national Asthma Day - Tips for Controlling Asthma
Asthma is a disease caused by an overactive immune response and characterised by the symptoms, of cough, wheeze, tight chest or the inability to breathe. Asthma ‘attacks’ where a person is struggling for breath are an extremely frightening medical emergency that can sadly lead to death. It is therefore vital to control asthma symptoms, to prevent this occurring. Not only is there a risk of severe asthma attack if symptoms are left uncontrolled, but there is good evidence to suggest that poorly controlled asthma can lead to chronic changes in the airways that can be difficult to alleviate.
By far the best way to control asthma symptoms is to take the prescribed medication. Most asthmatics will be prescribed inhalers, a few will be prescribed a pill, but the important thing is to take the medication as prescribed by your asthma nurse, and to attend regular check ups to assess asthma control.
Inhaled asthma drugs fall mainly into two categories, reliever drugs and preventer drugs:
Reliever medication
These are usually inhaled medications that open up the airways, making it easier to move the air in and out, hence they relieve immediate symptoms. They fall into three types of drug:
Short acting beta agonists, such as Salbutamol, or Terbutaline. These work quickly and last for up to four hours.
Long acting beta agonists, such as Salmeterol, or Formoterol. These last for up to 12 hours, but should only be used in conjunction with an inhaled steroid, as they can mask symptoms of inflammation, and severe asthma exacerbation (flare up) can result.
Anticholinergics, such as Ipratroprium Bromide, ‘Atrovent’ – only used in some cases.
Preventer medication
These are inhaled medications that soothe the irritation and inflammation within the airways, which caused by the autoimmune response, so they are vital in reducing asthma symptoms. It is important to use a preventer twice a day on a regular, basis and to keep using it, even when you feel well. An asthmatic should not stop this medication without talking to an asthma nurse first. Common inhaled steroids are, Beclometasone, Fluticasone, Ciclesonide and Mometasone.
Combination therapy
Many asthmatics now have inhalers that combine a steroid with a long acting reliever, so that they can take their inhalers twice a day and simply forget that they have asthma. For example, Seretide combines the inhaled steroid Fluticasone with the long acting beta agonist Serevent.
How do you tell when asthma is poorly controlled?
Most people would think that they know their own symptoms, but it’s amazing how often an asthmatic doesn’t realise that they are coughing, because they have just become used to it. Good control of symptoms is characterised by:
No daytime symptoms (cough, wheeze, tight chest)
No night time symptoms
No need to use the reliever
No exacerbations (flare ups) of the illness
No limitations to exercise
Asthma guidelines suggest that if a person uses their reliever three times a week, or more, that their symptoms are POORLY controlled, and they should visit their asthma nurse. Using a reliever three times a week equates to around two inhalers per year.
For some people, measuring their peak flow rate twice a day can help them recognise when their asthma is poorly controlled, this involves blowing into a little tube like meter and is something that an asthma nurse can teach a person to do. In uncontrolled asthma the peak flow is much lower first thing in the morning than in the evening.
If you want to know what to do if someone is having an attack, click here.
Self Help
Asthma is an illness that needs careful management by the individual alongside the asthma nurse or doctor. The most important method of management is to take preventer medication regularly and to use the reliever when needed. However, there are other things that the person can do to help themselves:
Allergen avoidance
This is easy if it’s a matter of avoiding a type of animal, for example, but less easy if it’s something like avoiding cold weather, or house dust. Nevertheless, some house dust reduction methods have been shown to work, such as barrier coverings for bedding and pillows, removal of carpets from the home, damp dusting, removal of soft toys from the bedroom, improved ventilation and possible humidification, and washing bedding at high temperatures (above 55C).
Smoking Cessation
It’s amazing how many asthmatics will say ‘Oh I don’t like taking my preventer, because it’s a steroid,’ but then will continue to puff away at twenty cigarettes a day. In reality, the dose of steroid in an inhaler is tiny, and highly beneficial if taken regularly, whereas twenty cigarettes a day is highly likely to affect your health detrimentally.
Smoking cessation is an important factor in protecting respiratory health. It’s also vital not to smoke around children, and there is good research to suggest that even third hand smoke (that smoke on clothing and hair) is dangerous to young children, so it’s best not to have contact with them for one hour after smoking. Read more about the hazards of smoking here.
Breast-feeding has a protective effect on early life wheezing in children.
Weight reduction is important for symptom control.
Butekyo breathing exercises have been shown to help patients control symptoms, and hence reduce the need for reliever medication, although they have no effect on lung function.
In short early diagnosis and compliance with treatment are the best way to treat asthma, alonsgside sensible precautions at home.
Information is current as printed in 2010 in accordance with the British Thoracic Society and UK National Asthma Guidelines.
