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Introduction of Medication

There are two main categories of asthma drug treatment: Relievers and controllers.

Based on the level of asthma control, doctors will adjust the combination of drugs and dosage to aim at total control.

  1. Relievers – short-acting bronchodilators (drugs to relax constricted airways)
  2. Controllers –
    • Inhaled steroid
    • Combination medication consisting of inhaled steroid and inhaled long acting bronchodilator
    • Leukotriene modifier
    • Sustained release theophylline
    • Others (oral steroid, Anti- IgE treatment)

Most asthma drugs are given through inhalational forms. In this way, they can be directly delivered to the small airways to take effect to dilate the constricted airways and target at the exact site of underlying inflammation. A smaller dosage of drug will thus be required compared with oral medication and the side effects will be lowered. However, for severe cases, both oral and inhaled medication may be required.

Short-acting bronchodilator

These are rescue drugs for asthma attacks. They expand bronchi rapidly, relieving the symptoms of wheezing and chest tightness, and improve breathing. They are inhaled or in aerosol form.

  • Use short-acting bronchodilators only when needed or recommended by doctors.
  • These drugs provide immediate relief but they are not anti-inflammatory. Do not rely too much on them and neglect the use of preventive medicine.
  • If you use a short-acting bronchodilator as a quick relief for acute attacks three times or more a week, this means that your asthma is not under control. Please see your doctor as soon as you can.
  • Don’t leave home without your short-acting bronchodilator. Use it as rescue drug in case of any attacks.
  • Only patients taking oral medicine will experience side effects such as shaky hands and racing heart.

Preventers

Preventers control the swelling and inflammation in the airways, stopping them from being so sensitive and reducing the risk of severe attacks, but not everyone with asthma will be prescribed preventer medicine.

The protective effect builds up over a period of time so they need to be taken every day (usually morning and evening) even when you are feeling well.

Preventers do not give immediate or quick relief when you are breathless but instead they reduce long-term inflammation. Preventer inhalers usually contain a low dose of steroid medicine.

There are several kinds of preventers, but they all work in the same way. You will be started on an appropriate level of treatment to get your symptoms under control; once this has been achieved the treatment will be reduced to the lowest possible dose.

If your regular preventer medicine and occasional use of your reliever inhaler does not control your asthma you should make an appointment with your doctor or asthma nurse to have a review.

Long-acting reliever inhalers

As the name suggests, long-acting relievers work in a similar way to your usual reliever inhaler but the effects last for longer - around 12 hours instead of four. Long-acting relievers open up the airways by relaxing the muscles that surround the airways and are generally taken twice a day. Long-acting reliever inhalers should only be used if you are also taking a steroid preventer inhaler. They are an add-on therapy and should not be used on their own to treat asthma.

Combination inhalers

Combination inhalers contain both a long-acting reliever and a steroid preventer. They should be taken regularly, every day as prescribed, even when you are feeling well.

One of the combination inhalers available can now be used both as a preventer and as your reliever. This is because the long acting reliever medicine in this particular combination inhaler has been shown to relieve asthma symptoms as quickly as short-acting relievers. If you have been prescribed a combination inhaler your doctor or asthma nurse should explain to you how it works.

Leukotriene receptor antagonists

These are medicines that are sometimes referred to as 'preventer' tablets, but unlike your preventer inhaler they do not contain steroid medicines. If your doctor or asthma nurse prescribes you preventer tablets, they should be taken in addition to your usual preventer inhaler.

Preventer tablets work by blocking one of the chemicals that is released when you come into contact with an asthma trigger. They may be particularly effective if your asthma is triggered by exercise or allergies. Preventer tablets are usually taken once or twice a day, even when you are feeling well. However, if you are prescribed preventer tablets, your doctor or asthma nurse should discuss with you how often you need to take them. If they have no effect after four to six weeks, then they are probably not the right medicine for you and you should discuss other treatment options with your doctor or asthma nurse.

Theophylline

Theophylline works by relaxing the muscles that surround the airways. It is usually prescribed as a tablet and is generally taken twice a day. It is important that your doctor gives you the dose of this medicine that is exactly right for you, so you should have regular blood tests to monitor the levels of theophylline in your blood. If your blood level of theophylline is too low the medicine won't work, but if it is too high it can cause unpleasant side effects. If you are taking other medicines, these can affect how well theophylline works. Smoking can also stop theophylline from working the way it should.

Ensure you tell your doctor if you are taking prescribed, complementary or over the counter medicines or if you are exposed to cigarette smoke. Different brands of theophylline may provide different doses so it is important to check that your pharmacist gives you the exact brand that you have been prescribed. You should continue to take the same brand unless your doctor discusses a change with you.

Xolair

Xolair is the first in a new generation of drugs for severe, difficult-to-control allergic asthma, where patients have an oversensitive immune system. It is a steroid free medication which is given by injection every two or four weeks.

Xolair has been shown to reduce emergency admissions to hospital, improve lung function and reduce asthma symptoms. It is suitable for people over the age of 12 years who have moderate to severe persistent asthma symptoms despite taking regular inhaled corticosteroid treatment.

There are 520,000 people with asthma in the UK for whom existing treatments do not work, and Xolair can provide a solution for around 6,000 of them.

Xolair is only available through respiratory clinics within the hospital following an assessment which will include a blood test to see if it will be suitable. People with persistent asthma symptoms and who have had two or more hospital admissions for asthma over a year may be considered for Xolair.

Combination Medication

Pharmaceutical companies have developed inhalers consisting of inhaled corticosteroid and long-acting bronchodilator. The bronchodilator relaxes the airways and increased airflow while inhaled corticosteroid reduces airway inflammation. They can be prescribed as controllers to prevent asthma attacks.

These inhalers are also known as “combination medication”. They are easy to use and help ensure the necessary dosing of inhaled steroid, which some patients fail to use regularly.