Beating Asthma. Seven Simple Principles

A simple intervention to help manage asthma patients
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Beta-2 agonists, such as salbutamol, are reliever inhalers. Salbutamol is useful because it causes rapid bronchodilation and hence eases the symptoms of asthma. For example, a Ventolin Evohaler will cause rapid bronchodilation onset within five minutes in reversible airway diseases such as asthma. The effect will last for four to six hours. This is, of course, useful in acute situations or pre-exercise but is rarely the answer to managing asthma on a long-term basis.

Breathe easy by understanding the disorder and minimizing triggers of asthma

The preventer inhaler usually an inhaled steroid alone or in combination with a long-acting beta-2 agonist inhaler has been shown to be effective at reducing and often reversing the inflammatory response. Overall compliance with preventer inhaled corticosteroids ICS was poor, with low repeat prescription fill rates both for patients treated with ICS alone and for those treated with ICS in combination with a long-acting beta agonist LABA. The management of asthma is complex, and successful treatment depends on factors beyond the compliant use of preventative inhalers.

That said, community pharmacists should be monitoring compliance of patients using preventer inhalers as part of the clinical check. If a patient is overusing a beta-2 agonist inhaler, it is not unlikely that they are underusing the inhaled steroid preparation. Spotting this as part of the clinical check in the dispensing process and then engaging with the patient in England through a medicines use review or in Scotland through the chronic medication service could help the prescriber manage the patient and lower the risk of asthma exacerbation. For community pharmacists, there is no better time to have this chat than when dispensing the inhaler.

This type of intervention is simple, requires no access to the patient record, does not depend on the pharmacist being a prescriber, and also can easily be completed in a busy community pharmacy.

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Whether you suffer from asthma or someone you love does, you and your family have the right to be in control. And you can. Beating Asthma: Seven Simple. Editorial Reviews. About the Author. Dr. Apaliski has been a practicing physician for over 30 Seven Simple Principles - Kindle edition by Stephen Apaliski.

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Spirometry measures the volume breathed in and out during inspiration and expiration, and can help your doctor determine whether there is obstruction. Your doctor will test your lung function before and after taking a bronchodilator medication. If your lung function improves, it is highly suggestive of asthma. Another measurement, called peak expiratory flow rate PEFR , is useful for monitoring your lung function over time and demonstrating the variability in lung function that is characteristic of asthma. Some patients only experience asthma symptoms during exercise.

Your doctor may perform spirometry before and after you do exercise. This can help diagnose exercise-induced asthma. Very rarely, your doctor may perform a test that involves you inhaling small amounts of histamine or methacholine, then taking measurements of your lung function periodically with spirometry. The theory behind this test is that patients with asthma have hyper-reactive airways, so small doses of these agents can lead to constriction of the airways.

What Asthma Looks and Feels Like

A reduction of lung function with increasing doses of these agents supports the diagnosis of asthma. Skin prick testing involves making several small pricks to the skin of the arm, and introducing small amounts of common allergens. The wheal which occurs over each site is an immune reaction; a large or long-lasting wheal indicates a hypersensitivity to the allergen.

This may identify allergic asthma triggers. Common allergens tested for by skin prick tests include dust mite, cat, dog, grass pollens and mould. Diagnosis of asthma in children is much more difficult. Unfortunately for young children, there is no definitive test to diagnose asthma. Only children older than 6 or 7 are able to adequately perform spirometry or peak expiratory flow rate to produce reliable measurements of lung function.

If your child is less than this age, it may mean your doctor cannot definitively say whether your child does or does not have asthma, which may be frustrating for you. In younger children, your doctor can try giving bronchodilator medications and seeing if there is a detectable clinical response. They can also perform some of the allergy tests described above, such as RAST or skin prick tests, to determine whether your child has an allergic tendency.

Furthermore, while atopy supports the diagnosis of asthma, it does not give a definite answer. There are a large number of people who live with asthma, many of whom are able to gain good control with no symptoms from day to day.

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Asthma should not prevent you from leading a fulfilling life or stop you from competing actively in sports and other hobbies. However, you should remember that asthma can be a potentially fatal disease and it is important to have your asthma regularly reviewed by your doctor, even when you are well. Figures show that approximately Australians die from asthma attacks per year, many of which are preventable.

Your doctor will be able to provide support and advice for you to achieve this. You and your doctor should work together as a team to devise a personal management plan and recognise when your symptoms are becoming worse. Asthma management involves more than just simple medications. Your doctor will try to devise a management plan which allows you to:. Medications for asthma include relievers, preventers and symptom controllers. Reliever medications are taken when an asthma attack happens, and before exercise to prevent attacks in those suffering from exercise-induced asthma.

Pharmacological classes of bronchodilator include B2 receptor agonists e. Ventolin and Bricanyl , ipratropium bromide e. Atrovent , and methylxanthines e. Reliever medications may also be taken by nebuliser, in which a solution of the medication is converted to a mist of small droplets by a flow of oxygen or air through the solution. This mist is then inhaled. Preventer medications are directed at preventing the bronchial hyper-reactivity and airway inflammation that occurs in asthmatics.

Pharmacological classes include corticosteroids , cromones and leukotriene receptor antagonists. They are taken regularly, irrespective of asthma symptoms, usually by puffer.

