Asthma management

About asthma

Asthma is an inflammatory disease of the airways in the lungs.

The airways are very sensitive and swell up in response to certain triggers. The muscles in the airways tighten and the airway lining becomes swollen and inflamed, producing sticky mucous.

These changes cause the airways to become narrow, making it difficult to breathe and causing typical asthma symptoms, such as coughing, wheezing, chest tightness and shortness of breath.

A flare-up can come on slowly over hours, days, or even weeks, or quickly over minutes.

Why asthma management is important

Medication is essential to manage asthma well. Good asthma care also involves treating other conditions that can affect asthma, such as hay fever or allergic rhinitis.

A healthy lifestyle can help you stay in control of your asthma symptoms and feel well.

With good asthma management, you can lead a normal, active life. Following your personal written asthma action plan, developed with your doctor, is the best way to keep your asthma under control.

An asthma action plan provides simple instructions for routinely managing your asthma, plus advice on what to do if your asthma symptoms flare up.

The main aims of asthma treatment are to:

• keep symptoms under control
• prevent flare-ups or ‘attacks’
• keep lungs as healthy as possible
• stop asthma from interfering with school, work or leisure or sport activities
• help you or your child enjoy a full and active life.

Asthma action plans

Every person diagnosed with asthma should have an asthma action plan. The goal of the asthma action plan is to prevent and control asthma symptoms.

The information on an asthma action plan sets out what steps to take to manage a person’s asthma day to day and what to do during a flare-up, asthma attack or emergency.

There is no ‘standard’ asthma action plan, as everyone’s asthma is different. Your plan needs to be developed to deal with your own triggers, signs and symptoms, and medication.

There are several templates for asthma action plans. Asthma Australia and National Asthma Council Australia provide commonly used asthma action plan templates, that, when completed by a doctor, contain all required content.

Asthma action plans can also be generated using GP medical software or provided by hospitals following admission for asthma.

The person’s asthma should be reviewed with a doctor (GP) every 6 months for children and every year for adults and the plan updated if necessary.

Up-to-date asthma action plans for children should be provided to schools, kindergartens, childcare services or other carers of children with asthma.

Common asthma triggers

Asthma is a big health problem in Australia. More than 2.7 million people have asthma (10.7% of Australians or about 1 in 10 adults and children). While the cause is not always known, allergy often plays a large part.

Asthma can be triggered by a variety of factors, including things in our everyday environment. Triggers can also vary from person to person.

Common asthma triggers include:

• viral infections – such as colds, flu and respiratory conditions
• cigarette smoke and e-cigarettes
• physical activity – having asthma should not stop you from playing sport or exercise, which is essential for your overall health and wellbeing. On advice from your doctor, symptoms can be managed with extra medication or warm-up exercises before you begin
• allergens – such as cockroaches, house-dust-mites and their droppings, pollens, mould and pets
• food – some food and food preservatives, additives, flavourings and colourings, and cold food and drinks (in rare cases)
• irritants in the environment – dust, pollution, gas cooking and heaters, wood smoke and bushfire smoke
• weather – changes in air temperature or thunderstorms
• workplace – wood dust, chemicals or metal salts
• chemicals and strong smells – such as perfumes, incense and household cleaners
• certain medications – including aspirin, anti-inflammatories, echinacea and some blood pressure medicines
• stress or high emotions (including laughter or crying).

Treatment for asthma

The 2 main types of asthma medication are relievers and preventers. Everyone who has asthma needs a reliever to use when they have asthma symptoms.

Some children and most adults with asthma also need to take preventer treatment. This helps to make the airways less sensitive to triggers and reduces the inflammation.

Reliever medication for asthma

Reliever medication is used for an asthma flare-up or emergency. It opens the airways quickly and is taken as needed for immediate relief from asthma symptoms.

Reliever medication is sometimes overused. Using too much, or too often, could lead to side effects, including tremors (shaking or trembling) and a rapid heart rate.

These side effects are not likely to cause harm. However, frequent use of reliever medication may be a sign that your asthma is not well controlled.

