Self help guide for asthma

Check with your doctor or asthma nurse that the following advice is applicable to your condition.

Most patients with asthma will have two types of inhaler. A preventer inhaler and a reliever.

Preventers are usually steroid inhalers and are often coloured brown or buff. Typical ones include drugs like beclomethasone, budesonide and fluticasone. They work by stopping the inflammation in the tubes in your lungs that leads to narrowing because of increased mucus production, spasm and thickening of the tube walls. They are the mainstay of most long-term treatment and work if used regularly. Their effect is over the course of days/weeks and months rather than minutes and hours. Don't stop them unless instructed by your doctor/asthma nurse The dose of steroid is tiny and is unlikely to cause side effect when used in standard doses.

Relievers are drugs that open up the tubes in the lungs on a temporary basis. The inhalers are often coloured blue and typically include drugs like salbutamol or terbutaline. Another type contains ipratropium bromide. These drugs work over the course of minutes to hours. Usually the effect lasts about 4-6 hours and helps to relieve symptoms of cough and breathlessness. Patients with asthma that is well controlled by their preventer medicine may not need to use these at all although may wish to keep an inhaler handy in case their asthma deteriorates and they develop symptoms of cough, wheeze or breathlessness. Too much salbutamol or terbutaline may make you feel shaky and tremulous (a bit like drinking too much strong coffee) but it is very hard to overdose on these drugs.

The speed with which you can blow air out of your lungs can be measured by a small meter called a peak flow meter. If the tubes in your lungs are healthy this will be normal, but if your tubes are narrowed because your asthma is not well controlled the speed will be reduced (think of a water hose and the speed the water comes out at and how this varies when you close off the tap or stand on the hose). By measuring your peak flow rate (PEFR) when you are well you can determine your normal value. This varies by age, height and sex, so is an individual value. Your doctor or practice asthma nurse can prescribe a peak flow meter. Children benefit from one that measures a lower range which makes it easier to read.

Measure your own peak flow each morning and evening,. If you keep your peak flow meter by your toothbrush this will be easier to remember. If it is in a draw or at the bottom of the cupboard it gets forgotten. Checking your PEFR may give you some advanced warning of an asthma attack. You can use the PEFR to guide treatment changes:-

If your peak flow is more than or equal to three quarters (75%) of your normal value continue your asthma inhalers as usual.
If your peak flow is between half and three-quarters (50-75%) of your normal value double the dose of your preventer inhaler and continue this increased dose for the number of days required for your peak flow to return to normal. Continue this increased dose for the same number of days again. This may be several weeks; remember, preventer inhalers work on a long-term basis. Return to your usual dose of inhalers after this time. You will also benefit from using your reliever inhaler regularly every 4-6 hours to help with symptoms of cough, wheeze and breathlessness.
If your peak flow is less than half (50%) of your PEFR double your preventer inhaler, use your reliever inhalers regularly and see your doctor at the next surgery. If you have severe difficulty breathing seek emergency care straight away. Whilst waiting for help, try using one puff of your reliever inhaler every minute for 20 minutes. If you have one, use a spacer device (e.g. volumatic, nebuhaler or aerochamber) as this increases the amount of drug that reaches your lungs and takes away problems of timing. This will work a bit like the nebulisers used in hospital or at the surgery. To give a comparison, the standard dose of, for example, salbutamol, used in a nebuliser is equivalent to either 25 or 50 puffs of a standard 100microgram inhaler.
If your peak flow is less than 150 especially if you have symptoms of breathlessness, contact your doctor urgently, or if he/she is unavailable, go to your nearest hospital casualty department. Remember, asthma can kill if not taken seriously.

For all patients, remember to check with your doctor or asthma nurse for advice as individual patients may need different treatment recommendations.

If you are a smoker put your mind to stopping smoking. It will help your asthma control and will also help prevent many other illnesses and problems like smelly breath. You will also save lots of money that otherwise goes to the tobacco companies and the exchequer.