Asthma treatment top tips – what everyone with asthma should knowFacts | 13/09/2023
Before we delve into the different treatments, Dr Murphy highlighted the importance of understanding what asthma actually is. “Asthma is the airways overreacting to triggers such as pollen or animal dander, meaning the airways become inflamed and swollen, “angry”. Managing asthma is all about trying to prevent the airways becoming overactive and controlling inflammation in the airways”.
What is the standard treatment for asthma?
“A low dose of an inhaled steroid should be taken one to two times a day (depending on your prescribed inhaler). This coats the inside of the airways and helps to reset the immune system, preventing chronic inflammation over time” explained Dr Murphy. “The aim of treatment is always to prevent symptoms and exacerbations. Sometimes airways can become tight. When this happens, a reliever inhaler is used to open them up to relieve symptoms. To reduce these asthma flare ups, it’s better to control asthma from the beginning with regular use of inhaled steroids – this reduces the need to use the reliever inhaler”.
Are there any long-term negative effects of using inhalers associated with asthma treatment and if so, is there a way to reduce these?
“People are often worried when they hear the word ‘steroid’, however in most people with asthma the inhalers use a very low dose of steroid which shouldn’t cause side effects.” clarified Dr Murphy. “The most common side effects asthma patients do experience are getting a hoarse voice, or a fungal infection in the mouth, however, these are often caused by incorrect inhaler technique. Overusing the reliever inhaler can also cause some patients to have a tremor, cramp in their hands and a racing heart which can cause anxiety.”
You mentioned that some people use an incorrect inhaler technique – what technique should people be using when using inhalers to ensure maximum efficacy?
“Good inhaler technique is vital as the drug needs to be able to enter the airways” highlighted Dr Murphy. “All inhalers can be grouped into two types of devices. If you have an inhaler with a canister, often called a “puffer”, “spray” or metered dose inhaler the drug comes out very fast when pressed, so you must breathe in slowly and steadily over three to five seconds to avoid the medicine hitting the back of your throat and you swallowing the medicine. Ideally, these devices should be used with a spacer device, which slows down how you breathe in and avoids the need to co-ordinate pressing the canister and inhaling correctly. If you are using any inhaler, you should sit upright with the chin up. However, if you have a dry powder inhaler you should breathe out first, put the inhaler mouthpiece in your mouth and then take a quick and deep breath in (over 2-3 seconds). If somebody is unsure of their inhaler technique, they should speak to a healthcare professional. I would advise everyone using inhalers to have their inhaler technique checked once a year as we often pick up bad habits over time. There are also lots of helpful videos online!”
Combination inhalers are used nowadays widely in asthma treatment. How do these combination inhalers work?
“Combination inhalers contain a steroid medicine to treat and prevent inflammation, and a drug which opens up the airways to relieve symptoms.” explained Dr Murphy. “We often start with prescribing a low dose inhaled corticosteroid, and if that doesn’t work, would add in the drug which keeps the airways open to be used as a combination inhaler. Increasingly, we may advise patients to use this type of combination inhaler twice a day every day but also advise that they can use it when they develop symptoms such as chest tightness, wheeze etc. to quickly improve asthma, instead of a separate reliever inhaler”
Aside from inhalers, what other treatments are available for asthma?
“If asthma is not well controlled with current inhaler treatment, it can be stepped up with additional medications after assessing the treatment with the physician. Most medications are inhalers, but there are some tablets and injections available also. A tablet called an antileukotriene antagonist may help some patients, and some patients with severe asthma benefit from medicines called biologics, which are given as an injection. Steroid tablets are not the preferred option in regular treatment anymore due to potential side effects, but in treating exacerbations (flare-ups), they are still essential”
Is there anything else about asthma treatment which you think it is important for patients to know about?
“Nasal symptoms are common in many people with asthma. It’s good to try and reduce symptoms so that you’re able to breathe through your nose. Treatments such as nasal steroid sprays will help calm everything down and improve nasal symptoms but also often asthma control as well” highlighted Dr Murphy. “Another consideration is the weather which can affect many people with asthma. High pollen count, hot and muggy weather and thunderstorms can have a big impact on asthma – antihistamines and using your regular inhalers containing steroid medicine will help with these triggering your asthma. Finally, it is essential that people understand the importance of using the inhaled corticosteroid every day as prescribed, even when their asthma is under control as this is what will really make a difference to their asthma long term and prevent long-term damage to the lungs. Unfortunately, many people just use their quick acting reliever inhaler thinking that treats asthma, but these reliever inhalers only treat the symptoms not the underlying asthma.
Despite being a chronic condition, there are good treatment options available for patients which can be tailored to their needs. Dr Murphy emphasised that it is crucial for patients to have an “asthma action plan personalised for you and your asthma” and urges people to speak to their healthcare professional if they don’t have one in place.
- Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention 2023. https://ginasthma.org/wp-content/uploads/2023/05/GINA-2023-Full-Report-2023-WMS.pdf (Accessed June 2023)
Date of preparation: September 2023 / EASYH-3417
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