If you need to use a reliever more than twice a week for asthma symptoms (apart from use before exercise), see your doctor to review your asthma and medication.

Preventer medication for asthma

Preventer medication makes the airways less sensitive and reduces inflammation and swelling. It needs to be taken as prescribed, regularly over the long term, to be most effective in reducing the risk and severity of any flare-ups.

Most preventer medication for asthma is inhaled corticosteroid. Because the medication goes straight to your lungs where it is needed, the risk of side effects from taking inhaled steroids is very low.

Most adults with asthma can achieve good control of their asthma symptoms with a low dose of inhaled corticosteroid.

Preventer medication for children with asthma

Some children with asthma need to take a regular preventer. This can be an inhaled corticosteroid (like the adult medication).

There is also non-steroid medication available, including a tablet.

Talk to your doctor about the best type of medication for your child – this usually depends on the child’s symptoms and age, as well as how easy it will be to give properly.

Safety and extra preventer medication for asthma

People who use a regular preventer (such as an inhaled corticosteroid), but still get regular asthma symptoms, may need to step up their medication.

These stronger preventers are called ‘combination’ therapies because they include a second medicine and the inhaled corticosteroid. Asthma preventers should be prescribed at the lowest strength that works for you or your child. There is no extra benefit in taking medication that is stronger than you need.

Inhaler devices for asthma medication

Some people need extra help to take their asthma medication and make it work more effectively.

Work with your doctor to decide which device is best for you.

Inhalers are the most common devices for asthma medication. The 4 main types of inhaler devices are:

• Metered-dose inhaler (puffer) – an aerosol canister that produces a fine mist of medication. Always shake the canister before use. It is recommended to always use a spacer (and mask for young children) with your puffer.
• Breath-activated inhaler (autohaler) – a spring-loaded aerosol canister. The medication automatically mists out when you start to breathe in through the mouthpiece. These are good for children and for people who find it hard to coordinate a puffer.
• Dry-powder inhalers – contain medication as a dry powder, rather than liquid like aerosol inhalers. Deep breathing is required to release medication to the lungs. Young children and anyone who struggles with shortness of breath may find these difficult to use.
• Soft mist inhaler – contains add-on medicine.

Watch National Asthma Council videos which show you how to use different types of inhalers, including this video on how to use a standard metered-dose inhaler.

Some other types of medication may be used for more severe asthma. Your doctor may prescribe these additional therapies or refer you to a respiratory specialist.

Spacers for asthma

A spacer is used to make it easier for people with asthma to inhale their medicine.

Using a spacer with an inhaler (puffer) lets more medication reach your lungs and reduces possible side effects from the medication.

A spacer is a special device that looks like a clear tube. It is attached to a metered-dose inhaler.

After shaking the puffer, fire one puff only of the medicine into the spacer, breathe in slowly and deeply, then hold your breath for about 5 seconds or as long as comfortable. If a second dose is required, repeat the same steps.

Young children should breathe in and out normally for 4 breaths, before the next puff is fired into the spacer. The 4 breath technique may also be preferred during asthma flare-ups.

Spacers should be cleaned at least once a month in warm soapy water and allowed to air dry.

Nebulisers for asthma

Nebulisers were once commonly used for asthma. Research suggests a puffer with a spacer works just as well as a nebuliser – they are also easier and cheaper to use and reduce the risk of side effects.

If you still use a nebuliser for taking asthma medication – whether day-to-day or just when symptoms flare up – talk to your doctor about making the switch.

How to take asthma medication effectively

Taking medication regularly can be difficult. It can be easy to forget and many people dislike having to take medication, especially when they feel well and have no symptoms. But it is important to take your medication correctly and follow medical advice.

