Asthma treatment

Various options are used to treat asthma. It is important to know that there is no one best treatment that is suitable for everyone. The disease in different patients proceeds differently, and in order for the medicine to work, the treatment of asthma depends on your personal needs. The goal of treatment is to achieve and maintain good asthma control , as well as improving the quality of life of an asthma patient. This result is desirable to achieve with the lowest dose of medication / drugs and with the least side effects. Asthma is well controlled if: 

• Symptoms do not appear in the daytime, or they appear only briefly and no more than two days a week. 
• At night, symptoms do not appear, or they appear no more than two episodes per month 
• Asthma does not limit physical activity 
• The patient does not need treatment for seizures (in fast-acting bronchodilators) or does not use these drugs more than twice a week.  
• Indicators of pulmonary functions remain within normal limits (at least 80% of indicators over the past five years). 
• There are no more serious exacerbations , or they appear no more often than once a year. 

If you suspect asthma, or is already diagnosed, it is very important that you tell your doctor about your health. Together with your doctor, you will find the treatment plan that suits you best. Before you visit a doctor, track:

• Your breath
• Can some activities trigger an asthma attack or respiratory failure
• Do you have breathing problems at work while at home
• You are feeling better

Write down all noted manifestations, as the doctor will need your exact descriptions. To track your asthma, you can fill out a test for asthma control. This is a simple questionnaire, the sum of the points of which gives information about the state of asthma (Jia et al 2013), and you can ask for a printed copy of it for yourself from a family nurse .   

Your doctor may ask you what symptoms you have, when they begin, and how often they occur. You will be asked about other health data, and you may be asked if any of your relatives have asthma. Information about whether your relatives had any breathing problems, lung disease, or allergies. For the doctor, you can make a list of medicines, nutritional supplements, and vitamins that you consume.

Non-drug treatment

In the treatment of asthma, in addition to taking medication, a lifestyle is important. Try to avoid upper respiratory tract irritants and known allergens. The most important respiratory irritant is tobacco smoke. Smoking is one of the most important risks to your health. Quitting smoking will help you significantly improve asthma control. An important risk factor is lack of physical activity (Lim et al 2012). Physical activity appropriate for you is highly recommended for asthma. Regular exercise can help you better absorb oxygen and can improve your quality of life and control your asthma (Carson et al 2013; Heikkinen et al 2012). For patients with asthma, flu vaccination is not contraindicated .

Drug treatment

The goal of the pharmacological treatment of asthma is not only to alleviate the symptoms, but also to achieve the necessary asthma control with as few side effects as possible. Asthma treatment is divided into basic treatment, which is used regularly to keep asthma under control, and seizure treatment, which, according to need, is used to quickly relieve asthma attacks. For patients with mild episodic asthma physicians recommend treating attacks β ₂ – agonists short action for patients with persistent asthma physicians prescribe constant basic treatment and if necessary, treatment of seizures. Basic treatment Inhalation or inhaled medicine is used as the basic treatment , the purpose of which is to alleviate the symptoms, as well as prevent exacerbations of asthma and preserve pulmonary function. Treatment usually begins with inhaled glucocorticosteroids or hormonal treatment. These drugs have an anti-inflammatory effect, they reduce swelling and irritation on the walls of the lower respiratory tract, thus alleviating breathing problems. In the basic treatment, a phased approach is used: they begin with a dose of drugs of the lowest level, if possible with drugs of primary choice. If the primary drugs cannot cope with asthma control, then the doctor will prescribe a dose of the medicine for the next level of basic treatment. If asthma can be controlled for at least three months, then the doctor can return the dose to the previous level. The doctor regularly monitors the effect of drugs and, if necessary, can change the dose of drugs. If one medicine does not give the desired asthma control effect, then the doctor may recommend another medicine in addition. Usually, β ₂ long-acting agonists are used for this . Two different inhalers can be used, but it is more convenient if two drugs are combined in one inhaler. β _{2 –} long-acting agonists (bronchodilators) help open the airways, making breathing easier. Medications that relax the bronchi help to avoid shortness of breath and wheezing. These drugs do not help with exacerbation of asthma. There is also a group of less commonly used drugs that can be taken by mouth in pill form. 

