If you have asthma, you may find it hard to breathe sometimes. A feeling of tightness in your chest and wheezing are the main symptoms of asthma. The main cause of this is swelling inside your airways, or what we medically call `inflammation` . This inflammation causes your airways to become narrower and filled with mucus, making it difficult to breathe.
What is the relationship between asthma and inflammation?
If you have asthma, you probably know that this inflammation causes the lining of your airways to swell and increase mucus production. Think of it like a clogged water pipe, making it difficult for the water to flow through. This inflammation makes your airways very sensitive. Then, when certain things (we call these ``triggers``) like dust, smoke, and animal dander enter your body, they can quickly bring on asthma, which means asthma attacks .
This is why anti-inflammatory medications are such an important treatment for people with asthma. They stop the process that causes asthma to flare up. Simply put, they are like putting water on a fire.
What are the treatments for asthma?
There are different types of medications that can be used to control the inflammation that occurs in asthma. The main ones are:
- Corticosteroids that are injected directly into the respiratory tract (we call this an inhaler).
- Systemic corticosteroids (taken as pills or injected into a vein) are given to affect the entire body.
- In addition, there are drugs called ``Mast cell stabilizers'' and ``Leukotriene modifiers''. These help reduce the inflammation caused by ``Corticosteroids''.
- A newer treatment option is ``Monoclonal antibodies'' or ``biologic therapy''. These directly target the cells involved in inflammation (``eosinophil cells'').
Now let's talk about each of these medications in a little more detail .
Inhaled Corticosteroids: A best friend for asthma control!
Inhaled corticosteroids are the most effective medications available to reduce swelling and mucus production in your airways . This type of inhaler is often the first thing a doctor will prescribe for asthma.
What are the benefits of using these?
There are many benefits to using this inhaler correctly:
- Asthma symptoms and flare-ups are reduced.
- Short-acting beta agonists, or as we call them , relievers, or rescue inhalers, are used in emergencies and reduce the number of times you need to use them.
- Your lung function improves.
- The need to go to emergency rooms and be hospitalized will decrease.
- Overall, asthma can be well controlled.
Important: Keep these things in mind when using these!
It's important to note that these inhaled steroids only prevent asthma symptoms, not relieve existing symptoms . This means that if you take them when you have an asthma attack, you won't get immediate relief. That's what the reliever inhaler is for.
This ``controller`` inhaler (as we call it) should be used every day, as directed by your doctor . For some, it may be twice a day, for others, once a day. It is not a good idea to reduce or stop using these without talking to your doctor, thinking that your symptoms are getting better. Doing so may make your asthma worse again.
What are these nasal corticosteroids?
There are many different types of inhaled corticosteroids on the market. Some examples are:
- ``Beclomethasone dipropionate (Qvar RediHaler®)''
- `Budesonide (Pulmicort®; Symbicort®)`. (This `(Symbicort®)` is a combination of `(budesonide)` and `(formoterol)`.)
- `Ciclisonide (Alvesco® HFA)`
- `Fluticasone (Flovent® HFA; Advair® HFA and diskus, Wixela® Inhub, AirDuo®)`. (These contain `(fluticasone)` and `(salmeterol)`.)
- Fluticasone furoate (Arnuity® Ellipta; Breo® Ellipta; Trelegy® Ellipta). (Breo® contains fluticasone furoate and a long-acting beta agonist called vilanterol. Trelegy® contains umeclidinium in addition to these two.)
- ``Fluticasone propionate (ArmonAir® RespiClick)''
- `Mometasone (Asmanex®, Dulera®)`. (`(Dulera®)` contains `(mometasone)` along with `(formoterol)`.)
How do these types of inhalers come about?
These ``(inhaled corticosteroids)`` come in three main forms:
1. `(Metered Dose Inhaler - MDI)`: This is the kind that looks like a small can, and you use it on top. When using this, it is best to use it with a `(valved holding chamber)` or a `(spacer)` (something we call 'intermediate chamber' in Sinhala). This `(spacer)` helps the medicine go directly to the lungs, and reduces the amount of medicine that gets deposited in the mouth and throat. This is like using a tube when spraying water from a watering can.
2. `(Dry Powder Inhaler - DPI)`: This contains the medicine in the form of a dry powder. It is used by taking a deep breath in.
3. `(Nebulizer solutions)`: This comes as a liquid. It is vaporized and inhaled using a small machine (`(nebulizer machine)`). This method is often used for young children and those with severe asthma.
Should I be afraid to use these? Are there any side effects?
Inhaled corticosteroids are a very safe medication for both adults and children . Side effects are rare, especially when used in low doses.
