Preventer inhalers are slower acting inhalers that reduce inflammation in the airways and prevent asthma attacks occurring. The preventer inhaler must be used daily for some time before full benefit is achieved. The preventer inhaler usually contains a medicine called an inhaled corticosteroid. Examples of preventer medicines include beclometasone (Becotide®, Beclazone®), budesonide (Pulmicort®) and fluticasone (Flixotide®). Preventer inhalers are often brown, red or orange. The dose of inhaler will be increased gradually until symptoms ease. For example, a patient may start on a beclamethasone 100mcg inhaler and may be put on a beclamethasone 250mcg inhaler if there is not sufficient improvement in symptoms. Preventer treatment is normally recommended if have asthma symptoms more than twice a week, wake up once a week due to asthma symptoms or have to use a reliever inhaler more than twice a week.
Regular inhaled corticosteroids have been shown to reduce asthma symptoms. Most patients require a dose of less than 400mcg per day to achieve maximum or near maximum benefit. Side effects are minimal at this dose. The main side effect of preventer inhalers is a fungal infection of the mouth or throat so it is important to rinse the mouth with water after inhaling a dose. You may also develop a hoarse voice. Using a spacer can help prevent these side effects. I will discuss spacer devices next week.
Long-acting reliever inhaler
If reliever and preventer inhalers are not providing sufficient symptom relief, a long-acting reliever (long-acting bronchodilator/long acting beta2-agonist) may be tried. Inhalers combining an inhaled steroid and a long-acting bronchodilator (combination inhaler) are more commonly prescribed than long acting beta 2-agonists on their own. These work in the same way as short-acting relievers, but they take longer to work and can last up to 12 hours. Examples of combination inhalers containing long acting beta 2-agonist and steroids include Seretide® and Symbicort®. They can be very effective in patients who didn’t respond to preventer inhalers on their own.
If treatment of your asthma is still not successful, additional preventer medicines will be tried. Two possible alternatives include leukotriene receptor antagonist tablets and theophylline tablets. Leukotriene receptor antagonist tablets block part of the chemical reaction involved in inflammation. Montelukast (Singulair®) is the name of the drug and the brand name is. Leukotriene receptor agonists do not usually cause side effects, although there have been reports of stomach upsets, feeling thirsty and headache. Theophylline tablets help widen the airways by relaxing the muscles around them. Theophylline has been known to cause side effects in some people, including headaches, nausea, insomnia, vomiting, irritability and stomach upsets. These can usually be avoided by adjusting the dose.
If asthma is still not under control, regular oral steroids (steroid tablets) may be prescribed. This treatment is usually monitored by a respiratory specialist. Long-term use of oral steroids has possible serious side effects, so they are only used for short term periods once other treatment options have been tried.
To be continued...
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