Bronchial Asthma

What are the treatments for asthma?

For most people with asthma, the symptoms can be prevented most of the time with treatment. So, you are able to get on with normal life, school, work, sport, etc.

Inhalers/Rotahalers/Cyclohalers

Most people with asthma are treated with inhalers. Inhalers deliver a small dose of drug directly to the airways. The dose is enough to treat the airways. However, the amount of drug that gets into the rest of your body is small so side-effects are unlikely, or minor. There are various inhaler devices made by different companies. Drugs delivered by inhalers can be grouped into relievers, preventers and long-acting bronchodilators:

  • A reliever inhaler is taken as required to ease symptoms. The drug in a reliever inhaler relaxes the muscle in the airways. This makes the airways open wider, and symptoms usually quickly ease. These drugs are also called bronchodilators as they dilate (widen) the bronchi and bronchioles (airways). There are several different reliever drugs. For example, salbutamol and terbutaline. These come in various brands made by different companies. If you only have symptoms every now and then, then the occasional use of a reliever inhaler may be all that you need. However, if you need a reliever inhaler three times a week or more to ease symptoms, a preventer inhaler is usually advised.
  • A preventer inhaler is taken every day to prevent symptoms from developing. The drug commonly used in preventer inhalers is a steroid. There are various brands. Steroids work by reducing the inflammation in the airways. When the inflammation has gone, the airways are much less likely to become narrow and cause symptoms. It takes 7-14 days for the steroid in a preventer inhaler to build up its effect. Therefore, it will not give any immediate relief of symptoms. However, after a week or so of treatment, the symptoms have often gone, or are much reduced. It can take up to six weeks for maximum benefit. You should then continue with the preventer inhaler every day even when your symptoms have gone – to prevent symptoms from coming back. You should then not need to use a reliever inhaler very often, (if at all).
  • A long acting bronchodilator may be advised in addition to a preventer inhaler. One may be needed if symptoms are not fully controlled by the preventer inhaler alone. The drugs in these inhalers work in a similar way to reliever inhalers, but work for up to 12 hours after taking each dose. They include salmeterol and formoterol. (Some brands of inhaler contain a steroid plus a long-acting bronchodilator for convenience.)

Spacer devices are used with some types of inhaler. They are commonly used by children, but many adults also use them. A spacer is like a small plastic chamber that attaches to the inhaler. It holds the drug like a reservoir when the inhaler is pressed. A valve at the mouth end ensures that the drug is kept within the spacer until you breathe in. When you breathe out, the valve closes. So, you don’t need to have good co-ordination to inhale the drug if you use a spacer device. A face mask can be fitted on to some types of spacers, instead of a mouthpiece. This is sometimes done for young children and babies who can then use the inhaler simply by breathing in and out normally through the mask.

Tablets to open up the airways

Most people do not need tablets as inhalers usually work well. However, in some cases a tablet (or in liquid form for children) is prescribed in addition to inhalers if symptoms are not fully eased by inhalers alone. Various tablets may be used which aim to open up the airways.

Steroid tablets

A short course of steroid tablets (such as prednisolone) is sometimes needed to ease a severe or prolonged attack of asthma. Steroid tablets are good at reducing the inflammation in the airways. For example, a severe attack may occur if you have a cold or chest infection. Some people worry about taking steroid tablets. However, a short course of steroid tablets (for a week or so) usually works very well, and is unlikely to cause side-effects. Most of the side-effects caused by steroid tablets occur if you take them for a long time (more than several months), or if you take frequent short courses of high doses.

Omalizumab

Omalizumab is a drug that is only used in a small number of people who have severe persistent allergic asthma that has not been controlled by other treatments. So, it is not a common treatment. It is given by injection. It works by interfering with the immune system to reduce inflammation in the airways which is present in asthma.

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