Do you know asthma treatment? All treatment of asthma patients

Personal asthma action plan

As part of your initial assessment, you should be encouraged to draw up a personal asthma action plan with your GP or asthma nurse. If you have been admitted to hospital because of an asthma attack, you should be offered an action plan (or the opportunity to review an existing action plan) before you go home.

The action plan should include information about your asthma medicines and will help you recognize when your symptoms are getting worse and what steps to take. You should also be given information about what to do if you have an asthma attack.

Your personal asthma action plan should be reviewed with your GP or asthma nurse at least once a year, or more frequently if your symptoms are severe.

As part of your asthma plan, you may be given a peak flow meter. This will give you another way of monitoring your asthma, rather than relying only on symptoms.

Taking asthma medicines

Inhalers

Asthma medicines are usually given by inhalers, which are devices that deliver the drug directly into the airways through your mouth when you breathe in. Inhaling a drug is an effective way of taking an asthma medicine as it goes straight to the lungs, with very little ending up elsewhere in the body. However, each inhaler works in a slightly different way. You should have training from your GP or nurse in how to use your device. This should be checked at least once a year.

Spacers

Some inhalers emit an aerosol jet when pressed. These work better if given through a spacer, which can increase the amount of medication that reaches the lungs and reduces the side effects. Some people find using inhalers difficult, and spacers can help them. However, spacers are often advised even for people who use inhalers well as they improve the distribution of medication in the lungs. Spacers are plastic or metal containers with a mouthpiece at one end and a hole for the inhaler at the other. The medicine is 'puffed' into the spacer by the inhaler and then breathed in through the spacer mouthpiece. Spacers are also good for reducing the risk of thrush in the mouth or throat, which can be a side effect of inhaled asthma medicines.

Reliever inhalers

Reliever inhalers are taken to relieve asthma symptoms quickly. The inhaler usually contains a medicine called a short-acting beta2-agonist. It works by relaxing the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again. Examples of reliever medicines include salbutamol and terbutaline. They are generally safe medicines with few side effects, unless over used. However, they should rarely be necessary if asthma is well controlled, and anyone needing to use them three or more times a week should have their treatment reviewed.

Everyone with asthma should be given a reliever inhaler, also known simply as a reliever. It is often blue.

Preventer inhalers

Preventer inhalers work over time to reduce the amount of inflammation and 'twitchiness' in the airways and prevent asthma attacks occurring. You will need to use the preventer inhaler daily for some time before you gain the full benefit. You may still occasionally need the reliever inhaler (usually blue) to relieve symptoms, but if you continue to need them often, your treatment should be reviewed.

The preventer inhaler usually contains a medicine called an inhaled corticosteroid. Examples of preventer medicines include beclometasone, budesonide, fluticasone and mometasone. Preventer inhalers are often brown, red or orange.

Preventer treatment is normally recommended if you:

• have asthma symptoms more than twice a week
• wake up once a week due to asthma symptoms
• have to use a reliever inhaler more than twice a week

Smoking can reduce the effects of preventer inhalers.

Inhaled corticosteroids can occasionally cause a mild fungal infection (oral thrush) in the mouth and throat, so rinse your mouth thoroughly after inhaling a dose. For more information on side effects, see below.

Other treatments and 'add on' therapy

Long-acting reliever inhaler

If your asthma does not respond to treatment, the dose of preventer inhaler can be increased in discussion with your healthcare team. If this does not control your asthma symptoms, you may be given an inhaler containing a medicine called a long-acting reliever (long-acting bronchodilator/long acting beta2-agonist or LABA) to take as well. Or you may be given an inhaler combining an inhaled steroid and a long-acting bronchodilator in the one device, called a 'combination' inhaler. These work in the same way as short-acting relievers, but they take longer to work and can last up to 12 hours. Examples of long-acting reliever inhalers include formoterol and salmeterol

Only use your long-acting reliever inhaler in combination with the preventer inhaler and never by itself. Studies have shown that using only a long-acting reliever can increase the chance of an asthma attack and can even increase the risk of death. Examples of combination inhalers include Seretide, Symbicort and Fostair. These are usually purple, red and white, or maroon.

Preventer medicines

If treatment of your asthma is still not successful, additional preventer medicines will be tried. Two possible alternatives include:

• leukotriene receptor antagonists (montelukast): tablets that block part of the chemical reaction involved in inflammation of the airways
• theophyllines: tablets that help widen the airways by relaxing the muscles around them

If your asthma is still not under control, you may be prescribed regular oral steroids (steroid tablets). This treatment is usually monitored by a respiratory specialist (a specialist in asthma). Long-term use of oral steroids has possible serious side effects, so they are only used once other treatment options have been tried. See below for more information on the side effects of steroid tablets.

Occasional use of oral steroids

Most people only need to take a course of oral steroids for one or two weeks. Once your asthma is under control, you can be 'stepped-down' to your previous treatment.

Omalizumab (Xolair)

Omalizumab, also known as Xolair, is the first of a new category of drugs. It binds to one of the proteins involved in the immune response and reduces its level in the blood. This reduces the chance of an immune reaction happening. The National Institute for Heath and Clinical Excellence (NICE) recommends that omalizumab can be used in people with frequent severe asthma attacks which require visits to A&E or hospital admission.

Omalizumab is given as an injection every two to four weeks. It should only be prescribed in a specialist centre. If omalizumab does not control asthma symptoms within 16 weeks, the treatment should be stopped.

Bronchial thermoplasty

Bronchial thermoplasty is a relatively new procedure not yet widely available. In some cases it may be used to treat severe asthma by reducing airway narrowing.

The procedure is carried out either with sedation or under general anesthetic. A bronchoscope (a type of hollow tube) containing a probe is inserted through the mouth or nose into the airway and expanded so it touches the airway wall and heated. Three treatment sessions are usually needed with at least three weeks between each session.

There is some evidence to show this procedure may reduce asthma attacks and improve the quality of life of someone with severe asthma. However, the long-term risks and benefits are not yet fully known.

You should discuss this procedure fully with your clinician if the treatment is offered.