Most asthma medicines are given by inhalers. There are a variety of different types of inhaler. Tablets may also be given as part of your treatment. Whichever inhaler you have, it's important that you use it correctly. This helps send the medicine straight to where it's needed, inside the airways of your lungs. Your doctor, nurse or pharmacist will help you choose the best device for you and show you how to use it correctly.
What is a spacer?
A spacer is a large plastic container, usually in two halves that click together. At one end there is a mouthpiece and at the other a hole for the aerosol inhaler to fit in. There are several different brands of spacer, which fit inhalers and are available on prescription (including Volumatic, Babyhaler and Aerochamber).
Spacers are very important because:
- They make aerosol inhalers easier to use and more effective
- You get more medicine into your lungs than you could using just the inhaler on its own
- They trap the medicine inside the spacer so you don't have to worry about pressing the inhaler and breathing in at exactly the same time
- They are a convenient and compact alternative to a nebuliser.
- Spacers work just as well as nebulisers in acute attacks of Asthma
- They help reduce the possibility of side effects from the higher doses of inhaled steroids by reducing the amount of medicine which is swallowed and absorbed into the body.
How to use a spacer device:
- Your doctor, nurse or pharmacist should show you how to use your inhaler and spacer properly
- Make sure that the spacer you have been given fits your inhaler
- Put one puff of your inhaler into the spacer and breathe in deeply through the mouthpiece. Hold your breath for ten seconds (or for as long as is comfortable) then breathe out slowly. It is best to take at least two deeply held breaths for each puff of your inhaler. If you find it difficult to take deep breaths, taking ten smaller breaths is just as good
- Repeat the step above for each dose/puff needed
- Wash your spacer once a month - leave it to drip-dry as this helps to prevent the medication sticking to the sides
- Using metal or anti-static spacers can help to make sure that most of the medicine gets into your lungs
Spacers should be replaced at least every year, especially if you use them daily. Spacers work as well as nebulisers in severe attacks of asthma.
When is a nebuliser used?
A nebuliser is a machine, which creates a mist of medicine which is breathed in through a mask or mouthpiece. They are most often used to give high doses of a reliever medicine in an emergency. With so many improved inhaler devices and spacers around, there is less and less need for nebulisers. However, if you have very severe asthma, your hospital consultant may prescribe one.
Complementary Medicines and Asthma
Many people find that complementary therapies, particularly yoga, acupuncture and homoeopathy, seem to improve their asthma symptoms. However, there is little scientific evidence that complementary treatments used on their own are effective. That is why it is better to regard them as 'complementary' rather than 'alternative'. If you want to try one of the many complementary treatments available, consult with your doctor and do not stop taking your normal asthma medication.
Read more information on asthma and complementary medicine.
Everyone with asthma should have a reliever. Relievers are medicines that you can take immediately when asthma symptoms appear. They quickly relax the muscles surrounding the narrowed airways. This allows the airways to open wider making it easier to breathe again. However, relievers do not reduce swelling in the airways. They are essential in treating asthma attacks. If taken before exercise they reduce your chances of getting asthma symptoms. Relievers usually come in blue inhalers. Salbutamol (e.g. Ventolin) and terbutaline (Bricanyl) are two examples of relievers. They work almost immediately to relieve the symptoms of asthma. That is why they are sometimes called rescue relievers. Ipratropium bromide (Atrovent) is a different type of reliever and is most commonly used by children under two or in older people. Atrovent takes around 45 minutes to work. If you are using your reliever inhaler two or more times a week, your asthma may not be fully controlled and you should go back to your doctor or asthma nurse for review. Relievers are a very safe and effective medicine and have very few side effects. Some relievers can slightly increase your heartbeat or give you mild muscle shakes. These effects are more common when taking high doses. These side effects generally wear off within a few minutes, or a few hours at most.
Preventers and Controllers
Preventers control the swelling and inflammation in the airways, stopping them from being so sensitive and reducing the risk of severe attacks. Their effects build up over a period of time so they need to be taken every day, usually morning and evening, even when you are feeling well. 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. Preventer inhalers usually contain a low dose of steroid medication. There are several kinds of inhaled steroids, but they all work in the same way to reduce the inflammation in your airways. Combination inhalers contain an inhaled steroid and a long-acting reliever medication in one device. Your doctor may prescribe a combination inhaler if your asthma is not controlled on an inhaled steroid alone.
