Asthma treatment

Asthma is a condition which causes the airways of the lungs (the bronchi) to become inflamed and swollen.

The bronchi are small tubes which carry in and out of your lungs. The bronchi are more sensitive if you have asthma and certain substances or triggers can irritate them. Common triggers include house dust mites, animal fur, pollen, tobacco smoke, cold air and chest infections.

When the bronchi become irritated they become narrow and the muscles around them tighten. This can increase the production of sticky mucus or phlegm which can make it hard to breathe and cause wheezing and coughing as well as a tightness in the chest.

SYMPTOMS
The symptoms of asthma might occur for no apparent reason. They might include the following:

feeling out of breath (you might gasp for breath)
a tightness in your chest as if a band is tightening around it
wheezing
coughing, especially at night (this is a more common symptom in children than in adults)

How severe symptoms of asthma are can often be variable and hard to predict. They are sometimes worse at night or with exercise.

The symptoms of a severe attack of asthma often develop slowly and take between 6 and 48 hours to become serious.

It is important to remain alert for any signs of worsening symptoms which might include:

a drop in your peak expiratory flow (see diagnosis)
an increased pulse rate
an increase in wheezing
a feeling of being agitated or restless

If you do notice that your symptoms are becoming worse it is important to contact your doctor.

Typical symptoms of a severe asthma attack include:

symptoms quickly becoming worse
difficulty breathing and talking
a racing pulse
lips and/or fingernails might turn blue
skin may tighten around neck and chest
nostrils might flare as you try to breathe

If you show symptoms of a severe asthma attack you should seek medical attention immediately.

DIAGNOSIS
Diagnosis of asthma will be able to be done by your doctor who will ask you about your symptoms, examine your chest and listen to your breathing. He will also ask about your medical history and if there is a history of allergic conditions in your family.

He will also ask you about the circumstances which surround the onset of your symptoms, for example when and where they occurred.

TREATMENT
Once the diagnosis has been confirmed your treatment will begin with an assessment. This may be done at an asthma clinic. The assessment's purpose is to asses the pattern of severity of your symptoms and what treatment would be best to manage them.

The plan will also investigate any possible triggers for your asthma.

You will be encouraged to draw up a personal asthma plan after discussions with your doctor or asthma nurse. This will include information about your asthma medication. You will learn how to recognise when your symptoms are becoming worse and what the appropriate steps are to take. You should keep a track of your symptoms and how well they respond to treatment It is also important to be on alert for any triggers which you think may be causing your asthma. Your doctor or asthma nurse should review your personal plan at lease once a year or if your symptoms are more severe, more frequently.

The Stepwise Approach
The "stepwise approach" is where the severity of your symptoms are assigned from "step" one to five and treatment follows accordingly. As your symptoms improve or get worse, you may move up or down a step. The goal is to find the lowest possible step that successfully manages your asthma.

Both relieving symptoms and preventing them from occurring are part of the treatment. Medicines can help prevention along with lifestyle changes and diet.

Step One - Mild Intermittent Asthma
You will be given an inhaler which contains a medicine called a short-acting beta2-agonist if your symptoms are mild and infrequent. Short-acting beta2-agonists work to relax the muscles of your airways and decrease the amount of mucus. They also stop the muscles around your airways from tightening. Medicines which relive symptoms of asthma are called reliever medicines.

Step Two - Regular Preventer Therapy
You will be given regular preventer therapy if your symptoms are symptoms are more frequent. This is normally recommended if:

you have symptoms of asthma more than twice a week
you wake at lease once a week due to your symptoms
you have had an asthma attack in the last two years
you need to use your short-acting beta2-agonist inhaler more than twice a week

If you have "step two" symptoms you will be given a second inhaler. This contains a medicine called inhaled corticosteroids. Two doses a day are normally recommended to prevent symptoms from occurring.

Exactly how inhaled corticosteroids work is unclear but it is known that they reduce how much inflammation is in the airways and prevent asthma attacks from taking place. Medicines that prevent the symptoms of asthma are called preventer medicines.

The effects of inhaled corticosteroids can be reduced by smoking.

You should rinse your mouth after inhaling a dose because inhaled corticosteroids are known to cause yeast infections in the mouth (oral thrush).

Step 3 - Add-On Therapy
If your symptoms are still not under control you will be given a second preventer inhaler. This will normally contain a medicine called a long-acting beta2-agonist. They work in the same way as the short-acting beta2-agnoist but take longer to take effect and can last up to 12 hours. The short-acting beta2-agnoists start working in five minutes but only relieve symptoms for three to six hours.

The doses of inhaled corticosteroids and long-acting beta2-agonists can be increased if your asthma is still not responding to treatment.

The long-acting beta2-agonist inhaler should only be used in combination the inhaled corticosteroid inhaler and not on its own. Studies have shown that using it alone can increase the risk of an asthma attack taking place.

Step 4 - persistent Poor Control
If treatment is still not successful, the amount of inhaled corticosteroids can be increased to its maximum safe dose and additional preventer medicine tried. Some possible alternatives include:

Leukotriene receptor antogonists - this is an oral tablet that blocks a chemical reaction which can lead to inflammation of the airways.

Theophyllines - this is an oral medication the helps to widen the airways by relaxing the muscles around them. They have been known to cause a number of side effects in some people including, headaches, nausea, insomnia, vomiting, irritability and upset stomach.

Slow release beta2-agonist tablets - these work like long-acting beta2-agonists but are especially good for prevention of night-time symptoms.

Step 5 - Continuous or Frequent use of Oral Steroids
The final step involves using oral steroids. You will be referred to a specialist of respiratory conditions to monitor your treatment.

Using oral steroids long-term can possibly cause side effects so they will only be used once all other options of treatment have been attempted and all trigger factors eliminated as far as is possible.

Oral steroids carry a risk if taken for three months or if taken frequently (three or four courses of steroids per year). Side effects include:

osteoporosis (fragile bones)
hypertension (high blood pressure)
diabetes
weight gain
cataracts and glaucoma (eye disorders)
thinning of the skin
bruising easily
muscle weakness

The following steps can be taken to minimise the risks of oral steroids:

eating a healthy, balanced diet which includes plenty of calcium
maintaining a healthy body weight
stopping smoking
taking regular exercise
not partaking in more than the recommended daily units of alcohol