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Management of Asthma


Management of Asthma

Asthma affects 1 in 4 children in New Zealand, and 1 in 6 adults. We have the 2nd highest rate in the World. It is the leading cause of hospitalisation in the under 5 year olds, and approximately 130 people die each year here as a result of severe asthma attacks. 

Asthma causes hypersensitivity (or over-reactivity) of the airways in the lungs. This results in a narrowing of the airways, often in response to certain triggers. Triggers might include:
- changes in weather,
- exercise,
- cigarette smoking,
- pollens,
- dust mites,
- pet fur.

The airway narrowing causes intermittent wheeze, cough and shortness of breath. Anyone can develop asthma, but it often runs in families and is closely associated with both hayfever (allergic rhinitis) and eczema.

Asthma cannot be cured, but with optimal treatment, asthmatics should be able to achieve:
- Minimal symptoms
- No absences from school/pre-school
- Little/no restriction of normal daily activities.

General tips for managing asthma well include:
- Understand your symptoms and reduce your exposure to known triggers.
- Take all asthma medication as prescribed.
- Devise and follow a self-management plan.
- Use a peak flow metre - this can help you recognise when your asthma is bad and you need to increase your medication.
- Keep active - exercise helps lung function and will reduce asthma symptoms.
- Be smokefree.
- Get a flu jab every year.
- Visit your "asthma team" regularly - this may be your GP, a nurse with an interest in asthma, or a respiratory specialist - annual reviews of symptoms and medication are recommended.

Inhalers

Inhalers are the main form of treatment for asthma. There are 3 main medications that are given via inhalers:

1. Bronchodilators :

- Salbutamol (often known as ventolin) and terbutaline (bricanyl).
- These inhalers rapidly and temporarily dilate the airways, relieving symptoms quickly and effectively. They can be used whenever symptoms are present, and also prior to exposure to known triggers (e.g. if taken before exercise they can avoid any symptoms occurring).
- These inhalers are known as RELIEVERS as they give symptom relief.
- They do not necessarily need to be taken regularly, but should be taken in response to symptoms.
- The usual dose is 2 puffs to relieve mild symptoms - and up to 6 puffs if symptoms are more severe. This dose can be repeated every 20 minutes or so if symptoms don't ease.

2. Corticosteroids :
- This group includes beclomethasone (becotide), budesonide (pulmicort) and fluticasone (flixotide).
- These are the primary way of controlling regular asthma symptoms, and are called PREVENTERS.
- Not everyone with asthma will need to use a PREVENTER - if your symptoms are mild and intermittent (less than 3 times a week) you can simply use a RELIEVER. However, people who have more persistent or severe asthma need to take these steroid inhalers REGULARLY as prescribed.
- They are not effective if only used when symptoms are present.
- There are potential long term side effects of steroid inhalers, but these can be minimised by using a spacer device with the inhaler (see below), and by reducing the dose (in consultation with your Doctor) to the lowest needed to control symptoms effectively. 
- They are usually taken twice daily, but the dose or frequency might be increased or decreased by your Doctor at times - e.g. lots of asthmatics will need more treatment over winter months and less during the summer ones.

3. LABAs (long-acting beta agonists):
- This group of inhalers includes salmeterol (serevent) and eformeterol (oxis).
- They are longer-acting versions of the bronchodilators (see above).
- They are added into treatment regimes if a steroid PREVENTER is not sufficient to control symptoms.
- They are highly effective, but again need to be taken REGULARLY every day.

Types of inhalers

There are 2 main types of inhalers used in NZ. Most of the medications above are available in both types of inhalers. Your Doctor or asthma nurse can help you decide which type will suit you best.

1. Metered dose inhalers (MDIs) - the most common. These can and ideally should always be used with a spacer device. This will deliver the maximum amount of medication to the airways and lungs where it is most needed. The spacer also reduces the potential side effects, especially for inhaled steroids. This is also a highly effective way of treating a severe asthma attack - 6 puffs of your bronchodilator given through a spacer has been shown to be as effective as the nebulisers we previously used.

Tips for using spacer and MDI:
- Shake inhaler and hold upright
- Fit end of inhaler into spacer
- Seal lips firmly around the mouth-piece of the spacer
- Press the inhaler once only
- Take 6 breaths in and out through your mouth - do not remove your mouth until all the breaths are done.
- Remove the spacer and repeat the above steps for further doses.
- Wash spacer in warm water and dishwashing liquid every week, and leave to dry - do not rinse. This "primes" the spacer, allowing it to work effectively.

2. Dry powder inhalers - these are a bit more complicated to use, and are only suitable for children over 6 years old. They are popular as they are small and easily portable - so very convenient for using at school or on the sports field. Different brands work in slightly different ways, so make sure you are fully instructed on how your inhaler works, and how to tell when it is nearly finished.

Oral steroids
If your asthma isn't responding to the above medications, your Doctor might recommend a short course of oral steroids, commonly called prednisone. These are available in a liquid form for young children. If you have severe asthma, your Doctor might suggest you have a small supply of prednisone at home to start if your symptoms are getting worse.

Peak Flow Metres
These simple devices record the maximum speed at which air can be forced from our lungs. They can be used to:
- Make the diagnosis of asthma and assess severity
- Establish your best peak flow reading when treatment is optimal
- Assess responses to changes in medication
- Recognise patterns in your asthma over time.

They are available free of charge from your medical centre.

Management Plan
Talk to your Doctor about devising a self-management plan to help you and your family know what to do when your symptoms get worse. It will show you how to step up your inhalers when necessary, and when to call for help.

You can download a plan, and access useful information/education and support, from  www.asthmafoundation.org.nz.


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