Asthma (Part 2)
Treatment is based on relief of symptoms and preventing future symptoms and attacks from developing.
Short-acting beta 2-agonist (SABA)
These are best known 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.
Preventer treatment is 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.
LABA/ Corticosteroid inhalers Combinations
Examples of combination inhalers containing long-acting beta 2-agonist (LABA eg. salmeterol) that open up the airways and steroids (eg. beclomethasone) that reduce inflammation 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.
Asthmatics are at more risk from COVID-19. Ask your doctor if you are eligible for the second Covid 19 booster. Whelehans Pharmacy Pearse St have a weekly walk-in clinic for Covid-19 boosters. Call 0449334591 for more info.
To be continued…next week I discuss newer treatment options for severe asthma.
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