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Treatment of asthma

Although there is no cure for asthma most people who have asthma are able to manage the disease and live normal active lives as long as they take good care of themselves and is compliant with their medication.  Famous sportsman such as footballer David Beckham, basketball player Dennis Rodman and marathon runner Paula Radcliffe did not let asthma affect their life.

The goal of good asthma treatment is to control the disease and will achieve the following:

  • Prevent troublesome symptoms such as shortness of breath or coughing

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  • Allows you to maintain normal activity and sleep undisturbed through the night
  • Reduce your need for quick-relief medicines
  • Reduce asthma flareups (exacerbations) and most importantly, prevent asthma attacks that could result in hospital admission

Medication for Asthma

Asthma is treated with two types of medication namely long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms while quick-relief (or ‘rescue’ medicine) is required to relieve asthma symptoms that may flare up.

(a) Long-term medication includes:

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  • Inhaled corticosteroids are the preferred medicine for long-term control of asthma because they reduce inflammation and swelling that makes airways sensitive to allergens
  • Inhaled long-acting beta2-agonists to relax the smooth muscles in the lungs open the airways may be added to inhaled corticosteroids to improve asthma control. Inhaled long-acting beta2-agonists should never be used on their own for long-term asthma control.

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  • Nebulisers using anti-histamines such as Cromolyn as prophylaxis to prevent airway inflammation
  • Oral steroids may be required in severe asthma to get the asthma under control
  • Singular (Montelukast) is a leukotriene inhibitor and is taken orally to relieve symptoms of allergies. It is useful in asthmatics with seasonal rhinitis, eczema and nocturnal symptoms
  • Immunomodulators, such as omalizumab (anti-IgE) is given as injection to reduce to body reaction to allergens

Long-term control medicine must be taken as instructed to control your asthma otherwise asthma symptoms will return or get worse if you stop taking your medicine.

(b) Quick-Relief Medicines

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All asthma patients need quick-relief medicines when asthma symptoms flare up and inhaled short-acting beta2-agonists are the first choice for quick relief.  This must be with you at all times to prevent a possible asthma attack which can occur anytime.

Take the quick-relief medicine the moment you first notice asthma symptoms.

Treatment Plan

The initial treatment plan depends on the severity of your asthma and during the followup period, your doctor will make adjustments to your medications depending on how well the medication is controlling your symptoms and preventing asthma attacks.  Do not worry too much if your asthma control varies over time because the medication will be adjusted to help you maintain the best control possible with the least amount of medicine necessary.

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Asthma treatment for certain groups of people such as children and pregnant women need more supervision as their control many be more challenging.

What is the definition of good asthma control?

Asthma is well controlled if you have:

  • symptoms no more than 2 days a week and don’t wake you up more than 2 nights a month
  • can do all your normal activities
  • take quick-relief medicines no more than 2 days a week
  • have no more than one asthma attack a year that requires you to take corticosteroids by mouth
  • peak flow which doesn’t drop below 80 percent of your personal best number

See your doctor is your asthma is NOT well controlled or if your peak flow score is less than 50% of your personal best score.

Asthma Action Plan

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This plan should describe your how and when to take your daily medications and also what to do during an asthmatic attack.  If your child has asthma, all his caregivers such as teachers or sport coach should be informed of the diagnosis.

You also need taking an active role to control your asthma.  This involves

  • Avoiding things that worsen your asthma (asthma triggers)

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  • Be aware of your environment such as air pollution (wear mask or avoid going out) or weather changes (wear appropriate clothing)
  • Understand your medication and never skip medication. Always have access to quick-relief medication (especially when travelling)
  • Learn to recognise the early symptoms of asthma attack and take appropriate action

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  • Self monitor to track your asthma using a peak flow meter on a regular basis and share the records with your doctor during the clinic followup. You should also record your symptoms to discuss with your doctor at the next visit

References: American Lung Association, National Heart, Lung, and Blood Institute, Asthma Malaysia

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