Asthma is a chronic inflammatory disease, the prevalence of which has greatly increased in recent years. It is believed that many people are not aware of having asthma, and therefore do not receive proper treatment. At the same time, most asthmatic patients can gain complete control of the disease with the help of treatment, and thus maintain the quality of life and working capacity. This article is dedicated to asthma diagnosis, treatment and medications, which can be found in My Canadian Pharmacy at reasonable prices. Although self-treatment is not advisable in case of asthma, information on symptoms and treatment strategies will be provided for reference purposes.
What are the main symptoms of asthma?
- shortness of breath (which can occur at night);
- stridor (abnormal breathing sound that resembles wheezing);
- cough that occurs more frequently during the night and/or in the early morning;
- chest tension or tightness.
Asthma symptoms can manifest in mild and severe forms, lasting from a few hours to a few days, if not treated. An asthma attack is a condition where all of the symptoms develop very quickly. Occurrence of these symptoms, especially for the first time, can cause a feeling of fear, uncertainty, and helplessness.
Let the doctor know about your asthma symptoms; self-diagnosis and self-treatment without professional supervision is potentially dangerous. To diagnose asthma, the doctor should thoroughly analyze the patient’s health data to learn which diseases have the patient suffered and whether he or she is allergic. There is no single method for diagnosing asthma, and it cannot be diagnosed based on the questionnaire only. Usually, the doctor begins with lungs auscultation using a stethoscope, which helps to reveal abnormal sounds and determine whether there is inflammation in the airways. In the case of asthma, whistles, wheezes and/or crackles are heard during the procedure. If auscultation did not reveal the above symptoms, the doctor may prescribe a spirographic examination.
Different means are used for asthma treatment; there is no universal medication suitable for everyone. The disease is progressing differently in different people, and in order for the treatment to work, asthma medication should be chosen according to patient’s personal needs.
The goal of treatment is to achieve and maintain good asthma control, as well as to improve the quality of life. This result is desirable to achieve with the lowest medication dose and with the least side effects. If asthma is suspected or has already been diagnosed, it is very important to keep the doctor informed about patient’s health condition. Working together with a healthcare professional, patients will find a treatment plan that suits them best.
Asthma treatment is divided into basic treatment, which is used regularly to keep asthma under control, and asthma attack management, which is used to quickly relieve life-threatening symptoms. For patients with mild episodic asthma, doctors recommend short-acting β2-agonists (fenoterol, salbutamol, terbutaline, hexoprenaline, and clenbuterol) to terminate asthma attacks. For patients with persistent asthma, doctors prescribe a permanent basic treatment and, if necessary, drugs for asthma attack management.
Inhaled drugs are used as the basic treatment, the purpose of which is to alleviate symptoms, prevent asthma exacerbation, and preserve pulmonary function. Treatment usually starts with inhaled glucocorticosteroids or hormonal medicines. These drugs have anti-inflammatory and anti-allergic action, reducing swelling and irritation in the lower respiratory tract, thus alleviating breathing problems. Synthetic glucocorticosteroids include prednisolone, methylprednisolone, prednisone, dexamethasone, and some others. Natural corticosteroids include cortisone, hydrocortisone, etc. Budesonide (marketed as Rhinocort and Pulmicort in Canada) is a popular drug for regular use to prevent asthma attacks, although it cannot eliminate an attack that has already started.
Usually, long-acting β2-agonists are used for basic treatment. They include arformoterol, bambuterol, clenbuterol, formoterol, and salmeterol. The basic treatment uses a phased approach, starting the therapy with the lowest drug dose. If first choice drugs cannot ensure asthma control, the doctor prescribes a more potent medication. If asthma can be controlled for at least three months, the medication dosage can be reduced. The doctor should monitor the patient’s condition continuously, to change the dose and type of medication if necessary. If one drug does not provide the desired effect, additional drugs may be prescribed. You can use two different inhalers, but it is more convenient if two medicines are combined in one product.
Common combinations include:
- levosalbutamol and ipratropium bromide (marketed as Combinist L);
- fluticasone and salmeterol (Advair Diskus);
- budesonide and formoterol (Symbicort).
Long-acting β2-agonists (bronchodilators) help open the airways, making breathing easier. Because of their long-lasting effect (12-24 hours) they are recommended for persistent asthma patients, but not for acute asthma exacerbations, due to a slower onset of action.
Asthma drugs in the form of tablets are used less commonly for more severe asthma symptoms. However, they are not intended for asthma attack management because of longer onset times:
- Salbutamol (Ventolin pills);
- Theophylline (Theo-24, Uniphyl Cr);
- Montelukast (Singulair).
If the desired result has not been achieved within one month of basic treatment, the doctor should evaluate the patient’s inhalation technique, adherence to recommended lifestyle and treatment plan. If necessary, the treatment regimen is changed, e.g. drug doses, medicines, and frequency of their intake. If proper asthma control has been maintained for at least three months, the physician may recommend a reduction in baseline treatment.
Asthma attack management (rescue therapy)
Treatment with long-acting bronchodilators helps to relieve existing asthma symptoms, but these medications don’t prevent asthma exacerbation. Short-acting β2-agonists (SABAs), also called fast-acting bronchodilators, relax the muscles, open the airways and make breathing easier. Thus, associated with asthma chest tightness, wheezing and cough are quickly relieved. Their action is short term and sometimes, due to worsening of symptoms, they have to be used several times. Ask your doctor for the exact number of doses that can be taken with no risk for health. In case of asthma exacerbation, glucocorticosteroid tablets are used as well. Popular short-acting β2-agonists include salbutamol (marketed as Ventolin Inhaler and Proventil).
Before starting the treatment, severity of asthma should be evaluated. The dose and the frequency of drug use depend on it. Next, find a suitable inhaler and learn the correct inhalation technique. Inhalers are convenient to use, easy to carry and deal with. In pharmacological treatment, the inhalation technique is very important and should be introduced by a health worker. There are several types of inhalers, so it is very important to learn a new technique when using products for the first time. Unfortunately, many patients with asthma use the inhaler incorrectly and thus don’t benefit from the medication.
Both powder inhalers and metered-dose inhalers are used for delivering drugs to the airways. There is no fundamental difference in how these inhalers work, their effect depends solely on the medication inside. Both can be used for treating asthma attacks as well as basic treatment.
Apart from taking medication, lifestyle is also important in asthma treatment. Try to avoid upper respiratory tract irritants and known allergens. The most significant irritant is tobacco smoke. For asthmatic patients, smoking is a very serious risk to their health. Quitting smoking and avoiding passive smoking too will help patients to significantly improve asthma control. Another important risk factor is physical inactivity. Physical exercise appropriate for one’s health condition is highly recommended for asthma patients. Regular physical training helps to increase oxygen absorption, can improve quality of life and asthma control.