Asthma is an inflammatory disease of the airways in the lungs. These 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.
Medication is essential to manage asthma well. Good asthma care also involves treating other conditions that can affect asthma, such as hay fever. 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 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 or work
- help you or your child enjoy a full and active life.
Causes of asthma
Asthma is a big health problem in Australia. More than two million people have asthma (about one 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. Common triggers include:
- viral infections such as colds and flu
- cigarette smoke
- exercise and physical activity – although exercise and activity are important for people with asthma to boost general health and fitness. Asthma triggered by exercise may be helped by medication or warm-up exercises
- allergens, including house-dust-mite droppings, pollens, moulds and pet dander (skin particles, sweat and saliva)
- dust, pollution, wood smoke and bushfire smoke
- changes in air temperature or weather, including thunderstorms
- workplace triggers such as wood dust, chemicals or metal salts
- chemicals and strong smells, including perfumes and household cleaners
- some medicines, including aspirin and some blood pressure medication
- emotional factors, including laughter or stress
- some foods and food preservatives, flavourings and colourings (in rare cases).
Treatment for asthma
The two 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 a regular preventer treatment every day. Taking a regular preventer makes the airways less sensitive to triggers and reduces the inflammation inside the airways.
Reliever medication for asthma
Reliever medication opens up the airways quickly and is taken as needed for immediate relief from asthma symptoms. This is the medication to use in an asthma flare-up or emergency.
Reliever medication is sometimes overused. Using too much of a reliever medication, or using it 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 being well controlled.
If you need to use a reliever puffer more than two or three times a week for asthma symptoms, apart from use before exercise, you should see a 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 every day, over the long term, to be most effective. Keep taking your preventer even when you have no symptoms, and also during colds and asthma 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 these steroids is very low. Most adults with asthma can achieve good control of their asthma symptoms with a low dose of inhaled corticosteroid.
Some children with asthma need to take a regular preventer. This can be an inhaled corticosteroid (similar to that taken by adults with asthma), but 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.
People who are using a regular preventer (such as an inhaled corticosteroid), but who still get asthma symptoms, may need to step up their preventer. These stronger preventers include a second medicine as well as the inhaled corticosteroid and are called ‘combination’ therapies.
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
There are several different devices that can deliver asthma medication. Typically, asthma medication is inhaled (breathed in), so it can go straight to your lungs where it is needed and can get to work quickly. It is important that you work together with your doctor to decide which device is best for you.
Inhalers are the most common devices for asthma medication. The three main types of inhaler are:
- Metered-dose inhaler (puffer) – this is an aerosol canister that produces a fine mist of medication. You should always shake the canister before use. A puffer is more effective and easier to use with a spacer. Doctors recommend that anyone with asthma uses a spacer with their puffer.
- Breath-activated inhalers (Autohaler) – these have 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 (Accuhaler, Ellipta, Turbuhaler) – these contain medication as a dry powder, rather than as a liquid like the aerosol inhalers. To use a dry-powder inhaler effectively, you need to breathe in deeply to get the medication into your lungs. Young children and people who are short of breath might find dry-powder inhalers hard to use.
A spacer is a special device that looks like a clear plastic football or tube. It is attached to a metered-dose inhaler (puffer). You fire one puff of medication at a time into the spacer and then breathe in and out normally for four breaths. Using a spacer with a puffer lets more medication reach your lungs and reduces possible side effects from the medication.
Spacers come in a variety of shapes and sizes, depending on your needs and age.
Nebulisers were once commonly used for asthma, but these are no longer the recommended way for most people to take their asthma medications. All the latest research shows that a puffer with spacer works just as well as a nebuliser for treating asthma symptoms, including during an asthma attack. A puffer with spacer is also easier, faster and cheaper, is much more portable, and reduces the potential for 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.
Taking your asthma medication
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 doctor, asthma educator or pharmacist about the role of all your medication. Ask for written instructions on how and when to use each one as part of your asthma action plan.
- Know the side effects of your medication so that you know what is and isn’t normal. If you have any concerns, talk to your doctor, asthma educator or pharmacist.
- Ask your doctor if your medication can be simplified. One way is to have the same kind of puffer for all your medication, so you don’t have to get used to several kinds.
- Ask your doctor to give you a puffer that you feel comfortable with. There are special aids for people who have trouble coordinating the ‘press and breathe’ kind.
- Make sure you use your puffers correctly. Ask your doctor, asthma educator or pharmacist to check your technique.
- Create memory aids for yourself, like taking your medication before you brush your teeth in the morning and evening.
Tips for parents of children with asthma
All the above tips also apply to children, but useful tips to help your child manage their asthma include:
- Generally, your child can take their preventer medication before and after school, so they have less need for teacher supervision, and they avoid hassles from other children.
- 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 will take asthma medication if they know it helps them to play better.
Other medication and asthma
Some medication for other 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. If you feel that a particular medicine is making your asthma worse, treat the symptoms and contact your doctor immediately.
Medication that is known to trigger asthma symptoms in some people includes:
- 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 action plan
An asthma action plan is an individual plan created by you and your doctor to help you manage your asthma. The plan advises you about what you must do to stay healthy, and what to do when your asthma is unstable and you need help.
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. It might be based on symptoms, peak-flow readings or both. However, symptom-based plans are usually used for children.
Action plans are available in many different formats, including a handy Z-card that folds down to credit-card size for your wallet or purse. You can also upload it to the Asthma Buddy action plan app on your smartphone.
Contents of an asthma action plan
An asthma action plan includes:
- how to care for your day-to-day asthma (it lists your regular medications and how many times each day you should take them)
- key things that tell you when your asthma is getting worse or an attack is developing, and the steps you should take to manage it
- symptoms that are serious enough to need urgent medical help (with emergency information on what to do if you have an asthma flare-up).
Review your asthma action plan with your doctor every six months, or after a severe asthma flare-up.
Asthma action plans for children
It is just as important for parents to obtain a clear, easy-to-understand written summary of your child’s asthma management in an asthma action plan. This will provide a source of reference to reinforce the advice given by your doctor.
This plan is also an important tool for anyone caring for your child. It provides up-to-date, detailed information (including your child’s emergency first aid plan) to help manage your child’s asthma. You should give a copy of the plan to your child’s school, kindergarten, childcare centre and anyone else caring for your child.
When your child is old enough to understand, make sure that you explain asthma to them and encourage them to be aware of their symptoms and how to treat them.
Asthma first aid
An asthma attack (flare-up) can take anything from a few minutes to a few days to develop. It can be a very frightening experience and people having an asthma attack need help straight away.
The four-step asthma first aid is:
1. Sit the person upright and give reassurance – do not leave them alone.
2. Without delay, give the person four separate puffs of their blue/grey reliever medication (such as Airomir, Asmol, Bricanyl or Ventolin). If using a puffer (like Ventolin or Asmol), this should be taken one puff at a time via a spacer. Ask the person to take four breaths from the spacer after each puff of medication.
3. Wait four minutes. If there is little or no improvement, repeat steps 2 and 3.
4. If there is still no improvement, call triple zero (000) for an ambulance immediately. Repeat steps 2 and 3 continuously while waiting for the ambulance to arrive.
Where to get help
- In an emergency, call triple zero (000)
- Your doctor
- Asthma educator or practice nurse
- Your local community health centre
- The Royal Children's Hospital has produced a number of videos to help you better understand and manage your child's asthma.
- Asthma Foundation of Victoria Tel. 1800 278 462 (1800 ASTHMA)