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Asthma

Asthma treatment

Medications for asthma

Controller (preventer) medicines | Rescue medicines

There are many safe, effective medicines that can help you control your asthma. You 'll need a doctor's prescription to get these medicines. You will also need special advice on when and how to use each kind of medicine.

Because asthma symptoms are variable - they can get worse or better, depending on many things - you need to know how to adjust your medicines depending on your symptoms. Your doctor can create a personalised asthma action plan for you. This written plan will explain how to adjust your medicine depending on your symptoms.

Your doctor, pharmacist, or Certified Asthma Educator can also:

  • Explain how each of your asthma medicines works
  • Answer your questions
  • Show you how to use your medicine inhalation device (your metered-dose inhaler, spacing chamber, Turbuhaler, etc.).
  • Teach you how to use a peak flow meter to monitor your breathing
Preventer and rescue medicines work together

There are two main kinds of asthma medicines: preventer medicine and rescue medicine. Each medicine is important, and each medicine does a different thing for your lungs.

For most people with asthma, the doctor will prescribe both kinds of medicine:

  1. Asthma preventer (controller) medicine : You take your preventer medicine every day, even if you have no symptoms, to make sure your airways stay clear and to prevent redness, mucus and swelling.
  2. Asthma rescue medicine: You keep your rescue medicine on hand and take it only when you need it - during an asthma attack, if your breathing gets bad, or (sometimes) before exercising.

Some people think they can skip the preventer medicine and only use the rescue medicine. This is dangerous. If you've been prescribed a preventer medicine, use it. The rescue medicine by itself won't control your asthma over the long term.

To make sure you get all your medicine into your lungs, be sure you know how to use your inhalation device (metered-dose inhaler, spacing chamber, Diskus, etc.).

Asthma preventer medicines

Basic information about asthma preventer medicines:

  • Preventer medicine WON'T help right away in an asthma attack
  • Preventer medicine is often in a orange- or red-coloured device
  • Preventer medicine acts slowly
  • Preventer medicine works over the long term
  • Preventer medicine reduces swelling and mucus in your lungs (corticosteroids) or work long-term to keep your airways open (long-acting bronchodilators)
  • You take preveter medicine every day, even if you have no symptoms

If you take preventer medicine as directed:

  • Your asthma will be better controlled
  • You will help prevent asthma attacks
  • You won't need to use your rescue medicine (blue puffer) so often
  • Your rescue medicine will work better and faster, because your lungs will be in better shape

It's really important to take your preventer medicine as directed, even when you don't have symptoms. If you don't take the preventer medicine that your lungs need, your lungs will be weaker. Without your preventer medicine, you 'll be more sensitive to your asthma triggers and more vulnerable to an asthma attack.

There are different kinds of preventer medicines:

Inhaled corticosteroids

Inhaled corticosteroid are the most common and effective type of asthma preventer. They are inhaled, not swallowed, so they go straight to your lungs and give you fewer side effects than pills. To get the most out of your medicine, it's important you know how to use your inhaler device.

Corticosteroids for asthma are NOT the same as the muscle-building steroids that some athletes use. Some athletes take anabolic steroids, a totally different kind of steroid. Corticosteroids used to treat asthma are not the same thing, and don't have the same risks or effects.

Examples of inhaled corticosteroids: budesonide (Pulmicort®), fluticasone (Flovent®)

What inhaled corticosteroids do: inhaled corticosteroids reduce the inflammation (swelling, redness, and mucus) in your airways.

Side effects of inhaled corticosteroids: For a full list of side effects, see your doctor or pharmacist. In most cases, inhaled corticosteroids have few side effects with the dose needed to control asthma. Most side effects happen in the throat:

  • Hoarseness and sore throat
  • Thrush or yeast infection (looks like a whitish layer on your tongue).
  • You can prevent thrush by rinsing your mouth, gargling and spitting out the water after you take an inhalation and using a holding chamber with your metered dose inhaler(if that is the device you are using).

Your doctor adjust your dose so you get the best asthma control using the least amount of medication.

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Corticosteroid pills

Sometimes, the swelling in people's airways is severe - this may be because they have a chest infection or for some other reason. In cases of severe airway swelling, the doctor may prescribe corticosteroid pills. Corticosteroid pills basically do the same thing as inhaled corticosteroids, but they are more powerful. Doctors often prescribe these pills for a short time, to get the swelling under control.

Examples of corticosteroid pills: Prednisone, Prednisolone (PediaPred®), and Dexamethasone (Decadron®)

What corticosteroid pills do: Corticosteroid pills reduce the swelling, redness, and mucus in the airways.

Side effects of corticosteroid pills: For a full list of side effects, see your doctor or pharmacist.

In the short term (prescriptions that last 3-7 days) side effects of corticosteroid pills may include:

  • Increased appetite, mood changes, water retention, hyperactivity in children

In the long-term (prescriptions that last many months), side effects of corticosteroid pills may include:

  • Increased appetite
  • Weight gain
  • Stomach irritation
  • Bone thinning
  • Dependency: your body can go into withdrawal if you stop taking prednisone all of a sudden. your doctor will ask you to taper off your dose slowly.

If your asthma is not controlled using only inhaled corticosteroids, your doctor may add on another preventer medication. Other preventers also need to be taken regularly. These include:

Long-acting bronchodilators

Doctors usually prescribe long-acting bronchodilators for people whose asthma isn't controlled by inhaled corticosteroids alone. Long-acting bronchodilators are inhaled medicines. They are always prescribed with inhaled corticosteroids and should not be takenwithout an inhaled corticosteroid.

