Asthma

Asthma is a common lung disease. It is caused by narrowing of the airways in the lungs which is partially or completely reversible. Symptoms of asthma include wheezing, coughing, chest tightness, and shortness of breath. These symptoms tend to come and go, and are related to the degree of airway narrowing in the lungs.

Asthma can usually be treated successfully. This requires being well informed about the disease and being an active player in managing it.

Triggers

In many patients, a trigger for asthma can be identified, and avoiding the trigger forms an important part of treatment. Some common triggers are:

• Allergens (including dust, pollen, and animal dander)
• Irritants – exposure to chemicals or cigarette smoke.
• Respiratory infections, often a virus.
• Physical activity – exercise induced asthma
• Certain medicines – including anti- inflammatories like aspirin and beta blockers
• Emotional stress

Symptoms

Asthma symptoms can be classified into intermittent or persistent.

Intermittent asthma - this is where asthma symptoms occur less than 3 days per week, symptoms do not generally interfere with daily activities, oral steroid treatment is rarely needed, and one gets night-time symptoms two or fewer nights per month.

Persistent asthma — patients in this group have regular symptoms which can interfere with daily activity, and there may be frequent night symptoms at night.

Treatment

Treatment depends upon the severity, as well as your level of symptom control. Avoiding triggers (see above) is an important part of treatment.

• Relievers

  ‘Short-acting’ bronchodilators (eg Salbutamol) are quick acting, and relax the muscles around narrowed airways. It is usually taken as an inhaler or occasional by nebulizer. If someone is requiring frequent use of their reliever medication (usually more than 2 days a week), a preventer should be considered (see below).They are generally well tolerated, but side effects include feeling shaky/anxious and a rapid heart rate.

• Preventers

  These medicines are best taken on a regular basis. The doses and types of preventers prescribed depend upon asthma severity and level of symptom control.

• Inhaled steroids decrease inflammation (swelling) of the airways. Regular use reduces frequency of symptoms, risk of serious asthma flare-ups and improved quality of life. Very little of any inhaled steroid is absorbed into the bloodstream, and there are few systemic side effects. The most common side effects are oral thrush, hoarse voice and sore throat. The side effects may be different with different steroids. Rare side effects of long-term high-dose treatment include glaucoma, easy bruising of the skin, osteoporosis and cataracts. Examples of inhaled steroids are Fluticasone, Budesonide and Ciclesonide.
• Long-acting bronchodilators are used together with an inhaled steroid, for those with persistent asthma. They work for a longer period of time than the ‘short-acting’ bronchodilators mentioned above and some have a quicker onset of action compared to others. Examples are Salmeterol and Eformeterol. (Indacaterol is not licensed in Australia for asthma).
• Sodium Cromoglycate can be an alternative to inhaled steroids, however, are generally less effective than inhaled glucocorticoids. They are also less convenient because they must be used three or four times daily. It can be useful in exercise induced asthma.
• Leukotriene antagonists (eg. Montelukast) are an alternative to inhaled steroids (but less effective than steroids) .They open narrowed airways, reduce inflammation, and reduce mucus production. They are taken by mouth as a pill and are well tolerated. They can be used to prevent symptoms before exposure to a trigger or before exercising.
• Oral steroids (eg Prednisone) - its best role is in the treatment of acute flare-ups. Due to side effects, and with availability of inhalers, long term use is discouraged.

An Asthma Care Plan

This is a plan made by the health care provider, which provides a written guideline on medication use and when to seek help. It is based on peak flow readings or on symptoms. Every asthmatic should have an asthma care plan which is reviewed regularly.

A peak flow meter is an inexpensive, but extremely useful device that every asthmatic should have, and use regularly. It gives a quick assessment of one’s lung function, and can detect a flare up of asthma even before overt symptoms develop.

Why is My Asthma Not Controlled?

There are many reasons for poor asthma control. Some of these are:

• Is the diagnosis right? Other conditions such as vocal cord dysfunction, COPD and lesions in the trachea can cause similar symptoms. A good quality spirometry is essential, and a diagnosis should never be made on the basis of symptoms alone.
• Am I on the right medications, at the right dose?
• Is there an issue with compliance? (medicines don’t work if not taken as prescribed)
• Is the inhaler technique right? A good technique vastly improves the amount of drug delivery compared to a poor technique. A spacer should always be used with metered dose inhalers.
• Are the triggers controlled? Trigger avoidance is an important part of treatment