How is asthma treated?
What is a nebulizer?
How is asthma treated?
The goals of treatment are:
Relief of acute symptoms
Control of airway symptoms
Reduce underlying inflammation
Removal of allergy triggers
There are some excellent treatments available to help you to control your asthma. The most effective way of taking most asthma treatments is to inhale the medicine so it gets straight into your lungs. There are many different inhalers available and it is important that you use an inhaler that you are comfortable with and can use properly. Your doctor or asthma nurse will advise you on the most appropriate inhaler for you and should show you how to use it correctly.
There are two main types of asthma medicine which are equally important but do different things. They are called relievers and preventers.
Reliever inhalers are usually blue and you take them when you have symptoms (like wheeze or cough). They work quickly by relaxing the muscles surrounding the narrowed airways making it easier to breathe. Reliever inhalers are essential in treating asthma attacks. If you need to use your reliever inhaler 3-4 times a week, you should go back to your doctor or nurse and have your asthma reviewed so that you can keep it under control. If you continue to need a lot of reliever medicine over a long time there is a risk that it will become less effective in you and your asthma may worsen.
Preventer inhalers usually come in brown, red or orange. They work by controlling the swelling and inflammation in the airways, stopping them from being so sensitive and reducing the risk of severe attacks. The effect of preventer inhalers builds up over a period of time and they need to be taken every day, usually morning and evening, even when you are feeling well. Preventers contain a steroid medicine. It is important to understand that the steroids contained in preventer medicines are not the same as anabolic steroids used by athletes to improve their performance.
There are other types of medicine that can be added to your reliever and preventer inhaler if needed, such as preventer tablets, long-acting relievers and combination inhalers (usually red and white or purple).
What is a nebulizer?
A nebulizer changes medication from a liquid to a mist so that it can be more easily inhaled into the lungs.
Nebulizers are particularly effective in delivering asthma medications to infants and small children and to anyone who has difficulty using an asthma inhaler.
It is also convenient when a large dose of an inhaled medication is needed. Nebulized therapy is often called a "breathing treatment."
And a variety of medications -- both for immediate relief and maintenance of asthma symptoms -- are available for use with a nebulizer.
What Questions To Ask Your Doctor About Asthma Treatment
Asthma Questions for Your Doctor
You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with asthma. By talking openly and regularly with your doctor, you can take an active role in your care.
General Tips for Gathering Information
Here are some tips that will make it easier for you to talk to your doctor:
Write out your questions ahead of time, so you don't forget them.
Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.
Consider keeping a diary of your symptoms, asthma triggers, and a schedule of your medications. Share this with your doctor during every visit.
Specific Questions to Ask Your Doctor
About Your Risk of Developing Asthma
Based on my medical history, lifestyle, and family background, am I at risk for asthma?
How can I decrease my risk of asthma attacks?
About Treatment Options
What is the best treatment for me?
What should I do if I am having an asthma attack?
What medications are best suited for my asthma condition?
What are the benefits/side effects of these medications?
Will these medications interact with other medications, over-the-counter products, or dietary or herbal supplements I am already taking for other conditions?
Are there any alternative or complementary therapies that will help me?
About Lifestyle Changes
Is it safe to exercise?
Are there certain exercises that are safer than others?
Are there any foods that I should avoid?
Should I avoid alcohol?
I'm a smoker. Where can I find help for quitting?
Do I need to avoid pregnancy because of my medications?
If I become pregnant, should I stop or restrict intake of asthma medication?
Is there something in my home and/or work environment that may cause asthma? If so, what can I do about it?
How can I modify my environment to reduce asthma attacks?
About Outlook
How will asthma affect my activities?
Will I continue to have asthma for the next several years?
Will I have asthma all my life?
Will the severity of the asthma change?
Will asthma shorten my life expectancy?
Will my children have asthma?
Is there any further testing that can be done?
What further treatment do you recommend?
Will you be prescribing something new? What are the side effects?
What is an MDI (inhaler)? What is a spacer?
Am I using my MDI (inhaler) correctly?
What is a peak flow meter? How do I use it? How often?
I have heard that some medications are ‘second-line’ treatments. What does that mean?
Are steroids in asthma medicines safe for me to take?
Why can't I take tablets to control my asthma?
How do I know if my asthma is getting worse?
What you must do during an attack
Are there things I can change in my life to reduce my risk of an asthma attack?
What kinds of tests will I need to monitor my asthma?
How do I use an asthma inhaler?
Are there some alternative therapies I can use along with my asthma medications?
Is it safe to exercise with asthma?
Why do I need an asthma action plan?
Does stress trigger asthma?
Are you aware of any asthma support groups?
Will complementary therapies help me to control my asthma?
Where can I go to get more information?
