Asthma

Medications

  For immediate relief for an asthma attack, your best is a bronchodilator inhaler,  or puffer, which opens constricted airways. These include short-acting beta2-agonists such as salbutamol (Ventolin). An anticholinergic drug that relaxes lung muscle spasms, such as ipratropium bromide (Attrovent), may also be beneficial. For a severe attack, you may need oral or even intravenous corticosteroids, such as prednisone, prednisolone or methylprednisolone, to decrease the inflammation. Oral corticosteroids typically are prescribed for short-term use only because they carry the risk of side effects if taken at high does for an extended period of time.

       

TAKING CONTROL

• Perform at your peak
• A peak flow meter can help you head off an asthma attack before it becomes serious. This simple and inexpensive plastic gadget measures how fast you can exhale air from your lungs. People with untreated asthma have low 'peak flow', which increases (often dramatically) within a few minutes after medication. Measure your peak flow twice a day when your asthma is under control to establish what's normal for you. With this baseline reading, you'll know when the readings begin to fall, possibly signalling an attack.
• Give yourself a spacer. A metered--dose inhaler, the most common type, lets out a burst of medication when you press down on it. But it can be tricky to time correctly. A special device called a spacer may help. This long plastic tube attaches to one end of the inhaler; the other goes into your mouth. Once the inhaler is activated, the medication remains in the spacer until you inhale it. With some, like pulmicort turbuhaler, the metered dose is released only when you breathe in.
• Clean house. Up to 90% of people with asthma react badly to dust mites, tiny insects that cling to carpets, mattress, bedding, upholstered furniture and even clothing. Solutions include banishing carpets, dusting religiously with a wet or oiled cloth and using a vacuum with a microfiltration bag. Wash all bedding in hot water (54degrees C or higher) once a week, and consider putting up shutters instead of dust-catching blinds or curtains.

   For long-term asthma management, the first line of defence is inhaled corticosteroids, which reduce inflammation in nasal passages and bronchial tissues. Familiar examples include fluticasone (Pulmicort). Inhaled corticosteroids are considered safe, and they rarely cause the more serious side effects reported with the oral forms. If asthma sysmptoms still persist you may also be commenced on a long-acting beta agonist such as Serevent, Oxis or Foradile. These are often combined with the corticosteroid in a single puffer such as Seretide or Symbicort. These combination puffers come in different steroid strengths depending on the severity of your asthma.

   The new leukotriene receptor antagonsits also reduce broncial inflammation. These tablets, Accolat and Singulair, counteract leukotrienes, potent chemicals that constrict airways and increase mucus production. Singulair is avialable on the PBS for children as a preventer medication in mild to moderate ashtma.

   Other useful asthma therapies include nonsteroidal inhalers such as sodium cromoglycate (Intal) and nedocromil (Tilade), and the oral bronchodialtor theophylline (Nuelin). Asthma medications will affect people differently, so it's important to work with your doctor to find the right drug or combination of drugs for you. Also, because respiratory infections can trigger or worsen asthma, make sure you get an annual flu vaccination and are vaccinated against pneumonia if you are over 65 years of age. 

PROMISING DEVELOPMENTS

A genetically engineered anti-body may hold the key to a new class of drugs that can block the immune system's overreaction in asthma.
Omalizumab targets immunoglobulin E (IgE), the antibody that causes mast cells to unleash histamine and other chemical weapons against allergens. By taking IgE out of circulation, the drug
short-circuits the allergic reaction. Ashtma patients who received Omalizumab by injection had less
wheezing and coughing, and significantly fewer attacks that required hospitalisation. The drug, being developed by Genentech and Novartis Pharmaceuticals, is awaiting US Food and Drug Administration approval before it can go on the market.

Lifestyle changes
While you are likely to need prescription medications to help manage your asthma, there's a lot you can do to help yourself.

• Have a plan. With your doctor, develop  an asthma action plan, making sure you share the information with your family. It should list the drugs you take for maintenance and prevention, those you'll take for specific symptoms, how you'll handle an attack, when to call the doctor and where to go during a serious episode.
• Identify your triggers. Keep a diary of your asthma attacks, nothing what seems to cause them. Besides animal dander (particularly  thats of cats), pollen, cold air, exercise, dust mites and cockroach droppings, other common triggers include aspirin, chocolate, milk, nuts and fish.
• Slim down. Obese women, defined as those with a Body Mass Index of 30 or higher, have almost double the risk of developing asthma as other women, according to one Canadian study. It's unclear whether obesity in men presents as great a risk as in women.