The mode of action of non-steroidal inhalers is not completely understood. These non-steroidal alternatives are considered to be less effective preventer therapies but they may be of value in treating allergic asthma.
There are two alternative non-steroidal preventer inhalers available; one is called Intal (sodium cromoglicate) CFC-free 5mg Metered Dose Inhaler (MDI) and the other is called Tilade (nedocromil sodium) CFC-free 2mg MDI. These medications need to be taken up to three or four times a day on a regular basis and this may be difficult to adhere to. Another factor for consideration is that Tilade (nedocromil sodium) has been reported to have a particularly bitter taste and for some people this unpleasant taste, may result in poor compliance.
Intal Spincaps (sodium cromoglicate) which came in a dry powder form and was used with a Spinhaler Insufflator have been discontinued. The Intal CFC-free MDI was introduced in September 2008 to replace this.
Asthma may go through good and bad patches, and when asthma becomes severe there is increased inflammation (swelling and soreness) in the airways and often a sticky mucus or phlegm is produced, which causes asthma symptoms. If your asthma symptoms become severe, your doctor or asthma nurse may give you a short course (3-14 days) of steroid tablets.
Steroid tablets work quickly and powerfully to help to calm your inflamed airways. Short courses of steroid tablets are also used to treat acute asthma attacks and are used for essential emergency treatment of asthma attacks.
The British Guideline on the Management of Asthma (2008, revised 2012) recommends the following daily doses; it is important to remember that under-treating the inflammation in the airways with a lower dose of prednisolone and/or not enough days of treatment can leave some inflammation behind and cause asthma symptoms to return.
Prednisolone (under 2 yrs)
10mg (usually 2 small tablets) to be taken all at once in the morning and for a minimum of three days.
Prednisolone (2-5 yrs inclusive)
20mg (usually 4 small tablets) to be taken all at once in the morning and for a minimum of three days.
Prednisolone (6-12 yrs inclusive)
30-40mg (usually 6 - 8 small tablets) to be taken all at once in the morning and for a minimum of three days.
Prednisolone (adults and children over 12 yrs)
40-50mg (usually 8 - 10 small tablets) to be taken all at once in the morning and for a minimum of five days.
Although prednisolone should be taken for a minimum of three days for children aged 12 years and under, and a minimum of five days for adults and children over 12 years they may need to be continued for longer. If you finish a short course of steroids but are not back to normal, you should visit your doctor. It is important that the tablets are not stopped before full recovery.
- Having few or no symptoms of cough, wheeze, tightness in the chest and shortness of breath.
- Hardly using the reliever inhaler.
- Peak flow reading should also be back to personal best (for children over the age of five and adults).
Stopping regular steroid tablets: A warning
When you are taking regular tablet steroids your adrenal gland becomes lazy, and makes less of its own natural steroids. This means you have less ability to cope with infections or deal with physical stress.
Long courses of steroid tablets (three weeks or more) can be stopped only by gradual reduction and under the guidance of your doctor or asthma nurse. If they are stopped suddenly you will be very vulnerable to infection and less able to cope with any crisis such as an operation. For this reason the doses should be reduced slowly over weeks or months.