Asthma inhalers, medicines and treatments Reliever inhalers Yur Emergency Rescue Reliever Everyne with asthma shuld ALWAYS carry a reliever (blue inhaler) inhaler at all the time s it s n hand in an emergency The drug in reliever (blue) inhalers is called Salbutaml It wrks by relaxing and pening the tightened breathing tubes and s it eases the symptms f an asthma attack. Yu shuld feel a difference t yur breathing within a few minutes. If yu need yur reliever inhaler MORE THAN THREE TIMES A WEEK, this means yur asthma isn t as well cntrlled as it culd be and yu shuld arrange a review f yur treatment with yur dctr r nurse. There are 3 main types f reliever inhalers. Metered dse inhalers (MDIs), such as Ventlin, Airmir, Salaml. If yu have been prescribed an MDI inhaler, yu need t use it with a spacer t make sure yur medicine is getting t yur lungs. Breath actuated inhalers (BAIs), such as Easi-breathe, Airmax, Authaler. Dry pwder inhalers (DPIs), such as Accuhaler It is imprtant t discuss with yur dctr r nurse which ne is suitable fr yu. It is imprtant t use it the right waynt gets the right dse f asthma medicatin int the lungs. If yur asthma is triggered by exercise, yu can take the reliever inhaler 20 minutes befre yu start exercising t prevent symptms appearing. Are there any pssible side effects? We use medicines t make yu better and t save lives, but smetimes they have ther effects that we d nt want (side effects). Because salbutaml is delivered directly int the lungs, it is unlikely t cause any side-effects. Hwever, it is pssible that yu may experience shakiness in the hands r a racing heart fr a shrt while.
Spacers Spacers make it easier t get the right amunt f medicine int yur lungs Spacers are large, empty devices that help yu t get the right amunt f asthma medicine t the right place (the lungs) if yu are using a metered dse inhaler (MDI). This may mean yur symptms are better managed and may mean yu need t use less medicine verall. Using a spacer device can reduce the risk f side effects frm yur medicine. Sme f the medicine may end up in yur muth r the back f yur thrat instead f yur lungs if yu d nt use a spacer device. There are several different brands and sizes f spacer that fit different inhalers and different age grups. If yu are nt sure whether yu are using the inhaler and spacer prperly, there are lts f places yu can g fr help: cntact yur asthma nurse talk t yur pharmacist lk at the infrmatin sheets and vides n www.beatasthma.c.uk It is imprtant that yu fllw the instructins when cleaning yur spacer. If it s a new spacer, clean it befre yu use it fr the first time, then nce a mnth afterwards. Yur spacer shuld be replaced at least every year.
Preventer inhalers Preventer inhalers cntain sterids medicine t reduce inflammatin, swelling and sensitivity in the airways, and s, reduce the number f asthma attacks. Yu shuld use it even if yu feel well because the sterids medicine takes time t build up t give yur airways prtectin. If yu stp taking yur preventer inhaler, yu will nt get the full benefits and yur airways are likely t react easily t asthma triggers. Preventer inhaler will nt reduce wheezing r breathlessness during an asthma attack. Yu shuld use their reliever inhaler (blue salbutaml inhaler) fr this. There are many types f preventer inhaler that cme in all shapes, sizes and clurs. It is likely that yu will be started n a brwn inhaler t begin with, thugh it can als cme in range. If yu were given pink, red, yellw, purple, r grey, this means yu have been given a cmbinatin inhaler, which als cntains lng-acting reliever medicine. Are there any pssible side effects? We use medicines t make yu better and t save lives, but smetimes they have ther effects that we d nt want (side effects). Recent research has shwn that the chance f side effects frm taking a lw dse f inhaled preventer medicine is small. It is imprtant t knw that using it daily as prescribed will means yu are less likely t need the reliever inhaler r a repeat prescriptin f ral sterid tablets which means higher dses f sterids. Sme f the mre cmmn side effects are: Sre thrat, harse vice, muth infectin called thrush. Ways t avid these side effects: Using a spacer with MDI inhaler Using gd inhaler technique Rinsing yur muth ut and brushing yur teeth after using yur inhaler Yu will always have yur height and weight measured at yur asthma review. This is because there is a small link between the lng-term use f high dse inhaled sterids and reduced grwth.