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Different people have different triggers for their asthma. What's your Asthma Score? Monitoring parameters including daily symptoms, nocturnal awakenings, albuterol use, exercise tolerance, peak expiratory flow in selected patients , and timeframe see Table Not at all. Publisher's Summary Whether you suffer from asthma or someone you love does, you and your family have the right to be in control. Skin prick testing involves making several small pricks to the skin of the arm, and introducing small amounts of common allergens. Pharmacotherapy Updates.

Side effects include oral thrush, hoarse voice, cough and, occasionally, adrenal gland suppression causing hormonal imbalance. Corticosteroid tablets oral are given as preventers to some patients with severe chronic asthma, but are usually only used in the treatment of severe asthma attacks. Cromones include Intal, Intal forte, and Tilade. They are inhaled from a puffer and side-effects are less common. The puffers need to be cleaned daily. Leukotriene receptor antagonists include Singulair and Accolate, and are taken as tablets.

They are commonly used in children with less severe asthma. Side effects are less common than with corticosteroids. Symptom controllers are long-acting relievers such as Oxis and Serevent. These are taken as puffers once or twice a day for people who still have symptoms when taking regular preventers. Symptom controllers can allow people with more severe asthma to reduce their steroid dose and hence minimise side effects without causing more symptoms of asthma to appear. As most asthma medications are taken by puffers, it is very important to use the correct technique.

At least one third of puffer users do not use their puffer correctly. This means that medication does not reach the lungs, and has a substandard effect. The most effective way to deliver medication via a puffer metered dose inhaler or MDI is in combination with a large volume spacer such as a Volumatic. This is a device that attaches to the puffer and allows more medication to be delivered to the lungs. Spacers are so effective at delivering medication that they are often used in emergency departments for acute asthma attacks instead of nebulisers, as studies have shown that they are at least as effective as nebulisers and are less expensive.

If a spacer is not available, the following technique is suitable for adults and children over the age of seven. Turbuhalers and Accuhalers are widely used as an alternative to MDIs. These are breath-activated devices which deliver medication in dry powder form and do not require a spacer.

Simply prime the puffer as shown in the instruction leaflet, then breathe deeply over seconds through your mouth and hold your breath for about 10 seconds before breathing out. Management of asthma in children follows the same general principles as management in adults, but there are some important differences due to variations in the severity, pattern and natural history of the disease, and potential for side effects in children. Like adults, a similar 6-step asthma management plan should be followed which involves regular review and follow-up.

It is also important that you understand the difference between preventer and reliever medications. Preventer medications should be taken every day as they inhibit underlying inflammation. Reliever medications are used to treat acute attacks. The majority of children have only mild infrequent episodic asthma. Most of these children can be managed with a bronchodilator medication as required. However, if your child has recurrent asthma symptoms, your doctor will need to start an anti-inflammatory medication.

Children are more susceptible to the side effects of long-term medications, so care must be taken to find the lowest effective dose.

Children with frequent intermittent or mild persistent asthma are often prescribed one of three classes of medications: inhaled cromones, oral leukotriene receptor antagonists, or low dose inhaled corticosteroids. The former are particularly effective for exercise-induced asthma in children, but are rarely used in adults. Children with more severe persistent asthma are usually managed with steroids.

Coordinating the inhaler technique is often difficult for children. It is therefore very important that children use their puffers in conjunction with a spacer device to ensure enough medication gets in the lungs. This also avoids local side effects from steroid preventers e.

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Children younger than 5 years should use a small volume spacer. Those above 5 should start on a large volume adult spacer as their lungs take in a greater volume of air. Children younger than 3 years should use a mask in conjunction with their spacer. Your doctor will demonstrate how to use these devices. Children using a large volume spacer use the same technique described above.

Those using the smaller spacers should take 5 deep breaths in and out following each puff. Acute attacks of asthma may require hospital admission. Here the doctors will administer regular bronchodilator medications such as salbutamol Ventolin and ipratropium Atrovent. These are usually given via a puffer and spacer, but are occasionally given via a nebuliser machine.

Beating Asthma Seven Simple Principles

You will also be administered oxygen and be closely monitored. Most adults and children will be given a short course of oral steroids following the acute attack. In very severe attacks it may be necessary for you to be intubated, ventilated or sent to ICU. Appropriate follow-up is essential to review medications, triggers and your asthma plan, in order to avoid future severe attacks. Please go to our Supportive Care section for doctor accredited support and public awareness groups on asthma. Health Engine Patient Blog. Tools Med Glossary Tools.

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Looking for a practitioner? HealthEngine helps you find the practitioner you need. Find your practitioner. What are you looking for? Search for articles. Popular searches How can I relieve my back pain? Children's Health. Men's Health. Women's Health. What is asthma? Statistics on asthma Risk factors for asthma Progression of asthma Symptoms of asthma Clinical examination of asthma How is asthma diagnosed?

Prognosis of asthma How is asthma treated? References What is asthma? For more information about the respiratory system, see Anatomy of the Respiratory System. Asthma is sometimes divided into four main groups as follows: Atopic asthma: This is the most common and classic type of asthma.

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Patients normally have relatives who have atopic asthma, and themselves experience other allergic diseases e.