steroids all the time. Doctors try to keep the dose as low as possible to avoid side effects.

How do I take inhaled medicine?

When you breathe the medicine into your lungs, it gets to where it is needed, the dose is small, and unwanted side-effects are few. You can use:

• an aerosol (traditional puffer), with or without a spacer. A spacer is a device which attaches to the inhaler. The medicine is sprayed into one end and is breathed in from the other. A spacer is especially useful when someone is breathless during an asthma attack, and for young children under two years of age, when used with a mask
• automatic inhaler
• dry powder inhaler.

Inhalers with new CFC-free propellants are being introduced. They are less damaging to the ozone layer. The inhaler has been redesigned and will feel and taste slightly different, but should work just as well as the old inhalers.

Having a written self management plan or child asthma plan from your doctor, nurse or asthma educator is the best way to monitor your asthma and help you understand how to make your asthma medicines work best for you.