Advances in asthma management
Australia and New Zealand had the world’s highest rates of death
from asthma. This seemed strange for Australia, a country with little
pollution and a pretty good health system.
Speculation about the high rates abounded, but did not prevent action.
Through a co-ordinated and structured response, treatment for asthma
has occurred with some good results in Australia over the last 10
years.
Asthma now describes lung conditions in which the lung function
changes fairly quickly. Within minutes, the ability of the lungs to
get oxygen to the blood can change. A measurable 15 per cent – or
more – change is how we define asthma. How this happens is also one
of the characteristics of asthma and, typically, the spasm of the
muscles in the airways causes the wheezing usually found with asthma.
As well as spasm of the muscles, there can be swelling of the air
tubes. This causes wheezing (narrowing) and mucus to plug up the tubes
and make strange noises. These three mechanisms are the basic problems
of asthma. They can happen separately or all together. In the worst
scenarios, the three happen all together within minutes and lead to
tragic deaths in relatively young people.
Treatment is based on altering one or all of the lung changes, and
the available medications will work on these key components.
Ventolin (salbutamol) is the most widely known medication, and works
by making the muscles of the airways open up. If the asthma is caused
purely by muscles’ spasm, the effects of salbutamol are dramatic:
someone wheezing and struggling to breathe can, within minutes, almost
completely improve.
Asthma bronchodilators now take different forms and are available
in blue. There can be salbutamol made by different manufacturers and
in different forms: liquid, puffers with different release mechanisms,
and for use in nebulizers. Other bronchodilators are also available,
and Bricanyl is an example of a different medication that does a similar
job to Ventolin. It is also available in a powder form to be breathed
in through a “turbuhaler”, a variation of the conventional puffer.
The recent years’ change in emphasis has come from the belief that
the best treatment for asthma is prevention, and that using a puffer
with different “delivery systems” is the best way to get the treatment
to the lungs.
It has been shown that, if treatment is needed, using a puffer in
the right way might be better than the mask and nebulizer. The biggest
breakthrough seems to be the use of a “spacer” that allows the medication
to be sucked in at just the right stage to get maximum effect in the
lungs. The size of the droplets seems to be the critical thing in
getting the medicine to where it needs to be.
To treat someone who is wheezing and see him or her get better is
rewarding, because of the dramatic improvement. But the fact that
he or she is wheezing now seems a failure of the prevention.
Success for someone with asthma is not to get an attack. To prevent
an attack, the action might be as simple as taking a puffer just before
exercise. That way, a person with exercise-induced asthma will not
feel any tightening of the lungs: the bronchodilator taken 15 to 20
minutes before the exercise will stop the bronchospasm and any lung
injury, and he or she will not have to struggle with the asthma.
Another benefit of preventing an asthma attack is that less lung
damage occurs every time a spasm is avoided.
One should see asthma as one sees any injury to the body. Imagine
you trip down the stairs and hurt your ankle. This is like an asthmatic
breathing in something to which he or she is allergic and having an
asthma attack. As the trigger can sometimes be predicted, it is best
to avoid the action that causes the damage. One would naturally avoid
jumping down the stairs if it frequently resulted in a twisted ankle.
Once the injury has occurred, you can take some medicine to let you
carry on as if you had no problem (paracetamol for the sore ankle).
If you injured yourself repeatedly, however, the problem could eventually
become worse, and the original treatment not strong enough.
With asthma, the lungs might take six to 10 weeks to settle down
after one episode, so that minor irritations do not stir up the condition.
This, again, is like the twisted ankle: once you have some swelling
and soreness, a minor irritation can set you back because the original
injury is still recovering.
As people recover from colds and flu in late winter and early spring,
their allergies make them particularly susceptible to asthma.
Preventive medication is useful to stop the known allergy or reason
for the worsening asthma. The most common and best forms of prevention
are the cortisone-based medications. These are usually in a “brown”
form known as “preventors”. Again, some of the new ways of getting
these medications to the lungs make for interesting shapes and contraptions
for the treatment of asthma.
Various combinations of preventor and bronchodilators have brought
about purple and red puffers. The added advantages of these are the
ease with which they can be used, and the invention of long-acting,
Ventolin-like medicines so that a bronchodilator can work for 12 hours
at a time. This is great for people who once had to wake at night
to take a puffer. They can now get a good night’s sleep.
Other medications are also available to make existing medicines work
better. And new tablets are doing what puffers once did – without
some of the problematic side effects.
Asthma management has come a long way in recent years, and reduced
the death rate in Australia and New Zealand. Smoking, of course, remains
one of the most preventable causes of lung problems. To see someone
smoke, and then take an asthma treatment, is to see a great paradox.
If you are struggling with asthma, even though you appear to be
doing everything right, you should review your approach and all your
medication. Some of the new options really make asthma an illness
that can be helped, prevented and managed to allow you to get on with
a normal life.
