Personal asthma plan
Once diagnosis has been confirmed, your treatment will begin with an assessment, possibly at an asthma clinic. The purpose of the assessment is to assess the pattern and severity of your symptoms and the treatment required to manage them. The plan will also investigate any possible asthma triggers. You should then be able to determine the potential impact of asthma on your daily life.
As part of the assessment, you will be encouraged to draw up a personal asthma plan following discussions with your GP or asthma nurse. The plan will include information about your asthma medicines. You will be taught how to recognise when your symptoms are getting worse and the appropriate steps to take. You will also be given information about what to do if you do have an asthma attack.
You will be encouraged to contribute to your plan by keeping a track of your symptoms and how well they respond to treatment.
You should also be alert to any associated triggers you think may be causing your asthma. Your personal asthma plan should be reviewed with your GP or asthma nurse at least once a year, or more frequently if your symptoms are severe.
As part of your asthma management you may be given a peak flow meter, so you that you can monitor your symptoms and the effects of your treatment.
Medical treatment - the stepwise approach
Treatment of asthma is carried out using what is known as 'stepwise approach', where the severity of your symptoms are assigned a 'step' from one to five, and treatment follows accordingly. As your symptoms get better or worse, you may move up or down a step in your treatment plan. The goal of treatment is to find the lowest possible step of treatment that successfully manages your condition.
Treatment involves both relieving symptoms and preventing them from reoccurring. Prevention can be achieved through the use of medicines, but lifestyle and diet also play an important role. This information below will cover the use of medicines for prevention. For further information on other methods and advice, see the 'prevention' section.
Step one - mild intermittent asthma
If your asthma symptoms are infrequent and mild, you will be given an inhaler containing a medicine called a short-acting beta2-agonist, which you should use to relieve the symptoms of asthma. Short-acting beta2-agonists work by relaxing the muscles of your airways and decreasing the amount of mucus. They also prevent the muscles around your airways tightening. Medicines that are used to relieve asthma symptoms are known as reliever medicines.
Step two - regular preventer therapy
If your asthma symptoms are more frequent, you will probably be given regular preventer therapy. This treatment is normally recommended if:
- you have asthma symptoms more than twice a week,
- you wake at least once a week due to your asthma symptoms,
- you have had an asthma attack in the last two years, or
- you have 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 containing a medicine called inhaled corticosteroids. You will normally be recommended to take two doses of inhaled corticosteroids a day to prevent symptoms from occurring. However, you should still use your short-acting beta2-agonist inhaler to relieve your symptoms.
Exactly how inhaled corticosteroids work is not entirely clear, but they are known to reduce the amount of inflammation in the airways and prevent asthma attacks occurring. Medicines that are used to prevent asthma symptoms are known as preventer medicines.
Smoking can reduce the effects of inhaled corticosteroids. Inhaled corticosteroids have been known to cause yeast infections (oral thrush) in the mouth, so you should rinse your mouth thoroughly after inhaling a dose.
Step 3- add-on therapy
If your symptoms are still not under control, you will be given a second preventer inhaler to take along with the first. Normally, this will contain a medicine called a long-acting beta2-agonist. These work in the same way as short-acting beta2-agonists, but they take longer to take effect and they can last up to 12 hours. Short-acting beta2-agonists only relieve asthma symptoms for three to six hours, but they start working within five minutes.
If your asthma still does not respond to treatment, the doses of inhaled corticosteroids and long-acting beta2-agonists can be increased.
You should only use your long-acting beta2-agonist inhaler in combination with your inhaled corticosteroids inhaler, and not by itself. Studies have shown that using only long-acting beta2-agonists can increase the risk of an asthma attack occurring.
Step 4 - persistent poor control
If treatment for your asthma is still not successful, the amount of inhaled corticosteroids may be increased to its maximum safe dose, and additional preventer medicines will be tried. Some possible alternatives are outlined below.
- Leukotriene receptor antagonists - this is an oral medication (tablet) that works by blocking a chemical reaction that can lead to inflammation of your airways.
- Theophyllines - this oral medication helps to widen your airways by relaxing the muscles around them. In some people, theophyllines have been known to cause a number of side effects, including headaches, nausea, insomnia, vomiting, irritability and stomach upsets.
- Slow release beta2-agonist tablets - these work in the same way as long-acting beta2-agonists, but they are particularly good at preventing night-time symptoms.
Step 5 - continuous or frequent use of oral steroids
The final step involves the use of oral steroids. You will need to be referred to a specialist in respiratory conditions in order to monitor your treatment.
Long term use of oral steroids carries possibly serious side effects, so they will only be used once all other treatment options have been tried and all trigger factors have been eliminated as far as possible.