Lng-acting Reliever inhalers A lng-acting reliever inhaler wrks ALONGSIDE yur preventer inhaler t make breathing easier. It desn t replace yur usual, shrtacting reliever inhaler (Blue inhaler) and shuld nt be used during an acute asthma attack. Yu may be given a lng-acting reliever inhaler as an add-n treatment. They wrk alngside yur usual daily preventer inhaler t keep the airways pened up by relaxing the muscles arund the breathing tubes and this help breathing easier. Lng-acting reliever inhalers shuld nly be used if yu have als been prescribed a sterid preventer inhaler t use daily. It is dangerus t use a lng-acting reliever inhaler withut als using a sterid preventer inhaler. This is because a lng-acting reliever inhaler des nt treat the underlying inflammatin (inflammatin makes yur airways mre sensitive and irritable) in yur airways. Withut cmbining with the sterids preventer inhaler, the underlying inflammatin will wrsen. There are 2 different types f lng-acting reliever inhalers Lng-acting beta agnists (LABA) Examples f these are: Serevent Evhaler (Salmeterl), Vertine Metered-Dse Inhaler (Salmeterl), Frmterl Easyhaler (Frmterl), Oxis Turbhaler (Frmterl) and Fradil Dry Pwder Inhaler (Frmterl). Lng-acting muscarinic receptr antagnists (LAMA) Examples f these are: Spiriva Respimat (Titrpium brmide) It is imprtant t discuss with yur dctr r nurse which ne is suitable fr yu. It is imprtant t use it the right way t get the right dse f asthma medicatin int the lungs. Are there any pssible side effects? We use medicines t make yu better and t save lives, but smetimes they have ther effects that we d nt want (side effects). Because lng-acting reliever is delivered directly int the lungs, it is unlikely t cause any sideeffects. Yu may get sme f the fllwing side-effects when first start taking these inhalers. They are usually mild and shuld wear ff after a few days as yur bdy gets used t the medicine. Yu may r may nt experience sme f these, such as dizzy, headaches, mild shakiness f hands. There may, smetimes, be ther side-effects that are nt listed abve. Cntact yur dctr r asthma nurse r pharmacist, if yu r yur child ntice anything unusual r are cncerned. Example f a Lng-acting Reliever Inhaler: Titrpium brmide
Cmbinatin inhalers A cmbinatin inhaler cmbine tw types f medicine (Preventer + Lng-acting Reliever) Yu may be prescribed a cmbinatin inhaler because the asthma symptms are nt well managed with yur usual medicines. This cntains tw kinds f medicine: A lng-acting reliever and A sterid preventer Examples: Seretide, Symbicrt r Fstair Cmbinatin inhalers will nt reduce wheezing r breathlessness during an asthma attack. Yu shuld use yur reliever inhaler (blue salbutaml inhaler) fr this. Take yur cmbinatin inhaler daily, even when yu feel well. This is because it is designed t wrk away in the backgrund t prevent airways inflammatin. Are there any pssible side effects? It is imprtant t knw that using it daily as prescribed will means yu are less likely t need the reliever inhaler r a repeat prescriptin f ral sterid tablets which means higher dses f sterids. Sme f the side effects might include: Sre thrat, harse vice, muth infectin called thrush. Ways t avid these side effects: Using a spacer with MDI inhaler Using gd inhaler technique Rinsing yur muth ut and brushing yur teeth after using yur inhaler Yu will always have yur height and weight measured at yur asthma review. This is because there is a small link between the lng-term use f high dse inhaled sterids and reduced grwth.
The SMART Regime (Maintenance and Reliever Therapy) This is a specific treatment regimen that cmbines a preventer and reliever Yu may be prescribed a specific regimen called MART (Maintenance and Reliever Therapy), which cntains a preventer and reliever. There are varius MART brands been used in the UK, but Symbicrt SMART Regime is the nly regime currently being used in lder teenagers. This is nrmally given fr mre difficult asthma and fr smene wh might benefit frm being able t increase the dse (t a maximum prescribed dse) they are taking thrughut the day when they experience wrsening symptms. Take yur MART inhaler daily, even when yu feel well. This is because it s designed t wrk away in the backgrund t prevent airways inflammatin. When yu are n MART regimen, yu d nt need a reliever inhaler fr emergency symptms. When the symptms wrsen, yu shuld increase the dse f yur MART inhaler, accrding t yur specific MART actin plan. Yu shuld still always carry a reliever inhaler (Blue Inhaler) at all times. Are there any pssible side effects? It is imprtant t knw that using it daily as prescribed will means yu are less likely t need the reliever inhaler r a repeat prescriptin f ral sterid tablets which means higher dses f sterids. Sme f the side effects might include: Sre thrat, harse vice, muth infectin called thrush. Ways t avid these side effects: Using gd inhaler technique Rinsing yur muth ut and brushing yur teeth after using yur inhaler Yu will always have yur height and weight measured at yur asthma review. This is because there is a small link between the lng-term use f high dse inhaled sterids and reduced grwth.
