Asthma
Asthma is a condition that affects the airways leading to your lungs. During an asthma attack your airways tighten, become inflamed and fill up with mucus. This makes breathing more difficult.
Symptoms of asthma include wheezing, being short of breath, and tightness in your chest. Another common symptom of asthma is coughing, especially at night or after exercise. People with asthma also commonly suffer from eczema and/or hayfever as well. Often in young children, cough is the only symptom.
These symptoms may occur suddenly as an 'asthma attack', or they can be present most of the time. During an 'attack', breathing becomes very difficult because of the narrowing of the airways leading to the lungs, and the extra production of mucus. Permanent damage of the airways can occur in people who do not get treatment for their asthma.
New Zealand has one of the highest incidences of asthma in the world, with over 20% of children and 15% of adults diagnosed with this condition. Only a small number of children appear to ‘grow out’ of it. The cause of it is not fully understood.
Asthma cannot be cured, but most people are able to manage it with inhalers or other types of medication so that it does not interfere with their day-to-day life. It is important for people with asthma, or for people who care for others with asthma, to be able to recognise symptoms of worsening asthma and to either get help quickly or to follow a medication plan written by their doctor. Anybody with asthma who develops a dry, nagging cough, especially at night or after exercise, or who has to use their reliever inhaler more often than usual, should talk to a doctor.
Asthma triggers
Asthma triggers do not cause asthma, but may trigger an attack. People vary in their susceptibility to these triggers and common ones include:
Animal fur (especially from cats)
Cigarette smoke
Cold air
Colds and flu
Exercise
House dust mites
Pollen
Stress
Strong perfume
Some medicines
Viral infections (such as the flu).
See Your Pharmacist or Medical Professional
If you are so breathless you cannot finish a sentence or find your reliever inhaler is not helping – get medical help immediately (phone 111 for ambulance).
See your doctor if you have the following symptoms:
If you are having to use your reliever inhaler more than three times a week
If you are waking at night with symptoms
If you have a dry cough every night
If you find your reliever inhaler is not helping as much as it used to
If you do not have a self-management plan and your asthma is getting worse.
If you are concerned about your asthma control, ask your doctor, asthma educator, or pharmacist if you can complete the Asthma Control test. This is a simple 5-minute test that will give you and your health professional a better idea of how good your asthma control has been. It is also a good idea to repeat this test every 3 months, so that any problems with your asthma control can be recognised early.
Treatment Tips
Check with your pharmacist or doctor if you are not sure what the differences are between your inhalers. Ask them to check your technique to make sure that you are using your inhalers correctly
Inhalers and spacers need to be cleaned regularly – check product information or ask your pharmacist
Try to avoid exposure to asthma triggers if possible
Exposure to house dust mites can be minimised by regular vacuuming and wet mopping, washing bedclothes in hot water weekly, using a hypoallergenic mattress and pillow covers, removing carpets from the house if possible, and keeping animals out of bedrooms
People who get exercise-induced asthma should warm up and use a reliever before exercising
People with asthma who smoke should try to quit smoking and avoid breathing in second-hand smoke
A special breathing technique called the Buteyko approach may be beneficial but should only be practiced after consultation with a doctor
Aspirin and anti-inflammatories such as ibuprofen (e.g., Nurofen), can make asthma worse in some people – paracetamol should be used instead
All people with asthma should see their doctor regularly to make sure their condition is as well controlled as possible
Ask your doctor or nurse for an asthma self-management plan. This can help you monitor your asthma and provide written instructions on what you should do if it gets worse.
Treatment Options
Types of treatment
[PRESCRIPTION ONLY]
Medications for asthma are divided into three main types: relievers, preventers and symptom controllers. They are available only on prescription. Make sure you get your doctor or pharmacist to clearly explain to you what each one is for. Also make sure you know how to use them properly!
Most asthma medicines are breathed into your lungs using an inhaler device. This reduces the chances of side effects developing because hardly any of the medicine reaches the rest of your body.
