By Janice Harvey, RPh, CDE
Asthma is a common condition where inflammation causes a narrowing of the airways, making it hard to breathe. When asthma is well-controlled, it is possible to be symptom-free. However, many people become over-reliant on rescue inhalers for quick relief — and that’s a problem.
How is asthma treated?
When asthma is well-controlled, you can breathe easily most of the time, can exercise and sleep through the night without symptoms, and don’t miss work or school because of asthma. Common triggers of asthma symptoms include allergens, pollution, respiratory infections, cigarette smoke, physical activity, and stress. These triggers can cause symptoms such as wheezing, cough, shortness of breath, chest tightness, and trouble sleeping (due to difficulty breathing).
Salbutamol (Ventolin) and terbutaline (Bricanyl) are in a drug class called short-acting beta agonists (SABAs). They relax the smooth muscle of the airways, opening them up, and making it easier to breathe. Many people refer to these as “rescue” or “emergency” inhalers. They act in 10 to 15 minutes, but their effects only last for about 4 hours. For people who have asthma symptoms only when they’re exercising or just once in a while (e.g., when allergies cause asthma symptoms), a SABA might provide enough benefit.
For most people with asthma, a SABA isn’t enough. Another medication, such as an inhaled corticosteroid (ICS), might be needed to get asthma under control and prevent worsening asthma. Drugs such as fluticasone (Flovent) and budesonide (Pulmicort) are commonly referred to as “controller” medications. Using an ICS regularly helps to reduce inflammation and mucus in the lungs. The lungs will also be less sensitive to asthma triggers. If the ICS alone is not able to completely control symptoms, then it can be combined with a long-acting bronchodilator (LABA). Other types of medications are also available, especially for severe asthma.
What’s the problem with using quick-relief medications?
If you need to use a rescue inhaler three or more times per week, you may think your asthma is controlled and you might delay treatment. In fact, while you are getting short-term relief from symptoms, the underlying inflammation is probably getting worse and could be causing permanent lung damage (called airway remodeling). This increases the risk of a severe asthma attack.
Over time, rescue inhalers can become less effective. Symptoms can worsen or increase in frequency, and you may require treatment in hospital. A severe asthma attack can be deadly.
How to improve asthma control
An important first step in controlling asthma is reducing triggers. You may find that you need less medication when you avoid or limit your triggers.
It’s estimated that up to 90% of people use inhalers incorrectly! Proper use of inhalers will help to improve symptoms so you can breathe easier, preventing flare-ups and keeping you out of hospital. If you have difficulty holding your breath, using a spacer will allow you to breath normally when inhaling the medication and will increase the medication that gets to your lungs. If you are not sure about the correct technique for using your specific inhaler or spacer, ask for help from one of our pharmacists. Or watch a video demonstration online. Lung Sask makes it easy: just click on an image of the type of inhaler you’re using, then watch and learn.
Work with your doctor to create an asthma action plan. This is a written plan that tells you what asthma medicines and doses to take based on your symptoms. It can help you know how best to prevent and treat an asthma attack. It will often involve using a peak expiratory flow meter, so you know whether you are in the green, yellow or red zone for symptoms and can choose the appropriate treatment.
Living symptom-free
Reducing exposure to triggers, taking asthma medications properly, and following an action plan when symptoms increase can improve asthma control and prevent worsening asthma. We’re happy to discuss your medications with you and can make recommendations that you can discuss with your doctor.
Your health. Our priority.