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Treating asthma in adults

Many people put up with asthma symptoms when they do not need to. Asthma is treatable.

Getting wheezy or short of breath more than three times a week is a sign that your asthma isn't well controlled and you may need to use a preventer inhaler.

You and your healthcare team should be able to agree on a treatment plan that will control your asthma.

Inhalers

Adults with asthma are usually given inhalers as part of their treatment.

With some inhalers, using a spacer helps get more of the medicine into your lungs. Many of the newer inhalers are designed to be used without a spacer.

Talk to your GP if you aren't sure which types of inhaler you have or if you're having problems using them.

If you're using your inhalers as agreed with your doctor and you're still having symptoms, it's important to discuss this with your doctor to find out why.

Single inhaler therapy or anti-inflammatory reliever therapy (AIR)

There has been a recent change in the best treatment for asthma. People used to have a reliever (blue) inhaler to use when they felt wheezy or short of breath. We now know that a combination inhaler containing a steroid preventer and a long-acting reliever is a better way of treating asthma.

The steroid part of the inhaler works by reducing the inflammation in your airways, so they do not react to triggers.

The reliever part works quickly to relax the small muscles in your airways, opening them up.

You can use this inhaler every day, both as a preventer and when you need quick relief if you feel wheezy or short of breath.

Symbicort, Vannair and Duoresp Spiromax are the only combination inhalers in New Zealand that can be used in this way. Other combination inhalers such as Seretide, Breo and Rexair shouldn't be used as single inhaler therapy.

Short-acting relievers

Short-acting relievers manage your symptoms quickly by relaxing the muscles in your airways, opening them up to allow more air to flow. Examples of short-acting relievers include salbutamol (Respigen and Ventolin) and terbutaline (Bricanyl).

We now know it's better to use a combination inhaler as your reliever instead of a short-acting inhaler. Discuss this with your doctor.

Preventers

Preventers reduce the inflammation in your airways. Unlike relievers, preventers do not make you feel better straight away. But if you use them every day, they make your asthma symptoms less likely to occur. These preventers are usually mild steroids. Examples of steroid preventers include beclometasone and fluticasone.

Long-acting relievers

Long-acting relievers help to keep your airways relaxed and open. You usually take these medications when your preventer inhaler isn't enough to keep your asthma under control. If you need a long-acting reliever, you'll take it as part of a combination inhaler.

Combination inhalers

Combination inhalers contain both a long-acting reliever and a steroid preventer. Examples of these medications include formoterol plus budesonide (Symbicort, Vannair and Duoresp), which are most suitable for asthma. Other types include salmeterol plus fluticasone (Seretide and Rexair) and vilanterol plus fluticasone (Breo).

Tablets

If you have a very bad asthma flare-up or attack, and inhalers alone aren't working, you may need a short course of steroid tablets. For adults the course is usually at least five days. The most commonly used steroid is prednisone. Like the inhaled steroid preventer, prednisone reduces inflammation in your airways.

Many people have a written, agreed plan for when to start prednisone and have a supply at home (see the self-management plans on Self-care for asthma).

Nebulisers

Nebulisers are sometimes used in hospital for severe asthma attacks. A nebuliser is a machine that has an air compressor and a breathing mask. You put liquid reliever medication into a container and the nebuliser produces a fine mist that you breathe in through the mask.

Respiratory specialist

If your asthma isn't well controlled with inhalers, you may need to see a Respiratory Specialist to consider additional treatments.

  HealthInfo recommends the following videos

• HealthSketch – What is asthma?

  A simple animated video about the asthma: its symptoms and triggers, how it's diagnosed and treated and how it can be managed.

  HealthInfo recommends the following pages

• Asthma Foundation – Medicines

  Information about preventer medication, reliever medication, symptom controllers, combination inhalers and prednisone.

On the next page: Self-care for asthma

Written by HealthInfo clinical advisers. Last reviewed June 2021.

Sources

Page reference: 37537

Review key: HIASA-39947