Do you have an interpreting service?
What is meant by good asthma control?
Good asthma control should mean that you can lead a normal
life. You should be able to do what you wish and participate in any activities unrestricted by your asthma. For most people, good control
means not noticing you have it! This should be possible for all but a small
percentage of people whose asthma is more severe.
How can I tell if my asthma is well controlled?
There are certain things which can indicate how well controlled
you asthma is or whether it may be getting worse. The table below summarises
some general signs which reflect how well you are. Remember that you do
not have to have all the signs: only one can indicate good or bad control.
| |
Sign of Control |
Good Control |
Poor Control or Worsening
Asthma |
| |
Asthma Symptoms |
No symptoms or as few as possible.
|
Your symptoms are getting worse. This
could be:
(a) You have some asthma symptoms when previously you had none.
(b) Your asthma symptoms are occurring more frequently.
(c) Your asthma symptoms are lasting longer when they come on.
(d) Your asthma symptoms are disturbing your sleep or waking you at night
|
| |
Peak Flow |
Peak flow is stable.
This means:
(a) Readings remain in your green zone.
(b) No morning dip.
(c) Diurnal variation of less than 20%.
|
Peak flow is not stable.
This can include one or more of the
following:
(a) Readings not all in your green zone.
(b) Signs of a morning dip.
(c) Diurnal variation above 20%.
|
| |
Activities |
Your normal activities are not restricted
by your asthma in any way. |
Your normal activities are restricted
in some way by you asthma. |
| |
School/work |
You do not miss school or work because
of your asthma. |
You have to take time off
school or work because of your asthma.
|
| |
Reliever Use |
You hardly need your reliever inhaler
at all. |
You need your reliever inhaler frequently.
|
Note:. Asthma is a very
variable condition. Not everyone will have the same signs of good or poor
control. The signs can also vary in one person from one time to another.
You should work closely with your doctor or nurse in establishing what applies
to your individual asthma.
What should I look for when monitoring my
asthma?
When you are monitoring your asthma, you will generally
be looking for signs of how well you are. Examples are the best way to answer
this question, so we will refer to the situations outlined in the question
When is monitoring particularly useful?
in Why Bother? Remember, these are general
guides on what to look for, and refer to the signs of how well you are as
illustrated in the table in the previous question How
can I tell if my asthma is well controlled?
| |
If Your Doctor is Not Sure it is
Asthma.
Look for any signs which indicate asthma is present.
These can be summarised as:
(a) An unstable peak flow which can include:
i Readings not in your green zone.
ii Signs of a morning dip.
iii Diurnal variation greater than 20%.
(b) Symptoms of asthma which:
i. Tend to come and go and are not present all the time.
ii. Are brought on by exercise.
iii. Are brought on by one or more common trigger factors.
iv. Are worse at night and in the early morning, then start to improve
by the middle of the day. |
| |
If You Have Just Been Diagnosed
With Asthma
If you have just found out you have asthma then the
chances are that you will have started on one or more treatments.
You would therefore be looking for an improvement in your condition
and a move from signs of poor control to signs of good control. How
long this takes to happen will depend on the treatments you have been
given. |
| |
If Your Medication is Changed in
Any Way
(a) Increasing Your Medication
Look for an improvement in your condition, and a move from signs of
poor control to signs of good control. The time you take to improve
and how much you improve will depend on a number of things:
i. If the change is an increase in your current preventer, it will
depend on how much the dose goes up by.
ii. If your asthma has been very bad for a long time, you may take
longer to see an improvement. If, however, you are normally well controlled
and have had an asthma attack, you may recover more quickly.
iii. If a medication is being added to your current medication(s),
the time you take to improve will depend to some extent on the type
of medication. For example, if you already take a preventer and you
doctor is adding in serevent (a long acting reliever), you should
notice an improvement in a day or two. If you only had a relief medication
in the past, and are being started on a preventer, the steroid based
preventer inhalers take between 7 - 10 days to work so you will probably
see a gradual improvement during this time.
iv. Your individual asthma! If you have severe asthma, which is more
difficult to treat, you may only notice a slight benefit. This may
be in how well you feel rather than a specific improvement in your
peak flow and other asthma indicators. This 'feel good' factor is,
however, very important to people with more severe asthma.
(b) Decreasing Medication
If you are decreasing your medication, monitoring will ensure you
do not miss any signs that your asthma is becoming uncontrolled. You
would therefore be looking for signs of poor asthma control creeping
in. Remember, only decrease your medication on the advice of your
doctor or nurse! |
| |
To Check That You Really Are as
Well as You Can be!
