Medicines and treatment

Asthma medicines

The two main types of asthma medicines are relievers and preventers. These are usually in inhalers or puffers. There is also a preventer which is a tablet, used by some people. Some other medicines (e.g. prednisone tablets) are only used for severe asthma flare-ups. There are many different medicines and brands for asthma in Australia. 

Relievers for adults and children

Everyone who has asthma needs a reliever (e.g. a ‘puffer’) to use when they have asthma symptoms.

In Australia, most relievers are available from pharmacies without a prescription. Relievers should only be used when you or your child has symptoms (or if your doctor tells you to take it before exercise) and should not be over-used.

In preschool children, wheezing may not be asthma. Wheezing does not need to be treated if your child is still happy and active while wheezing and does not seem to be having any problem breathing. If it is hard for your child to breathe while wheezing (i.e. if you can see the muscles of your child’s chest and neck working harder to suck in air with each breath), you must seek medical help immediately.

Preventers

Adults and adolescents

Most adults with asthma need to take a low dose of an ‘inhaled corticosteroid’ preventer medicine every day, as well as taking their reliever when they have symptoms.

An inhaled corticosteroid medicine is usually prescribed for an adult who:

• has had asthma symptoms twice or more in the past month, or
• is sometimes woken by asthma symptoms, or
• has had a flare-up severe enough to need an urgent visit to their GP or hospital emergency department within the previous 12 months.

Inhaled corticosteroids include several different medicines and brands. This type of preventer medicine reduces inflammation in the airways and reduces a person’s risk of a severe asthma flare-up. Most adults can achieve good control of asthma symptoms with a low dose.

Preventers sometimes include a second medicine as well as the inhaled corticosteroid. These are called ‘combination’ therapies.

If you have been prescribed a preventer, you should take it every day even when you have no symptoms and also during colds and asthma flare-ups.

Keep taking it unless your doctor decides it is safe to stop. You should not change the treatment without talking to your doctor, unless your asthma action plan tells you what to do.

Children

Some children with asthma need to take regular preventer treatment every day, as well as taking their reliever when they have symptoms.

Children aged 6 years and over may need regular preventer treatment if they need to take their reliever more than twice a week. Also, if they have flare-ups more often than every six weeks. The best type of medicine depends on their symptoms and age. If your child has been prescribed a preventer, you should make sure they take it every day (even during colds and asthma flare-ups) and keep taking it unless your doctor decides it is safe to stop.

Most preschool children do not need preventer treatment. Your child may need preventer treatment if wheezing occurs often and it is hard work to breathe when wheezing (e.g. your child’s chest sucks in while breathing in), if wheezing is severe enough to interrupt eating, play, exercise or sleep, or if your child has been hospitalised because of breathing problems.

Parents should not change their child’s treatment without talking to their doctor.

Side-effects

All medicines have  possible  side-effects. Most asthma medicines have been taken over many years by a large number of children and adults around the world, so there is reliable information about possible side-effects.

Ask your doctor or pharmacist about possible side-effects and what you can do to avoid them.
Preventers that contain inhaled corticosteroid medicines can cause hoarseness of the voice and thrush (a type of throat infection). The risk can be reduced by attaching a spacer to the puffer when taking the medicine, and by rinsing the mouth with water after using the medicine.

More serious side effects can occur, but the risk is very small with normal (low) doses. The risk of serious side-effects is higher for people with severe asthma who need to take high doses for months or years.

Preventer tablets that contain montelukast may cause problems with mood and behaviour. In adults, this could include sleep problems, feeling agitated or feeling depressed. In extreme cases, adults taking montelukast feel suicidal, but this is rare. In children, side effects can include nightmares, sleep problems, feeling sad, irritability or tantrums.

Adjusting treatment

Each person’s asthma medicines may be adjusted up and down if necessary to achieve the best possible control of symptoms and avoid flare-ups. The aim is to use the lowest doses that control symptoms.

This means that you or your child needs regular checkups to assess asthma – not just a visit to the doctor during asthma symptoms.

Adults should plan an asthma check-up every 6 or 12 months (even if your asthma symptoms are well controlled). You also need a check-up soon after a flare-up, and about 1–3 months after beginning preventer treatment or adjusting the dose. Pregnant women with asthma should ask their doctor to check their asthma every 4–6 weeks.

Children with asthma that is well controlled need an asthma check-up every 3–6 months. Your child also needs a check-up soon after a flare-up, and about 4 weeks after changing treatment or adjusting the dose.

At each visit, your doctor will ask about symptoms during the previous month. If your asthma symptoms are causing problems, your doctor may increase your treatment. This could be an increase in the number of doses each day, a change to a stronger dose, or adding a second medicine (another inhaler or tablets).

Your doctor should also check that you are using your inhaler correctly.

If your asthma has been very well controlled for at least 3 months, your doctor may suggest that you try decreasing your treatment. Your doctor will work out the safest way to do this with you. It’s usually best not to try reducing treatment when you are about to go on holidays or travel, during a cold or flu, or if you are pregnant.

A spirometry test is usually also needed for adults and children old enough to do the test. Your doctor or nurse may do the test, or arrange for it to be done at a testing centre.

Adults should stop if they become dizzy during the test, and should not do the test if they have another health condition that could cause harm (e.g. heart attack or angina, aneurysm, recent surgery, fractured ribs or other serious conditions).

Your doctor may ask you how often you or your child really take the prescribed asthma medicines. Do not be offended – most people miss doses sometimes. It is very important for your doctor to know what someone is actually taking before they work out whether it is the right medicine and the right dose.