Challenges in treating asthma

Everyone who has asthma experiences symptoms slightly differently, and what works for one person might not work for someone else. In this article, expert respiratory physician Dr Syed Husain explains the treatments offered for different grades of asthma, the side effects involved, and the psychological challenges of the condition.

What are the main treatments for asthma?
In asthma the mainstay of treatment is usually an inhaled corticosteroids. This is often called the preventer treatment and should be used regularly to prevent symptoms from occurring.

The inhaled corticosteroids are sometimes combined with long acting Beta antagonists.

In addition, we recommend the use of a reliever treatment called salbutamol (Ventolin). This is only a short acting bronchodilator and should accompany the patient all the time on a regular basis. Just like a spare wheel kept in your car, you only use it in a crisis for immediate relief of symptoms. It’s important not to overuse this medication – it’s only effective for a short period of time, and side effects of can sometimes include tremors and increased heart rate

What if these don’t prevent symptoms?
If these treatments aren’t enough to control the symptoms of asthma, we might recommend the following “add-on” treatments:

Medication in the form of tablets, such as the anti-leukotrine Montelukast, or a drug combination called Aminophylline is used
A long-acting anticholigergic inhaler
Aminophylline can sometimes cause nausea, vomiting and palpitations, and if these side effects occur we would usually advise stopping this treatment.

The main side effects of a long-acting Beta antagonist inhaler are sore throat or hoarseness of voice, but this be prevented by regular rinsing of the mouth after using the inhalers (puffers). If you are using inhaled corticosteroids with long acting Beta antagonists, then leg cramping can be a worrying side effect but usually settles as you continue with the treatment.

How is severe asthma treated?
Severe asthma is seen only around 10% of cases but takes up big chunk of the health care resource funding.

Steroid tablets (Prednisolone) usage for one to two weeks are sometimes useful to settle symptoms down from an acute exacerbation and a week’s worth antibiotics is also helpful in the settling of an infection.

Some patients do require longer use of steroid tablets, and when used for a longer than 6 weeks period, side effects can include:

weight gain
thinning of the skin
high blood sugar
osteoporosis (thinning of the bones)
In this case we would usually recommend bone protection tablets, to be taken once a week, as well as stomach protection tablets.

The good news is that treatment for severe asthma has now expanded to include new drugs such as Omalizumab or Mepolizumab, which are dispensed through designated hospital centres, and a form of radiofrequency treatment called a Brochial thermoplasty.

What can I do myself to improve the symptoms?
It’s important to follow the doctor’s advice about the regular use of preventer inhalers or puffers, and your inhaler technique should also be regularly reviewed. Non-compliance in asthma is a big problem for both children and adults, as non-compliance could be as high as 50%.

Asthma care plan is very important in controlling the symptoms well, as asthma we know is a chronic disease fluctuating from a good day to a bad day, it can help to understand your symptoms and know what to do when your control over them isn’t very good. This care plan usually includes your best Peak Flow meter readings and spirometry readings and your management inhalers and medications.

People with asthma who smoke do very badly, so if you smoke, quitting smoking is very important in your management plan as well.

Finally, many people with asthma experience stress and anxiety, and this can often make the symptoms of asthma worse. If you’re affected, then getting effective psychological support can make a big difference, and in particular Cognitive Behavioural Therapy (CBT) could be very useful.