When are preventers prescribed?
You should be prescribed a preventer if you:
- are breathless, cough or have a tight chest during everyday activities more than twice a week
- need to use your reliever inhaler more than twice a week
- have sleep disturbed by cough or chest tightness more than twice a month
- have bad attacks of breathlessness when you have a chest infection or are in a smoky atmosphere.
What will my preventer do for me?
As the protective effect of the steroid builds up, you will be less likely to have asthma attacks. You will be less likely to be breathless during the day and at night and you will not need to use your reliever inhaler as often.
Why is my reliever inhaler not enough?
Reliever inhalers relax your airways, which help breathlessness, but they do not treat airway inflammation. As well as the relaxing effect of a reliever inhaler, you need the anti-inflammatory effect of a preventer. Once airways are less inflamed they are less sensitive to triggers such as cigarette smoke and viral infections.
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How long will it take to work?
It may take up to 14 days for your preventer medicine to reduce inflammation and mucus in your airways. For children, it could take 1-2 months.
Don't stop taking your preventer if you do not notice an improvement in the first few days. it if nothing much happens for a few days. Gradually, chest tightness, night cough and wheeze should become less. You should also notice that you need to use less reliever inhaler. You should continue to take your preventer every day, morning and evening even when you are feeling well. This is how you keep your asthma symptoms under control.
When should I see my doctor or asthma nurse again?
Your doctor or asthma nurse will probably want to see you within a month after you start using a preventer to review your symptoms. They will be able to adjust your medicines if your symptoms have not improved.
Do I really need to take my preventer every day?
Yes. To work properly, preventers need to be taken every day, usually morning and evening, even if you are feeling well. The protective effect of the preventer medicine builds up gradually. Once this protection is working, occasionally forgetting to take your inhaler will usually not have bad effects. But forgetting or stopping for several days at a time will mean your protection begins to disappear.
If your asthma is not well controlled by using your preventer/controller medicine regularly, you should go and see your doctor. Before increasing the dose of your preventer/controller, your doctor may suggest other treatments or 'add-on therapies' to help you.
The first 'add-on therapy' to be tried is usually a leukotriene receptor antagonist (LRA) which blocks the action of naturally occurring chemicals in the lungs, called leukotrienes, which lead to inflammation in both upper and lower airways. If asthma treatment remains suboptimal after the addition of an LRA, a long-acting reliever may be prescribed, in addition to your steroid preventer/controller. Long-acting reliever should always be taken with an inhaled steroid. Your doctor may prescribe these separately or in a combined inhaler.
Long-acting relievers go on working for a longer time than normal relievers and are usually taken twice a day to have an effect. Another treatment which may be prescribed by your doctor is a slow-releasing theophylline. Before changing any medicines or offering you new ones, your doctor or nurse should speak to you about how you take your medicines, if you are taking them regularly and whether you are taking the prescribed dose. If you are taking an 'add-on therapy' that is not helping to control your asthma symptoms, your doctor may stop it before you start a different treatment.
When are steroid tablets used in asthma?
If your asthma gets really bad, your doctor may give you a short course of steroid tablets. They work quickly and powerfully to help calm down your inflamed airways. Short courses of tablets, anything from 3-14 days, will not give any long-term side effects. Steroid tablets can lower the body's resistance to chickenpox, so you should contact your doctor if you are taking steroids and come into contact with chickenpox. A small minority of people with severe asthma need to take steroid tablets for a longer period. These people are more at risk of experiencing side effects. Always talk to your doctor or practice nurse about any concerns you have about the side effects of your asthma treatment.
Concerns About Steroids
Many people are anxious about the side effects of steroids used in preventer treatment. Here are some points to remember:
- The steroids used to treat asthma are called corticosteroids
- Corticosteroids are a copy of those produced naturally in our bodies
- They are completely different to the anabolic steroids used by bodybuilders and athletes. Most people with asthma use low dose inhaled steroids, which go straight down to the airways, so very little is absorbed into the rest of the body.
- Your doctor will prescribe the lowest possible dose to get your asthma under control
- There is a small risk of a mouth infection called thrush and hoarseness of the voice. You can avoid this by using your inhaler before brushing your teeth, and by rinsing out your mouth well afterwards. Using a spacer will also help reduce the possibility of thrush.
How to manage adult asthma in steps
Read more information on how children should take asthma medicine
Information provided by the Asthma Society of Ireland