Asthma

Ask the Pharmacist

Submitted by Robert Wojtas, Pharmacist

Asthma is a chronic lung condition. Inflammation, increased mucus, and muscle tightening cause the airways to narrow, and as a result, air can't move through the lungs as well as it should, which makes it difficult to breathe.

For reasons we do not completely understand, asthma is becoming more common each year, especially in children. According to the World Health Organization (WHO), about 300 million people in the world have asthma. Over 3 million Canadians suffer from this condition.

The cause of asthma is poorly understood, but it may be partly inherited. Everyone's lungs are sensitive to different things such as pollen, air pollution, or strong chemicals. In simple terms, people with asthma have lungs that are more sensitive than average.

Asthma is in part an allergic response. It may be triggered by some external substance that particularly irritates your lungs. These triggers are often small protein particles called allergens. Some people are sensitive to more than one trigger.  Other people can get an asthma attack from something they swallow rather than breathe. Examples of these triggers include ASA, nuts, shrimp, and preservatives found in some drinks or foods. While most people develop asthma as children, adults can become asthmatic by being exposed to allergens, irritants, or occupational sensitizers for a long time.

Asthma attacks can also be triggered by non-allergic irritants, such as laughing hard, crying, shouting, smog, smoke, strong smells, suddenly breathing cold air, or vigorous exercise.

There's no cure for asthma. It's a chronic condition that can last a lifetime. The goal of asthma treatment is to keep you as symptom-free as possible. This includes being able to engage in normal activities, keeping the use of rescue medications down (less than 4 doses per week), having daytime symptoms less than 4 days per week, and reducing episodes of worsening asthma. This goal can be reached by most people with asthma.

Avoiding triggers is your first defence against an asthma attack. Making simple lifestyle changes to avoid your asthma triggers can go a long way toward preventing attacks.

Although avoiding triggers is an important part of asthma management, it is not always possible to escape them completely. Therefore, medications are often needed to prevent and treat asthma symptoms.

The most common asthma prevention medications are called corticosteroids, which are inhaled through a "puffer" or inhaler. They are designed to decrease the swelling or inflammation in your airways. It usually takes a week or two for these medications to get the swelling and inflammation under control. They don't provide fast relief of asthma symptoms, but they will help prevent future symptoms. They control inflammation, which is the underlying cause of asthma.

If corticosteroids do not control your asthma symptoms, your doctor may suggest that you use a long-acting bronchodilator combined with your corticosteroid in a single combination inhaler.

For some people, leukotriene receptor antagonists may be used to help control asthma. These medications work by blocking a chemical from causing inflammation in the airways. If your asthma is caused by allergies and your asthma symptoms have not been controlled with corticosteroids, your doctor may suggest allergy shots or an injectable medication called omalizumab.

People with asthma symptoms often need treatment that provides immediate relief. Fast-acting bronchodilators work quickly to relax the muscles around the airways and allow you to breathe more easily. These are reliever medications that treat the symptoms but not the underlying cause. If you are using relievers 4 or more times a week (not including before exercise), talk to your doctor or health care professional. You may need some changes in your medications.

Asthma itself is difficult to prevent, but a lot can be done to reduce or eliminate your asthma symptoms.

If your doctor has given you a preventive medication to use every day, follow the instructions carefully. If you use it as suggested, it should control the swelling in your airways and reduce your asthma symptoms over the long term.

Since asthma medications are often inhaled through a "puffer," they require extra knowledge and care on your part. Asthma inhalers have to be used properly to get the right amount of medication into your lungs.

Learning how to use inhalers properly can take some practice. Ask your doctor or health care professional to check to see if you are using your inhaler properly. If you are using a metered-dose inhaler (MDI), which is a pressurized inhaler, your doctor may recommend a spacer device that fits on your inhaler to make it easier for you to ensure that more of your medication is reaching your lungs. Spacers also help to reduce some of the side effects of inhaled corticosteroids. Spacer devices are not needed for dry-powdered devices that are not pressurized.

As part of your asthma treatment plan, your doctor may suggest that you use a peak flow meter. A peak flow meter helps you to monitor your lung function and it gives an indication of how well your asthma is controlled. It will also help you monitor how well your medications are working, recognize when you need to adjust your medications as recommended by your doctor or health care professional, and know when to get emergency medical attention.

Keeping a diary of your asthma symptoms is also an important way to monitor your asthma control.