Approximately 2.5% of Canadians over the age of 16 (roughly 525,000 individuals) are diagnosed asthmatics. Characterized by episodic cough, wheeze and breathlessness, asthma impacts the ability of sufferers to function at work, school, or just to carry out simple day-to-day activities.

Asthma is a chronic, progressive disease of the lungs caused largely by inflammation and its components, such as mucus and discarded cells. This inflammation produces spasms and contractions in the tubes of the lungs so that air cannot pass. Acute spasms occur for a variety of reasons, for instance exercise or cold air, but the ease with which spasms begin depends on the degree of inflammation in the airway.

In the past, treatment for asthma was reactive, treating only the spasms (the symptoms of asthma). Today, because it is known that inflammation causes spasms, we can treat the cause of asthma, as well as its symptoms. In many cases, asthma can actually be modified and damage can be reversed.

Goals Of Asthma Management

There are a number of goals for managing asthma.

• Eliminate inflammation in the airways to modify the course of asthma.
• Eliminate the factors which cause inflammation, e.g. allergies
• Use medication correctly to control inflammation.

Education and awareness of new developments is also vital for both patients and physicians to ensure the best possible treatment. Asthma medications, and devices like metered dose inhalers (MDIs), peak flow meters, nebulizers and spacers, also help reach these goals.

Asthma Medications

The following briefly describes many of the medications currently used to treat asthma.

1. Bronchodilators. Open airways and provide immediate relief from bronchospasms, but do not control inflammation. Examples include inhalers such as salbutamol, (brand name, Ventolin) and terbutaline (Bricanyl).
2. Anti-Inflammatory Medications. Work gradually to eliminate inflammation caused by asthma. Examples of anti-inflammatories include nedocromil sodium (Tilade), sodium cromoglycate (Intal), oral corticosteroids (Prednisone) and inhaled corticosteroids, [e.g., beclomethasone dipropionate (Beclovent); flunisolide, (Aerobid) budesonide, (Pulmicort); triamcinolone acetonide, (Oracort)].
3. Anti-Allergic Medications. Demonstrate some indirect anti-asthma properties, for instance, ketotifen (Zaditen).

Asthma Devices

Metered Dose Inhalers (MDIs)

Inhaled medicine usually works more quickly because it goes directly to your lungs where it's needed. Inhalers help you breathe in your medicine. MDIs send an aerosol (mist) form of medication to your lungs. Incorrect or poor technique is the most common reason for inhaled medicines failing to work. Ask your doctor or pharmacist to watch you use your inhaler and assess your technique.

The Correct Procedure To Use an MDI:

1. Shake the inhaler.
2. In a standing or sitting position, hold the inhaler as shown on the package.
3. Empty lungs as completely as possible.
4. Tilt head slightly, hold 1 to 2 inches from the mouth and, while breathing slowly and deeply through the mouth, press top of the canister once to release medication. Continue to breath in and keep the tongue depressed so it does not block the spray.
5. After medication is in your system, try holding your breath. Then take the inhaler away from your mouth and exhale slowly.
6. If your doctor prescribed two puffs, repeat steps using only one puff at a time.

The most frequent errors in using an MDI are:

• NOT starting inhalation from function residual capacity (breath out completely)
• NOT activating inhaler at the start of inspiration (or just after)
• NOT inhaling slowly
• NOT holding breath (8 to 15 seconds as recommended)
• Activating MDI twice during the same inhalation.

Spacers

Some people (including children) who have problems using their MDI or have problems with thrush from inhaled steroids can add on a spacer device. The spacer holds the medication for a few seconds before it is breathed in. With the spacer, patients can breathe in the medicine without having to breathe and spray at the same time.

Dry Powder Inhalers

Dry powder inhalers are used for different types of bronchodilators and anti-inflammatory medicines. The technique for using a dry powder inhaler may vary according to the medicine being used, and each type of inhaler has special instructions on how to use the inhaler. Be sure to read the instructions carefully, or speak with your doctor or pharmacist for more information. All of these devices send a powdered form of your medication directly to your lungs without propellants (like the aerosol used in MDIs)

Nebulizer/Compressors

These devices turn medication into a fine mist that is inhaled through a facemask or a mouthpiece. These devices come with special instructions on how to prepare and use your medication and care for your nebulizer.

Peak Flow Meters

Your doctor may ask you to monitor your asthma with a peak flow meter. This is a small device that shows how open or narrow your airways are. It is also used to check changes in your airways that may be caused by triggers, exercise and/or work-related products. Peak flow monitoring should be done early in the morning, evening, anytime you do not feel well or before and after using your reliever inhaler. If work-related asthma is suspected, you may be asked to measure your peak flow levels at home and at work.

Your highest peak flow when you are well is called your 'personal best'. This is used to develop an action plan that will help you look after your asthma. Peak flow monitoring and a record of your asthma symptoms will show how well controlled your asthma is and will help your doctor decide on the best way to look after your asthma. Recording peak flows in moderate to severe asthma is recommended.

Regardless of how you take your medication, take care not to use the medicine more often than is recommended by your doctor. If you are still not able to breathe freely after using recommended dosage, contact a physician immediately, or go to the nearest emergency ward.

Compiled by Ron Waller
Lakeside Clinical Pharmacy, Kelowna, B.C.
Edited by Megan Stiles
Last Reviewed: September 2001