If your symptoms aren't well controlled with reliever and preventer inhalers, you may need one or more of the treatments below.
Long-acting reliever inhalers
Long-acting reliever inhalers work in the same way as normal reliever inhalers, but their effects can last for up to 12 hours so they can be used less often.
They usually contain a medicine called a long-acting reliever (long-acting bronchodilator/long-acting beta2-agonist).
Long-acting reliever inhalers are always used alongside preventer inhalers, often in a single combined inhaler. This can allow your preventer dose to be lowered, while still keeping your symptoms under control.
Combination inhalers are usually purple, maroon or red.
Long-acting relievers can cause similar side effects to short-acting relievers, such as temporary shaking or cramps.
It's important never to take a long-acting reliever on its own without a preventer. This may temporarily relieve your symptoms, while allowing the inflammation in the breathing tubes to build up, which could result in a sudden severe asthma attack.
If you still have symptoms despite using a preventer inhaler and a long-acting reliever inhaler, your doctor may suggest taking tablets to control your symptoms.
The main tablets used for asthma are:
- leukotriene receptor antagonists – taken once a day to stop the airways becoming inflamed (syrup and powder forms are also available)
- theophyllines – taken twice a day to help widen the airways
- steroid tablets – see below
Leukotriene receptor agonists can cause tummy (abdominal) pain and headaches. Side effects of theophylline tablets include nausea, vomiting, tremors and palpitations.
Different people require different doses of theophylline for it to work best. Your GP will periodically measure the level of medication in your blood to check it's not too high or too low. If it's too low, the medication may not work, and if it's too high, side effects are more likely.
If your asthma is still not under control, an asthma specialist may prescribe regular steroid tablets.
Steroids are powerful medicines that can reduce inflammation in the airways. They can be used in two ways:
- as an immediate, short-term treatment if you have occasional severe asthma attacks
- as a long-term treatment if other medications don't control your symptoms well enough
Long-term or frequent use of steroid tablets can cause side effects, such as:
With the exception of increased appetite, which is a very common side effect, most of these unwanted effects are uncommon.
You'll be monitored regularly while taking steroid tablets to check for signs of any problems.
Omalizumab (brand name Xolair), is a new type of medication that can sometimes help prevent frequent, severe asthma attacks that are triggered by allergies. It's less effective at relieving persistent symptoms.
The National Institute for Heath and Care Excellence (NICE) recommends that omalizumab can be used in people over six years of age with allergy-related asthma who need continuous or frequent treatment with steroid tablets.
It's only available on prescription from an asthma specialist and isn't suitable for everyone with asthma.
It's given as an injection every two to four weeks. If your symptoms aren't under control within 16 weeks, treatment should be stopped. It may be continued indefinitely if it does help.
Side effects of omalizumab can include temporary pain, swelling, redness and itching where the injection is given.
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Bronchial thermoplasty procedure
Bronchial thermoplasty is a procedure that is very occasionally used as a treatment for severe asthma.
It involves damaging some of the muscles surrounding the airways, which can help stop them becoming narrow.
The procedure is carried out either with sedation (where you're awake but take medication to help you relax) or under general anaesthetic (where you're asleep).
A bronchoscope (a long, flexible tube) is passed down to your lungs through your mouth or nose. Heat is then used to damage the muscles around the airways.
Three treatment sessions are usually needed, with at least three weeks between each session.
There's some evidence to suggest this procedure may reduce asthma attacks and improve the quality of life of someone with severe asthma.
But the long-term risks and benefits are not yet fully understood. There's a small risk it could trigger an asthma attack and cause other complications.
Make sure you discuss this procedure fully with your doctor or surgeon if it's offered.
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