Oral steroids carry a risk if they are taken for more than three months, or if they are taken frequently (three or four course of steroids a year). Side effects can include:
- osteoporosis (fragile bones),
- high blood pressure (hypertension),
- diabetes,
- weight gain,
- cataracts and glaucoma (eye disorders),
- thinning of the skin,
- easy bruising, and
- muscle weakness.
In order to minimise the risk of taking oral steroids, you should:
- Eat a healthy, balanced diet with plenty of calcium.
- Maintain a healthy body weight.
- Stop smoking (if you smoke),
- Do not drink more than the recommended daily amount of alcohol (three to four units for men, and two to three units for women). A unit of alcohol is equal to about half a pint of normal strength lager, a glass of wine or a single of spirit (an ordinary pub measure).
- Take regular exercise.
You will also need regular appointments to check for high blood pressure, diabetes and osteoporosis.
Exercise-induced asthma
It is likely that your general symptoms and personal asthma plan will be reviewed to determine whether your exercise-induced asthma is a result of poor asthma control. If it isn't, you will be advised to:
- use a short acting beta2-agonist 10-15 minutes before you exercise, and again after two hours of prolonged exercise, or when you finish,
- try to structure your exercise plan around short-burst activities,
- exercise in humid environments, such as swimming pools, and
- breathe through your nose to avoid hyperventilation (excessively rapid and deep breathing).
If you do not respond to treatment and you are already taking an inhaled corticosteroid, you may be given an additional preventer medicine, such as a long-acting beta2-agonist or a leukotriene receptor antagonist.
Beta2-agonists are normally regarded as a banned substance under the regulations concerning anti-doping in sport. If you are a competitive athlete, you may need to contact your relevant governing body in order to get permission to use them.
If you do not respond to treatment, you may be referred to a respiratory specialist (someone who specialises in conditions that affect breathing).
Occupational asthma
If it is possible that you have occupational asthma, you may be referred to a respiratory specialist to confirm the diagnosis. If your employer has an occupational health service, they should also be informed, along with your health and safety officer.
It may sometimes be possible to substitute or remove the substance that is triggering your occupational asthma from your workplace. If not, you should try to relocate away from your work environment as soon as possible, ideally within 12 months of your symptoms becoming apparent.
Some people with occupational asthma may be entitled to Industrial Injuries Disablement Benefit. Your local Jobcentre should be able to provide you with more information about this.
Asthma and pregnancy
Due to the changes that take place in the body during pregnancy, many women find that the symptoms of their asthma change when they are pregnant. However, it is not clear exactly what processes are involved.
Studies have shown that one third of pregnant women experienced an improvement in their asthma, one third experience a worsening of their asthma, and one third remained the same.
The most severe asthma symptoms experienced by pregnant women tend to be between the 24th and 36th week of pregnancy. Symptoms then decrease significantly during the last month of pregnancy. Only 10% of women experience asthma symptoms during labour and delivery, and these symptoms can normally be controlled through the use of reliever medicine.
You should manage your asthma in the same way as you did before you were pregnant. The medicines used for asthma have been proven to be safe to take during pregnancy, and when breastfeeding your child. The one exception is leukotriene receptor antagonists. While there is no evidence that it can harm babies during pregnancy and breastfeeding, there is not enough evidence about its safety compared with other asthma medications.
However, if you need to take leukotriene receptor antagonists to control your asthma, your GP or asthma clinic may recommend that you carry on taking it. This is because the risks to you and your child from uncontrolled asthma are far higher than any potential risk from this medicine.
Smoking during pregnancy puts both yourself and your child in danger. Smoking increases the chance of you having a severe asthma attack, which can lead to other complications, such as premature birth, low birth weight and, most seriously, the death of your child.
Smoking during pregnancy also increases the chances of your child developing asthma, being born under-weight, or being born prematurely. You should therefore quit smoking immediately. See the 'prevention' section for resources that can help you quit smoking.
Asthma attacks
As part of your assessment, and when drawing up your personal asthma plan, you will be taught to recognise the initial symptoms of an asthma attack, how you should respond, and when you should seek medical attention.
Treatment typically involves taking one or more higher doses of your reliever medicine. If the symptoms of the asthma attack progress and worsen, you may require hospital treatment. If admitted to hospital, you will be given a combination of oxygen, beta2-agonists and oral steroids to bring your asthma under control
Your personal asthma plan will then need to be reviewed, so that the reasons for your asthma attack can be identified and avoided in future.
Alternative therapies
A number of alternative therapies have been suggested for the treatment of asthma including:
- traditional Chinese medicine,
- acupuncture,
- ionizers (a device that uses an electric current to charge, or ionize, molecules of air),
- the Alexander technique (a training programme designed to change the way you move your body),
- homoeopathy,
- breathing exercises, including yoga and the Buteyko method (a technique involving shallow breathing), and
- dietary supplements.
However, there is no evidence that any of these treatments are effective.