However, rarely, if you use them in large doses, a fungal infection in the mouth (thrush) can develop, and your voice may change (become hoarse). This is very easy to prevent. After each use of the inhaler , rinse your mouth thoroughly, gargle, and spit out the medicine . If you use an MDI, you can also reduce this risk by using a spacer. If you do accidentally get thrush, it can be easily treated with an anti-fungal mouthwash prescribed by your doctor.
How does a doctor give these?
Your doctor will always try to give you the lowest dose of this medicine that will control your asthma. Many people are scared when they hear the word "steroids." This is because they have heard of anabolic steroids, which are used by athletes to build muscle. But steroids for asthma are not like that . They are anti-inflammatory drugs. In fact, taking them every day can help control your asthma.
Systemic Corticosteroids: Help for severe asthma!
These ``Systemic corticosteroids`` are medicines used to treat severe asthma episodes. They are given as pills or liquids (``oral``), or they are given into the body through a vein (``intravenous - IV``).
What time are these given?
This medication is used in combination with other medications to control asthma attacks that are suddenly severe, or to treat long-term, difficult-to-control asthma.
How do these start working?
Systemic steroids take about three hours to start working, with the best results seen after six to twelve hours. Sometimes they are given in high doses for several days (called a steroid burst), or the dose is gradually reduced over time (called a steroid taper). Sometimes, for long-term control, they can be given in low doses every day or every other day.
What are these `(Systemic Steroids)` types?
There are several types of ``systemic steroids'' that are commonly used (these are also available as ``generic'' products):
- `Cortisone acetate`
- `Dexamethasone`
- `Hydrocortisone (Cortef®)`
- `Methylprednisolone (Medrol®, Solu-Medrol®, Depo-medrol®)`
- `Prednisone (Deltasone®)`
- `Prednisolone (Prelone®, Pediapred®, Orapred®)`
Should we also be aware of the side effects?
Side effects of systemic steroids usually occur with long-term use . These side effects may include:
- Acne.
- Weight gain.
- Changes in mood or behavior.
- Stomach upset (e.g. gastritis).
- Bone weakness, bone loss.
- Eye changes, for example glaucoma (increased eye pressure) or cataracts (clouding of the eye).
- (Children's names) growth retardation.
But remember, these side effects are very rare when used short-term . You should only use them for a short period of time when your asthma is very severe. If you have uncontrolled asthma and need to use steroids for a long time, you should see a pulmonologist or an allergist. They can help you decide on more advanced treatments and refer you to other specialists if necessary.
Leukotriene Modifiers: Another help!
What are these? How do they work?
Leukotrienes are chemicals that occur naturally in our bodies. They cause the muscles in our airways to tighten and increase mucus production. Leukotriene modifiers block the action of leukotrienes. Studies have shown that these drugs can help improve breathing and reduce asthma symptoms. They come in the form of tablets. They are taken once or twice a day. You may be able to reduce the amount of other asthma medications you need.
What are the types of `(Leukotriene Modifiers)`?
The drugs in this category are:
- `Montelukast (Singulair®)`
- `Zafirlukast (Accolate®)`
- `Zileuton (Zyflo®)`
Are there any side effects?
The most common side effects are headache and nausea. Leukotriene modifiers can also interact with some other medications (for example, the asthma medication theophylline and the blood thinner warfarin). So it's important to tell your doctor about all the medications you're taking.
Monoclonal Antibodies - Biologic Therapy: New hope for severe asthma!
Monoclonal antibodies are a type of biologic therapy used to treat severe asthma. They work by blocking the body's response to triggers that cause inflammation. They directly target cells that are part of our immune system, such as eosinophil cells.
There are several types of these medications. They are given either as an injection under the skin in a doctor's office, as an IV infusion in a clinic or hospital, or some are self-injectable at home. People taking these biologics usually receive treatment every 2 to 8 weeks (depending on the biologic). You will need to be under the care of a pulmonologist or allergist if you are taking these medications.
Mast Cell Stabilizers: A Rarely Used Drug
Mast cell stabilizers work by blocking the release of histamine and other inflammatory substances from mast cells. However, these are rarely used to treat asthma.
What you need to remember most of all!
Asthma is a chronic (that is, persistent) inflammation of the airways in your lungs. It can be like a small spark that is always inside. Therefore, by taking the medications your doctor has prescribed for you, you can control your asthma well and maintain healthy lungs in the long term.
Remember, living with asthma can be challenging, but with proper treatment, you can lead a normal, active life. Talk to your doctor and develop a treatment plan that works best for you. It's the best way to breathe healthy!
` Asthma, Inflammation, Inhaler, Corticosteroids, Treatment, Respiratory Disease
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