When can therapy be reduced?
Once control is achieved and sustained, gradual stepping down of therapy is recommended. Good control is reflected by the absence of night time symptoms, no symptoms on exercise and the use of relievers less than three times a week. Patients should be maintained on the lowest effective dose of inhaled steroids, with reductions of 25-50% being considered every three months.
Spacers are large plastic or metal containers with a mouthpiece at one end and a hole for the inhaler at the other. The medicine is puffed into the spacer by the inhaler and it is then breathed in through the spacer mouthpiece. Spacer devices in combination with metered dose inhalers (MDI) have advantages: a) no need to co-ordinate inhaler activation with inspiration, b) increase in the amount of drug that enters the lungs and c) reduction in deposition of the drug in the mouth and throat (which reduces the risk of oral side effects such as oral thrush). Some inhalers emit an aerosol jet when pressed. These work better if given through a spacer, which increases the amount of medication that reaches the lungs and reduce side effects. Some people, especially children and elderly patients, find using inhalers difficult, and spacers can help them. However, spacers are often advised even for people who use inhalers well as they improve the distribution of medication in the lungs. Spacers are also good for reducing the risk of thrush in the mouth or throat with corticosteroid inhalers. When a spacer device is being used, only one puff of the inhaler must occur at a time. Ask your GP or pharmacist for more details.
Asthma and pregnancy
Medication used for asthma will not cause any problems for the developing baby in the womb. Due to the changes that take place in the body during pregnancy, asthma symptoms may change during pregnancy. For some women asthma improves, for others asthma worsens and for others asthma stays the same. The most severe asthma symptoms experienced by pregnant women tend to occur between the 24th and 36th week of pregnancy. Symptoms then decrease significantly during the last month of pregnancy. Only 10% of women experience asthma symptoms during labour and delivery, and these symptoms can normally be controlled using reliever medication. Asthmatics who are pregnant should manage their asthma in the same way as before pregnancy. The medicines used for asthma have been proven to be safe to take during pregnancy and when breastfeeding. The one exception is leukotriene receptor antagonists (Singulair®). There is no evidence that it can harm babies during pregnancy and breastfeeding. However, there is not enough evidence about its safety compared with other asthma medications.
However, if leukotriene receptor antagonists (Montelukast) are needed to control asthma during pregnancy, the GP or asthma clinic may recommend that they are continued. This is because the risks to the patient and child from uncontrolled asthma are far higher than any potential risk from this medicine.
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