Make sure you really are as well as you can be by
looking for any signs of poor asthma control. Most people with asthma,
with the correct treatment and education, should not suffer regular
symptoms and their peak flow should be stable. |
| |
If You are Trying to Establish
Your Personal Best Peak Flow
Look for your very highest peak flow reading over
a 2 - 3 week period. Make sure this is when your asthma is stable
and you are as well as you can be. |
| |
If You Suspect Something is Making
Your Asthma Worse But are not Sure What it is
If you are trying to identify what is triggering your
asthma, look for any signs of poor control after contact with anything
you suspect as a trigger. This can be quite difficult and is explained
more fully in Getting to Know Your Triggers!
|
| |
If You Have Recently Had an Asthma
Attack
The time you take to fully recover from an asthma
attack will vary depending on your individual asthma, the treatments
you are given and how severe your attack was, amongst other things.
What you should see is a move from indicators of poor control to good
control. Even when monitoring shows you are back to normal, look out
for any signs that your condition is worsening if you are advised
to reduce your medication or you have just finished a course of oral
steroid tablets. |
Note:. All these guidelines
on interpreting the results of asthma home monitoring are general. You are
strongly advised to discuss your individual asthma with your doctor or asthma
nurse.
Are there any common patterns to look out
for?
There are a number of common patterns which can occur in
asthma. Establishing common patterns between symptoms, peak flow, triggers
and medication can help you keep yourself well. Monitoring your asthma can
help you identify these patterns. Some possible patterns are summarised
below.
| |
A Change in Peak Flow Before any
Change in Symptoms
It is not uncommon for peak flow to become unstable
before asthma symptoms come on or get worse. This is why peak flow
monitoring is so useful: you may be able to detect changes early enough
to prevent a bad asthma episode. The change in peak flow may present
as a falling average peak flow, an increase in diurnal variation and/or
the presence of a morning dip. The time over which the change occurs
will vary. It may be over a number of days or it may be just the day
before the symptoms come on that you notice changes. |
| |
An Increase in Symptoms Before
Change in Peak Flow
Although less common, sometimes your asthma symptoms
may come on or become worse before your peak flow shows signs of becoming
unstable. |
| |
A Change in Symptoms and/or Peak
Flow after Contact with a Trigger
A huge benefit of home monitoring is as an aid to
identifying your triggers. This can sometimes prove a difficult task!
The reasons for this are explained in Getting
to Know Your Triggers. You may be able to establish patterns over
time between changes in peak flow and/or symptoms that can help in
identifying your triggers. Go to Case
Study V: Identifying Your Triggers for an example. |
Why might my asthma get worse?
There are a number of reasons why your asthma may be uncontrolled
or getting worse. It is important to discuss your particular problems with
your health professional. However, there are several common reasons why
you may not be as well as you should be. The main reasons are summarised
below. Fortunately, most of them are surprisingly easy to remedy!
| |
Not Taking Medication Regularly
Forgetting to take your medications each day can cause
your asthma to worsen. If you are fortunate enough to have very mild
asthma, your only medication may be the occasional puff of immediate
reliever as needed. However, many people with asthma require daily
preventer medication(s) as well. It is very easy to fall into bad
habits and forget the odd dose or day here and there. It does not
take long for the symptoms to creep back in! |
| |
Poor Inhaler Technique
You may be shown how to use your inhaler when you
are first prescribed it by the doctor. It is very easy to fall into
bad habits when using inhalers. The slightest change in your technique
can mean the difference between getting all the medication or none
at all! Make sure you have your technique regularly reviewed.
|
| |
Your Inhaler is Past its Expiry
Date
If you are using an old inhaler you must check the
expiry date. The medication will not have the same effect once this
date has past. |
| |
Old or Dirty Spacer Device
If you use a spacer, it is essential to follow the
cleaning instructions supplied with the device. If you do not keep
it clean, the medication will stick to the inside surfaces instead
of passing into your lungs when you breathe in. Your spacers should
also be changed regularly. Check the manufacturers recommendations
on the leaflets that accompany your spacer. Speak to your doctor or
nurse if you are unsure as to when to change your spacer or how to
clean it correctly. |
| |
Contact with Trigger(s)
You may previously have come into contact with a trigger
that has made you asthma worse. Sometimes, contact with one trigger
makes your airways even more twitchy and sensitive to other things.
Alternatively, there maybe something in your everyday environment
which is responsible for your symptoms on a daily basis. This is why
it is important to get to know your triggers. |
| |
Not on Best Treatment to Keep you
Well
Owing to the variable nature of asthma, it may just
be that you are going through a 'bad patch' with no specific identifiable
reason. This usually requires a change in your medication. This might
mean increasing the dose of what you already take, changing to a different
medication or adding in something else. There are many options available
and changes can usually be made to improve your asthma. You should
discuss this with your doctor or nurse. |
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