Tips to help you take asthma medication include:

• Ask your health professional for written instructions on the role of each medicine as part of your asthma action plan. Include details on how, when and how much to take, and what to do if symptoms get worse.
• Know the side effects of your medication so that you know what is and isn’t normal.
• Ask your doctor if your medication can be simplified, such as using one device for all your medications.
• Ask for a device that you feel comfortable with. There are special aids for people who have trouble coordinating inhalers (puffers).
• Make sure you know how to use your devices correctly. Ask your doctor or pharmacist to check your technique at every opportunity.
• Create memory aids to remind yourself to take your asthma medication, such as before brushing your teeth in the morning and evening.

If you have any concerns, talk to your doctor, asthma educator or pharmacist.

Tips for parents and carers of children with asthma

All the above tips also apply to children. Useful tips to help your child manage their asthma include:

• Generally, your child can take their preventer medication before and after school.
• As your child gets older, involve them in decisions about their asthma medications and management.
• Linking asthma medication to your child’s own goals can help. For instance, a child who loves sports may take asthma medication more readily if they know it helps them participate.

Other medication and asthma triggers

Some medication for other health conditions can make asthma symptoms worse and trigger an asthma flare-up or attack.

It is very important that you inform your doctor and pharmacist that you have asthma when a new medicine is prescribed to you or when you are buying over-the-counter medication or complementary therapies (for example, echinacea, propolis and royal jelly).

If you feel a particular medicine is making your asthma worse, treat your symptoms and contact your doctor immediately.

Some medicines known to trigger asthma symptoms in some people include:

• aspirin – contained in some medication, such as pain relievers
• non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen (Nurofen) and naproxen (Naprogesic)
• beta-blocker tablets – often used to control high blood pressure
• beta-blocker eye drops – to treat the eye condition glaucoma
• ace inhibitors – often used to control high blood pressure.

Asthma first aid

An asthma flare-up (attack) can take anything from a few minutes to a few days to develop. It can be a very frightening experience. Anyone who is having an asthma attack needs immediate help.

The 4 steps of asthma first aid are:

1. Sit the person comfortably upright. Stay calm and reassure them.
2. Without delay, give the person 4 separate puffs of their blue/grey reliever medication (such as Airomir, Asmol, Bricanyl or Ventolin). If using an inhaler/puffer (such a Ventolin or Asmol), this should be taken one puff at a time via a spacer. Ask the person to take 4 breaths in and out of a spacer after each puff of medication. Repeat until 4 puffs have been given.
3. Wait 4 minutes. Stay with the person – watch carefully and reassure them. Call triple zero (000) for an ambulance at any time if you need to. Say that someone is having an asthma attack.
4. After 4 minutes:
   • Worse or better? If getting worse or severe breathing problem, call triple zero (000) for ambulance NOW. Keep giving 4 puffs every 4 minutes until ambulance arrives. (Give 4 separate puffs, 4 breaths with each puff.)
   • Still hard to breathe? If the person still cannot breathe normally, give 4 more puffs. If still cannot breathe normally within a few minutes, call triple zero (000). Keep giving 4 puffs every 4 minutes until ambulance arrives. (Give 4 separate puffs, 4 breaths with each puff.)
   • Breathing normally? If the person feels better and is breathing normally, get them to a doctor for a check-up.

Where to get help

• In an emergency, always call triple zero (000)
• Emergency department of your nearest hospital
• Your GP (doctor)
• Your nearest pharmacy (for medication)
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• National Home Doctor Service Tel. 13 SICK (13 7425) – for after-hours home GP visits (bulked billed)
• National Asthma Council Australia – videos, resources, facts sheets and asthma action plans
  • Asthma first aid – information about how to obtain prompt medical assistance in an emergency
  • My asthma guide – helpful guide to help understand and manage your asthma
• Asthma Australia Tel. 1800 ASTHMA (1800 278 462)
• The Royal Children's Hospital Melbourne – videos to help you better understand and manage your child's asthma
• Asthma Australia Asthma App – asthma information, asthma medication and devices, device technique videos, asthma action plans, asthma first aid steps
• Severe Asthma Toolkit – an evidence-based website developed by clinicians for clinicians, led by the Centre of Excellence in Severe Asthma. It provides educational content on topics relevant to severe asthma and practical resources and tools to guide optimal asthma management by health care professionals