Asthma (Part 2)
Treatment is based on relief of symptoms and preventing future symptoms and attacks from developing.
Short-acting beta 2-agonist (SABA)
A short-acting beta 2-agonist (SABA) opens the airways and is best known to patients as a reliever inhaler. These work quickly to relieve asthma. They work by relaxing the muscles surrounding the narrowed airways. Examples of beta 2-agonists include salbutamol and terbutaline. They are usually blue in colour. They are generally safe medicines with few side effects unless they are overused. It is important for every asthmatic to have a beta-2 agonist inhaler. If an asthmatic need to use their beta agonist inhaler too regularly (three or more times per week) should have their therapy reviewed.
Corticosteroid inhalers are slower acting inhalers that reduce inflammation in the airways and prevent asthma attacks occurring. The corticosteroid inhaler must be used daily for some time before full benefit is achieved. Examples of corticosteroids used in halers include beclomethasone, budesonide, and fluticasone. Corticosteroid inhalers are often brown, red, or orange. The dose of inhaler will be increased gradually until symptoms ease. For example, a patient may start on a beclamethasone 100mcg inhaler and may be put on a beclamethasone 250mcg inhaler if there is not enough improvement in symptoms.
Preventer treatment is normally recommended if the patient:
- has asthma symptoms more than twice a week
- wakes up once a week due to asthma symptoms
- must use a reliever inhaler more than twice a week
Regular inhaled corticosteroids have been shown to reduce symptoms, exacerbations, hospital readmissions and asthma deaths. The main side effect of corticosteroid inhalers is a fungal infection (oral candidiasis) of the mouth or throat.
This can be prevented by rinsing the mouth with water after inhaling a dose.
Long-acting reliever inhalers (LABA)
If short acting beta 2-agonist inhalers and corticosteroid inhalers are not providing enough symptom relief, a long-acting reliever (long-acting beta 2-agonist or LABA) may be tried. Inhalers combining an inhaled steroid and a long-acting bronchodilator (combination inhaler) are more commonly prescribed than LABAs on their own. LABAs work in the same way as short-acting relievers, but they take longer to work and can last up to 12 hours. A salmeterol inhaler is an example of a long-acting reliever inhaler. Long-acting reliever inhalers should only be used in combination with a preventer inhaler. Studies have shown that using a LABA on its own (without a combination corticosteroid) can increase asthma attacks.
LABA/ Corticosteroid inhalers Combinations
Examples of combination inhalers containing long-acting beta 2-agonist and steroids include Seretide® and Symbicort®. Combination inhalers containing beta 2-agonists and corticosteroids can be very effective in attaining asthma control.
Long-acting muscarinic antagonists (LAMAs)
Long-acting muscarinic antagonists (LAMAs) have been long recognised in the treatment of chronic obstructive pulmonary disease (COPD). Recently a LAMA inhaler, tiotropium (in the form of Spiriva® Respimet) has been approved as an add-on therapy in patients with poorly controlled asthma. LAMAs work by opening narrowed airways for at least 24 hours.
Occasional use of oral corticosteroids
Most patients only need to take a course of oral corticosteroids for one or two weeks. Once the asthma symptoms are under control, the dose can be reduced slowly over a few days. Oral corticosteroids can cause side effects if they are taken for more than three months or if they are taken frequently (three or four courses of corticosteroids a year). Side effects can include weight gain, thinning of the skin, osteoporosis, hypertension and easy bruising.
To be continued…next week
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