If within one month of using the basic treatment the desired result has not been achieved, the doctor should first of all evaluate your inhalation technique and how much you adhere to the treatment plan and recommended lifestyle. If necessary, the treatment regimen is changed – for example, the dose of the drug, the medicine itself or the frequency of their administration. If proper asthma control has been maintained for at least three months, your doctor may recommend a decrease in basic treatment. If control is not achieved with a combination of two drugs in increased doses, then the family doctor will refer you to a consultation with a pulmonologist. Treatment of seizures Treatment of seizures with bronchodilators effectively helps alleviate existing asthma symptoms, but these anti-seizure medications do not help prevent asthma exacerbations. β _{2 –} short-acting agonists, also called fast-acting bronchodilators, help relieve asthma symptoms. They relax the muscles in the walls of the airways, help open the airways and facilitate breathing. Thus, chest tension associated with asthma, wheezing and coughing are reduced. Their effect is short-term and sometimes, in case of exacerbation of symptoms, they need to be reused. Ask the doctor to write down for you what exact maximum number of doses for which time can be used without danger to health. In case of exacerbation of asthma, glucocorticosteroid tablets are used. The treatment plan is prescribed by your doctor. In addition to tablets, it is necessary to continue the continuous intake of an inhaled drug from the basic treatment. Before starting treatment for asthma, the doctor must evaluate the severity of asthma. The dose of the drug and the frequency of its use depend on this. Next, you need to find a suitable inhaler with your doctor and nurse and learn the inhalation technique. Inhalers are easy to use, easy to carry and easy to handle. In the case of pharmacological treatment, the inhalation technique is very important, the attending physician or nurse will introduce you to it. It is also very important the choice of an inhalation suitable for you. There are several types of inhalers, so it is very important to learn a new technique when receiving the first medicine or when changing it. The best way is a visual test, which can be done, for example, while taking a family nurse. Both powder inhalers and inhalers with a dispenser are used. Medicines used both in metered-dose inhalers and powder inhalers work the same way. NB! Unfortunately, many patients with asthma use the inhaler incorrectly. In case of improper use of the inhaler, there will be no benefit from the medicine. 
 

1. Inhalers with dispensers 

From these inhalers, the drug is released by pressing the canister and inhaling directly. Metered-dose inhalers are used to treat seizures and to take basic medicines.

How to use a metered-dose inhaler? 

1. Remove the cap from the inhaler.
2. Shake the inhaler.
3. Keep the inhaler upright; the ring finger will help you release the medicine from the inhaler.
4. Hold the mouthpiece of the inhaler near your mouth and exhale deeply.
5. Place the mouthpiece in your mouth, grasping it firmly with your lips, raise your chin slightly up. At the same time, when you inhale deeply and evenly, press the canister to release the dose of medicine.
6. Inhale long and deep so that the medicine enters deep into the lungs.
7. Remove the mouthpiece from your mouth, close your mouth and hold your breath for 10 seconds.
8. Exhale through the nose and repeat the procedure if necessary.
9. After inhalation, rinse your mouth.
10. Avoid getting medicine in the eye.

 
If you read the technique manual, try using the medicine yourself in front of a doctor or nurse. First time using medicine at home, do it in front of the mirror. If you have any questions about using the medicine, be sure to ask the doctor or nurse, since taking the medicine correctly will help you keep control of asthma. If the use of the inhaler is complicated or you cannot use it due to your health condition, be sure to inform your doctor about this, who will prescribe the type of treatment suitable for you. Cleaning the inhaler The inhaler must be cleaned at least once a week. This is necessary so that the medicine does not clog the nets of the mouthpiece of the inhaler. Intermediate reservoir for using the medicine The intermediate reservoir (or spacer) is the container in which the medication is collected and allows you to slowly and deeply inhale the medication once or twice. An intermediate reservoir reduces the likelihood of drug sedimentation on the tongue or on the oral mucosa, and helps more medicine enter the lungs. The intermediate tank is suitable for those who find it difficult to simultaneously inhale and inject the medicine.

Despite the fact that the remainder of the drug remaining in the intermediate tank is harmless, it still needs to be washed regularly after every 1-2 weeks. The easiest way is to rinse with warm water. After washing, the tank must be dried in air, in no case wiping it with a towel.
 

2. Powder inhalers

 
Powder inhalers contain doses of the drug in the form of a fine powder, which when inhaled enters the lungs. When using a powder inhaler, you do not need to inhale and release the medicine at the same time , but the entrance should be more intense. Therefore, a powder inhaler may not be suitable for elderly patients or people whose nerves or muscles are weakened. Powder inhalers are also used both in the treatment of seizures and as a basic treatment, depending on the medication they contain. 2 types of powder inhalers are mainly used:       

1. Multi-dose inhalers that include up to 200 doses.
2. Inhalers in a single dose – when using them, before each use it is necessary to replace the capsule with the medicine. It must be remembered that capsules must not be swallowed! The medicine is effective only by inhalation!

 
The use of a powder inhaler depends on the specific type and brand of production. The following are general guidelines for using such inhalers. When taking your prescribed medicines, it is very important that you read the information sheet and consult with your doctor or nurse. How to use a powder inhaler? 
 

1. Remove the nebulizer plug and release the dose. If you have the nebulizer to which the capsule needs to be attached, follow the instructions
2. Holding the mouthpiece aside, exhale deeply (not into the mouthpiece).
3. Place your front teeth around the mouthpiece and close your lips tightly around it.
4. Inhale quickly, intensively and deeply through your mouth for 2–3 seconds.
5. Remove the mouthpiece of the inhaler from the mouth. Hold your breath for another 2-19 seconds.
6. Breathe out slowly and calmly through your nose.

Be careful when cleaning the powder inhaler. Most powder inhalers should not be washed with water or soap. The mouthpiece can only be cleaned with a dry cloth.

Treatment of concomitant diseases
Be sure to inform your doctor about your other diseases (for example, high blood pressure, diabetes, etc.), as the treatment prescribed for you may depend on this. In the case of cardiovascular diseases, drugs are used that are not suitable for asthma patients . Be sure to let your doctor know about all the medicines you are taking, including painkillers. In rare cases, some patients may be allergic to aspirin. In this case, only paracetamol can be used as a painkiller.