Singulair/Mntelukast (Leuktriene Receptr Antagnists (LTRAs)) LTRAs are smetimes als knwn as anther type f preventer medicine. They are nt sterids. They are an add-n t yur usual asthma medicine. Yu may be prescribed a medicine called Leuktriene Receptr Antagnists (LTRAs) LTRAs wrks by blcking the effects f chemicals in the bdy that cause inflammatin and narrwing f the airway. They als reduce yur bdy s respnse t substances (allergens) that can trigger yur asthma. Taking LTRAs regularly will help t stp yu frm having asthma attacks. It can take up t 2 weeks befre yu start feeling the full effects f LRTAs. Hwever, if they have had n effect after 6 weeks, then LTRAs are prbably nt the right medicine fr yu. Speak t yur dctr r asthma nurse befre stpping it. LTRAs will nt reduce wheezing r breathlessness during an asthma attack. Yu shuld use yur reliever inhaler (blue salbutaml inhaler) fr this. The mst cmmn type f LTRA is Mntelukast (Brand name knwn as Singulair). Occasinally, yu might be prescribed Zafirlukast (Brand name Acclate) Are there any pssible side effects? We use medicines t make yu better, but smetimes they have ther effects that we d nt want (side-effects). Fr teenagers wh take LTRAs, sme f the side effects might include: Frequent sre thrats, infectin. (1 in 10 peple may experience this) Nausea, vmiting, jaundice (yellwing f yur skin r whites f yur eyes), and generally feeling unwell. These can be signs f a liver prblem, and yu shuld cntact yur dctr fr review, which includes bld tests. Flu-like symptms, numbness in yur arms r legs, difficulties in breathing and a skin rash. These may be a sign f a rare but serius disrder called Churg-Strauss Syndrme. Always speak t yur dctr r asthma nurse if yu are wrried abut anything at all.
Thephylline Yu may be prescribed a medicine called Thephylline. It is an add-n t yur usual medicine and des nt replace ther treatment yu are taking. Thephylline wrks by relaxing the muscles in the airways s that they pen up and can let air flw thrugh them mre easily. It is very imprtant that yu take Thephylline regularly and exactly as it is prescribed as this will help t stp yu frm having asthma attacks. Yu may need regular bld tests t make sure the level f thephylline in yur bld stays at a safe level. Thephylline will nt reduce wheezing r breathlessness during an asthma attack. Yu shuld use their reliever inhaler (blue salbutaml inhaler) fr this. There are 2 types f thephylline medicines: A tablet r capsule yu take at hme t help yu manage yur asthma symptms. An emergency medicine that is nly ever given directly int a vein in hspital. As there are ther brands f thephylline being used in the UK, it is imprtant t ensure yu get the same brand f thephylline each time yu pick up a new prescriptin as the amunt f thephylline absrbed by yur bdy may vary between brands. It can take up t 6 weeks befre yu start feeling the full effects f thephylline. Hwever, if yu have had n effect after 6 weeks, then thephylline is prbably nt the right medicine fr yu. Speak t yur dctr r asthma nurse befre stpping it. Sme f yur lifestyle can interact with thephylline; this means that the levels f thephylline in yur bld can g up (ptentially harmful) r dwn (s it desn t wrk). If yu are taking thephylline, it is imprtant t knw that it can interact with Alchl, tbacc, caffeine, St. Jhn s Wrt (herbal medicine), sme antibitics, sme anaesthetics. Are there any pssible side effects? We use medicines t make yu better, but smetimes they have ther effects that we d nt want (side-effects). Pssible side effects may include: Headache, insmnia, nausea, irritability, stmach upset. If yu experience any f the fllwing symptms, please seek medical attentin immediately Vmiting, a racing heart, a feeling f yur heart beating in an unusual rhythm, fits, skin rashes
Prednislne (Sterids) taking them in the lng-term If yu have been taking prednislne fr a lng duratin, d nt stp the medicine suddenly, as yu may becme unwell. Always speak t yur dctr befre stpping yur prednislne. Yu may be prescribed a medicine called Prednislne. It is frm a family f medicatins knwn as sterids. Yu may have heard f sterids when reading abut prfessinal sprts peple. Sterids can make yu strnger, and in small dses sterids are used t reduce asthma symptms. Many peple with asthma will need t take shrt curses f sterids during their asthma attacks. Hwever, a small number f individuals with severe asthma may need t take prednislne regularly and fr a lnger perid f time. This helps t prevent asthma attacks by calming