FAQ on Asthma

Do I have to use my preventer inhaler all the time, even when I am well?

This is an important question, and one that is frequently asked. After all it may be hard to accept that you should take treatment all the time if you have no symptoms. Firstly, we need to remember that the aim of modern asthma management is for you to be free from symptoms at all times, and to be able to lead a full life with no restrictions. Preventer inhaler has been prescribed with that purpose in mind. It works by damping down, and removing, swelling and mucus in your airways. This controls your asthma, and keeps symptoms to a minimum - as long as it is taken regularly. Even in mild asthma, inflammation is present in the airways of the lungs, and if left untreated could cause long-term damage. If you stop taking the preventive treatment as soon as you are well, the symptoms are likely to return. If you have been free of symptoms for months, you may well be able to reduce the treatment gradually or stop it, but this should be done in conjunction with your doctor or asthma nurse.

I only cough at night, so why do I need my preventer inhaler during the day?

Your asthma is a condition that is present most of the time, even if it is not causing you any symptoms. There is a continuing inflammation in the lining of your lungs, something like a slow burning fire where the embers are smouldering constantly and burst into flames from time to time. This inflammation causes the walls of your airways to swell up and causes phlegm (consisting of cells and mucus) to collect on them. It can vary at different times, from being very mild to severe. When your asthma is mild, then symptoms such as cough may occur only on some days or nights. When the inflammation flares up and becomes more severe, your symptoms will be present most of the day and night. The process of asthma is there in the background for most of the time, and if you get symptoms - even though it may only be at night - it is best to take regular preventive treatment.

Salbutamol works better for me than Steroid inhalers, so why should I take steroid?

Salbutamol and corticosteroid work in different ways. Salbutamol is a bronchodilator which means that it 'dilates' or opens up the airways (a 'reliever'). Because of this it relieves asthma symptoms quickly. This is why you may feel, understandable, that this must be the best treatment. Inhaled steroid is purely a preventive treatment (a 'preventer'). It doesn't have an immediate effect on symptoms and needs to be taken twice daily for about a week before it begins to prevent asthma symptoms from occurring. Taken on a long term basis they are highly effective. In some way they control the underlying inflammation of the airways.

It is important to continue to use the inhaled steroid regularly. It is not a cure, and forgetting to use steroid inhalers, in many cases, is the cause of asthma becoming out of control again.

If I forget to take my Preventer inhaler one day, should I take twice the amount the next?

Firstly let us say that we realize it is extremely easy to forget to take your preventer inhaler - particularly when you are well and free from symptoms. It is of course much better if you can remember. However, if you forget a dose of Cromone inhalers then no benefit will be gained if you take twice the amount the next day.

If, on the other hand, it is steroid inhaler that you have forgotten, it may be worthwhile doubling up the dose next time, particularly if you have developed asthma symptoms.

Why won't my Doctor prescribe antibiotics to have at home to be taken at the first sign of a chest infection?

This form of treatment meant less time off work for me, and consequently less pressure from my employers, which itself tends to make my asthma worse. This is a rather tricky question which, without knowing your individual details, we will have to answer in general terms. The difficulty arises in having to distinguish between asthma and a true chest infection. Although antibiotics may help to clear a chest infection rapidly, they are not often helpful in the treatment of asthma. Although asthma is often triggered by an infection, such as the common cold, this infection is nearly always caused by a virus. Viruses are not affected at all by antibiotics, so there is no point giving them for virus infections.

The symptoms of an asthma attack may resemble a chest infection, with coughing, wheezing and shortness of breath. Asthma may also cause you to cough up lots of phlegm - leading to the false impression that your symptoms are due to an infection which needs antibiotics.

It is usually much better for you to increase your asthma medication at the start of these symptoms. Then only if they do not improve should you consult your doctor to see if an antibiotic is needed.

Are there particular times of the day when medication should be taken, or should I leave it as long as possible before taking it?

The answer to this depends on the medication you are taking. Inhaled steroids are usually taken twice daily. The actual time does not matter, but it is useful to take them at night and morning, before brushing your teeth. This makes it part of a routine, but also ensures that you rinse your mouth out afterwards. This reduces the chance of side effects, especially thrush in the throat. The other preventers (cromones) are usually prescribed two to four times spread through the day, they do not need to be taken at particular times. However, it is good to get into a routine. The benefit from preventer treatments comes from taking them regularly, and to do this it is best to have a routine.

Reliever treatments such as Salbutamol or Terbutaline should be taken when you feel wheezy or short of breath, or if you feel an attack coming on - there are no set times for these.

Long acting b2 agonists belong to a class of bronchodilator treatments which have a prolonged action of 10-12 hours. They should be taken regularly, twice daily.

As you can see, you don't have to be rigid in the times when you take your medication. However, we do not advise you to leave it as long as possible before you take it as there are no benefits to be gained from unnecessary delay.

When my daughter, 6 months old, coughs a lot, should I give her cough mixture together with the inhalers?

Most certainly not! There is really no point in giving cough mixtures to anyone with asthma. They are rarely of any benefit, and may even make matters worse.

- They may make the phlegm sticky, causing the air passages to become blocked. This can lead to a secondary infection in the lungs, which may require antibiotic treatment.

-They create a false sense of security. Parents may wrongly believe that they are treating their child and that no other treatment is needed. The asthma may get worse and the child may suffer unnecessarily. It is safest to use the asthma medicines as advised by the doctor and to call for help if this doesn't work.

How do I strap my baby down if she is fighting away from the nebulizer mask or Nebuhaler?

It is a battle to persuade any breathless infant or child to take medication. When it is your own baby, it is even more difficult, but we hope you will not have to resort to strapping her down. Sometimes it is sufficient simply to hold the nebulizer mask a little distance away from the baby's face. If you hold it just below the level of her mouth then much of the mist will drift upwards towards her face, and be sucked in as she breathes. The small amounts which are breathed in by this method will be enough to give relief. Once the airways start to open, the baby often starts to relax more, and then will accept the mask. There are different types of face appliances with which you can experiment. Some babies are happier with masks, whereas others do much better with mouthpieces that do not need to be held over the face. There are other ways of approaching this problem. A Volumatic or Nebuhaler spacer device can be separated so that one open end is held in front of the baby's face. A large polystyrene cup or PET bottle of mineral water, with a hole cut in the bottom for the inhaler mouth is another version of this, and can be an excellent emergency method of getting reliever drug into young children.

Will giving inhalers to a baby prevent asthma developing?

This is a difficult question to answer. It is not possible to tell which babies will develop asthma in the future, and as yet there is no case for giving anti-asthma treatment before the condition has developed. However, many professionals believe that early, effective treatment of asthma may well reduce the risks of any long-term problems. It may also shorten the duration of asthma symptoms. Evidence to support this belief is beginning to emerge, but it is still a controversial subject.

At present the main reason for prescribing inhaled treatment is to help reduce current symptoms and suffering due to asthma, and give a better quality of life. This is our practice, and we also believe that good control in the early stages of asthma means fewer problems in later life.

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