Examples of long-acting bronchodilators: salmeterol (Serevent®), formoterol (Foradil®, Oxeze®)

What long-acting bronchodilators do: Long-acting bronchodilators work slowly, over a 12 hour period. They help to keep the airways open and the muscles relaxed. They help to prevent asthma episodes (attacks).

Because long-acting bronchodilators take many hours to open airways, they should not be used as rescue medication.

You should keep taking your inhaled corticosteroids while taking long-acting bronchodilators.

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Combined inhaled corticosteroids and long-acting bronchodilators

If you need to both a corticosteroid and a long-acting bronchodilator, your doctor may prescribe one inhalation device that has both of these medicines in it. That makes it easier to take your medicine on a regular basis because you can take them together.

Examples of combination asthma medicines:

  • Symbicort®: Made of a corticosteroid (budesonide / Pulmicort®) plus a long-acting bronchodilator (formoterol / Oxese®)

    This medicine is also approved for use as a rescue medicine - see below
     
  • Advair®: Made of a corticosteroid (fluticasone / Flovent®) plus a long-acting bronchodilator (salmeteral / Servent®)
Leukotriene receptor antagonists

Leukotriene receptor antagonists are come in the form of a pill you take every evening. Leukotriene receptor antagonists act against one of the inflammatory components of asthma and provide protection against bronchoconstriction (airways muscles squeezing tightly).

For people with mild asthma, doctors may prescribe leukotriene receptor antagonists alone.

Doctors may also prescribe leukotriene receptor antagonists to people who are already taking inhaled corticosteroids, with the idea that the relief they get from leukotriene receptor antagonists will allow them to (slowly) reduce their dose of corticosteroids and still keep their asthma under control.

Examples of leukotriene receptor antagonists: zafirlukast (Accolate®), montelukast (Singulair®)

Side effects of leukotriene receptor antagonists: For a full list of side effects, see your doctor or pharmacist. In general, side effects with are very rare. Occasionally, people notice these side effects from leukotriene receptor antagonists:

  • Headache
  • Dizziness
  • Heartburn
  • Upset stomach
  • Tiredness
Theophylline

Theophylline is not commonly used in the treatment of asthma. It is taken in the evening if shortness of breath disturbs sleep, or regularly if asthma is severe. Theophylline levels can be affected by other medications - ensure your physician is aware of all the medications you are taking, including over-the-counter drugs.

Examples of theophylline: TheoDur®, Uniphyll®, Phyllocontin®, TheoLair®

What theophylline does: Theophylline is an oral bronchodilator that works directly on the airway muscle to relax it.

Side effects of theophylline: For a full list of side effects, see your doctor or pharmacist.

Some side effects of theophylline include:

  • Diarrhea
  • Nausea
  • Heartburn
  • Loss of appetite
  • Headaches
  • Nervousness
  • Rapid heart beat
  • Upset stomach

The right dose is important and must be determined by your doctor.

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Asthma rescue medicines

Basic information about asthma rescue medicine:

  • Rescue medicine helps during asthma attacks- take it right away
  • Rescue medicine is usually in a blue-coloured device
  • Rescue medicine acts quickly
  • Rescue medicine reduces the effects of asthma triggers like exercise and cold air
  • Rescue medicine lasts a short time
  • Rescue medicine makes your tight airway muscles relax
  • Usually, you take rescue medicine when you need them - only when you have symptoms. You may also take some before exercising

It's important you keep your rescue medicine close by, so it's there when you need it.

If your asthma is under control, you won't need to take rescue medicine more than 3 times a week (except with exercise). If you use your rescue medicine more than 3 times a week, tell you doctor. Find out what you can do to get your asthma under control.

Combination corticosteroid and long-acting bronchodilator as a rescue medicine

Health Canada has approved a combination corticosteroid and long-acting bronchodilator for use as a rescue medicine to take when asthma symptoms get suddenly worse. Symbicort, a combination of the corticosteroid budesonide / Pulmicort®) plus a long-acting bronchodilator (formoterol / Oxese®), has been used as an asthma preventer medicine to reduce symptoms over time. Symbicort is now also approved for use as an asthma rescue medicine. Your doctor may tell you to take Symbicort morning and evening, as a preventer, and may also advise you to take it as a rescue medicine, when you feel your symptoms getting worse.

Short-acting bronchodilators

You take short-acting bronchodilators as needed, for quick relief of asthma symptoms.

When to use short-acting bronchodilators

  • For quick relief during an asthma attack
  • To relieve the symptoms of cough, chest tightness, wheezing and shortness of breath
  • Fifteen minutes before exercising, as prescribed by your doctor

Examples of short-acting bronchodilators:

  • salbutamol (Ventolin®, Apo-Salvent®, Novo Salmol®, Gen-salbutamol®, Alti-Salbutamol®, Airomir®)
  • fenoterol hydrobromide (Berotec®)
  • terbutaline sulfate (Bricanyl® inhaler - Bricanyl® pill is not a rescue medicine as such)

Side effects of short-acting bronchodilators: For a full list of side effects, ask your doctor or pharmacist). short-acting bronchodilators are safe when used properly; for example, when you are experiencing symptoms or before exposure to a trigger.

Some common side effects of short-acting bronchodilators are:

  • Trembling
  • Nervousness
  • Flushing
  • Increased heart rate

If you are using your short-acting bronchodilators too much (more than three times a week besides with exercise), it may mean your asthma is not under good control. It may mean that you have lots of inflammation (swelling and redness) in your airways that need to be treated. Use your asthma action plan and follow the instructions. You may need to increase your asthma preventer medicine until your asthma is under good control.

During a serious asthma attack, while you wait for ambulance to arrive, it is safe keep taking puffs of your rescue inhaler every few minutes . If your asthma keeps getting worse and you are on your way to the hospital keep taking your rescue inhaler.

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