Many different types of inhaler devices exist, and spacers are also available. Spacers are plastic chambers that fit over the end of the inhaler and allow the person with asthma to breathe in the medicine from the other end, without having to coordinate activation of the inhaler and inhalation. Many people find inhalers easier to use with them. Speak to your pharmacist or doctor about which inhaler device would be best for you, or if a spacer would be suitable.
RELIEVER inhalers (for immediate relief from breathlessness)
[PRESCRIPTION ONLY]
e.g., salbutamol (Salamol, Respigen, Ventolin), terbutaline (Bricanyl), salbutamol + ipratropium (Duolin)
These inhalers are used for immediate relief of asthma symptoms – they should help relieve symptoms within a couple of minutes
Using two puffs of a reliever 20 minutes before exercise is recommended for people who get exercise-induced asthma.
PREVENTER inhalers (regular use prevents the airways from becoming narrow and full of mucus)
Corticosteroid inhalers
[PRESCRIPTION ONLY]
e.g., beclomethasone (Beclazone), budesonide (Budenocort, Pulmicort), fluticasone (Flixotide)
Reduce inflammation in your airways and help reduce the number and severity of asthma attacks
Must be used every day, even if your asthma seems better, and they take a few days to start working properly
They do not give immediate relief from symptoms, so a reliever inhaler will still be needed for breathlessness or an asthma attack
Rinse mouth out with water following use (and don't swallow the rinse water), since corticosteroids can sometimes cause oral thrush or hoarseness in your voice. Using a spacer device can also reduce your chances of getting oral thrush
Oral corticosteroid tablets, such as prednisone, may need to be taken short-term by some people with severe asthma in addition to their corticosteroid inhaler. Depending on how long they are needed for, the dose may need to be reduced slowly. Check with your pharmacist or doctor.
Other preventer medications
[PRESCRIPTION ONLY]
e.g., nedocromil (Tilade), sodium cromoglycate (Intal, Vicrom)
These types of asthma preventer are not commonly used because they are less effective than using corticosteroid inhalers
They are sometimes helpful for preventing exercise-induced asthma
They may take six weeks or more to improve symptoms.
LONG-ACTING SYMPTOM CONTROLLERS (used in conjunction with preventer inhaler; not for immediate relief)
[PRESCRIPTION ONLY]
e.g., eformoterol (Foradil, Oxis), salmeterol (Serevent)
These medicines can be added to your treatment if your symptoms are not controlled by a preventer inhaler
You must continue using a preventer inhaler as well
Do not take more than the doctor has told you
These inhalers do not give immediate relief from symptoms, so a reliever inhaler will still be needed for breathlessness or an asthma attack.
COMBINATION symptom controller/preventer inhalers
Some inhalers contain more than one type of medication. They help some people by reducing the number of inhalers needed.
[PRESCRIPTION ONLY]
e.g., eformoterol + budesonide (Symbicort, Vannair), salmeterol + fluticasone (Seretide)
These combine a symptom controller and a preventer medicine
Must be used regularly to work properly
Since they contain a corticosteroid, rinse mouth out with water following use (don't swallow the rinse water) to prevent oral thrush from developing
These inhalers do not give immediate relief from symptoms, so a reliever inhaler will still be needed for breathlessness or an asthma attack.
Spacers
e.g., Space Chamber, Volumatic, EZ-fit Paediatric Mask (children aged 6 or less)
Help to improve delivery of metered dose inhalers to the lungs
Help prevent oral thrush developing when used with corticosteroid inhalers
Wash once a week with warm water and detergent and allow to drip-dry. This leaves a slight residue of detergent inside the spacer which helps reduce static and stops the medicine in the inhaler sticking to the sides
Replace every 6 to 12 months (tiny scratches or abrasions can prevent the spacer working as effectively).
More Information
For more information on asthma, see the Asthma & Respiratory Centre on everybody website.
Availability of medicines
GENERAL SALE available through pharmacies and possibly other retail outlets.
PHARMACY ONLY available for sale through pharmacies only.
PHARMACIST ONLY may only be sold by a pharmacist.
PRESCRIPTION ONLY available only with a prescription from your doctor or other health professional.
Consumer Medicine Information on some medicines is available at the government website www.medsafe.govt.nz