and preventing inflammatin in the airways. The dse and length f the curse f the prednislne given t yu will depend n yur age, hw yur airways respnd t treatment and hw well yur symptms are managed. Yur dctr will always try t manage yur asthma using the lwest pssible dse. They may als cnsider prescribing ther medicines knwn as sterid-sparing medicines t reduce the need fr lng-term prednislne, r t keep the dse as lw as pssible, t reduce the risk f side effects. Prednislne is usually used alngside with ther asthma medicines. It is imprtant that prednislne is taken as prescribed and that yu shuld cntinue t take the preventer inhaler daily. If yu have been taking prednisne fr a lng time, please d nt stp the medicine suddenly withut cnsulting yur dctr, as yu may becme unwell. This is because the sterid may stp yur bdy s natural sterid hrmnes being made fr a shrt time. If yur dctr decides t stp prednislne, they will reduce the dse gradually befre stpping it cmpletely. Make sure yu fllw yur dctr s instructins. Occasinally, yur dctr may discuss anther sterid medicine, called Kenalg (triamcinlne) if yur asthma is very severe and difficult t cntrl. This medicine will usually be injected int the buttck, at regular intervals. Yu may want t carry a sterid treatment and warning card. This acts a reminder t yu abut the ptential side effects, as well as a warning t healthcare prfessinals.
Are there any pssible side effects? We use medicines t make yu better, but smetimes they have ther effects that we d nt want (side-effects). Yu are mre likely t have side-effects when yu are n lng term prednislne. It can be wrrying thinking abut the side-effects but remember yur dctr will nly prescribe prednislne when it is essential t stp yu having lifethreatening asthma attacks as asthma attacks can kill. Pssible side effects may include: Weight gain due t increased appetite. Affecting grwth and puberty. In girls, it can cause grwth f bdy hair and irregular perids. Yu will always have their height and weight measured at yur asthma review. Talk t yur dctr if yu have any cncerns. Lwer immune system, meaning at risk f severe infectins. Yu shuld stay away frm anyne with an infectin such as chickenpx, shingles, measles if yu have nt had these illnesses r have nt been vaccinated fr measles. Yur skin may becme thinner and heal slwer than usual. Spts (Acne) may wrsen, and muth ulcers r thrush (ral fungal infectin) can develp. Yu may have truble sleeping, md changes, stmach ache r heartburn.
Omalizumab Omalizumab (Brand name Xlair) is ne f the newer asthma medicines that may be an ptin fr yu with uncntrlled mderate t severe asthma. They are als knwn as sterid-sparing agent. Yu may be prescribed a medicine called Omalizumab (Brand name Xlair) if yu have severe allergic asthma. This wrks cmpletely differently t ther asthma medicines. Omalizumab wrks by blcking the activity f sme f the immune system (IgE) that triggers swelling in the airways. This means that when yu meet an allergic trigger, yur airways will nt be as sensitive as it was befre and s yu are less likely t becme unwell. It is an injectin given under the skin every 2 r 4 weeks, A skin r bld test is perfrmed t see if yu have allergies. It is an add-n t yur usual medicine and des nt replace ther treatment yu are taking. Hwever, Omalizumab might help manage yur asthma symptms better s that the sterids medicine can be taken at a lwer dse r less frequently ver time. Omalizumab will nt reduce wheezing r breathlessness during an asthma attack. Yu shuld use yur reliever inhaler (blue salbutaml inhaler) fr this. Are there any pssible side effects? We use medicines t make yu better, but smetimes they have ther effects that we d nt want (side-effects). The list f ptential side effects can lk wrrying, but it is imprtant t remember that mst peple will nt experience them. Pssible side effects may include: Shrt lasting discmfrt at the injectin site Pain in arms and legs, dizziness, feeling tired, skin rash, bne fractures Cmmn cld symptms, headache, sre thrat, pain r discmfrt f yur ear, abdminal pain, nausea, vmiting and nse bleeds. Fever, muscle aches and rash. Sme peple get these symptms after 1 t 5 days after receiving Omalizumab. Infrm yur healthcare prvider shuld yu experiences such symptms. There is a ptential risk f severe allergic reactin (anaphylaxis) t Omalizumab. This can ccur after the first dse, r after many dses. Yur healthcare prvider will mnitr clsely fr symptms f allergic reactin while yu are receiving Omalizumab fr a perid f time.