General Information

Asthma is a condition that affects the airways leading to your lungs. During an asthma attack your airways tighten, become inflamed and fill up with mucus. This makes breathing more difficult.

Symptoms of asthma include wheezing, being short of breath, and tightness in your chest. Another common symptom of asthma is a dry cough, especially at night. People who suffer from allergies (such as hayfever) are more than three times as likely to develop asthma as people who do not suffer from allergies.

Asthma affects around 1 in 9 Australians. It is more common in children and although some people seem to ‘grow out of it’ they are still at risk of attacks. The cause of it is not fully understood. Unfortunately, people can still die from this condition, which is why an asthma cycle of care plan is important for every asthmatic.

Asthma triggers

Asthma triggers do not cause asthma, but may trigger an attack. People vary in their susceptibility to these triggers, and common ones include:

  • animal fur and urine
  • cigarette smoke
  • weather (e.g. cold air, change in temperature, thunderstorms)
  • colds and flu
  • sinus infections
  • heart burn
  • exercise
  • house dust mites
  • pollen (grass and tree)
  • stress and emotions
  • strong perfume
  • some medicines
  • some foods

See Your Pharmacist or Medical Professional

If you are so breathless you cannot finish a sentence or find your reliever inhaler is not helping, get medical help immediately (phone 000 for an ambulance).

See your doctor if you:

  • are using your reliever inhaler more than 2 days per week (other than before exercise)
  • find asthma is interfering with your usual activities
  • are waking at night with symptoms
  • find your reliever inhaler is not helping as much as it used to
  • do not have an asthma action plan and your asthma is getting worse
  • last had a review with your GP more than 6 months ago

Treatment Tips

  • exposure to house dust mites can be minimised by regular vacuuming and wet mopping, washing bedclothes in hot water weekly, using a hypoallergenic mattress and pillow covers and removing carpets from the house if possible
  • pets should be kept out of bedrooms
  • minimise exposure to allergens such as pollen by remaining indoors and keeping windows shut at high risk times (e.g. in spring)
  • people who get exercise-induced asthma should warm up and use a reliever at least five minutes before exercising
  • people with asthma who smoke should quit smoking, and avoid breathing in second-hand smoke
  • aspirin and anti-inflammatories such as ibuprofen (e.g. Nurofen), can make asthma worse in some people; check with your pharmacist or doctor before taking these
  • all people with asthma should see their doctor regularly to make sure their condition is as well controlled as possible
  • ask your doctor for an asthma action plan as part of the asthma cycle of care. This can help you monitor your asthma and provide written instructions on what you should do if it gets worse
  • check with your pharmacist or doctor that you are using the best type of inhaler for you, and you are using it correctly
  • inhalers and spacers need to be cleaned regularly; check product information or ask your pharmacist

Treatment Options

Types of treatment

Medications for asthma are divided into three main types: relievers, preventers and symptom controllers. Some relievers are available over the counter as Pharmacist Only medicines, and the rest are Prescription Only medicines.

Most asthma medicines are breathed into your lungs using an inhaler device. This reduces the chances of side effects developing because hardly any of the medicine reaches the rest of your body.

Many different types of inhaler devices exist, and spacers are also available for certain inhalers. Spacers are plastic chambers that fit over the end of the inhaler which help improve delivery of the medicine to the lungs. Many people find inhalers easier to use with them, and they also optimise the amount of medication reaching your lungs. Speak to your pharmacist or doctor about which inhaler device, or if a spacer would be suitable for you.

Reliever inhalers (for immediate symptom relief)

[PHARMACIST ONLY]
e.g. salbutamol (Airomir Autohaler and Inhaler, AsmolVentolin CFC-Free Inhaler, Ventolin Rotacaps), terbutaline (Bricanyl for Inhalation)

  • these inhalers are used for immediate relief of asthma symptoms; they should help relieve symptoms within five minutes
  • using two puffs of a reliever at least five minutes before exercise is recommended for people who get exercise-induced asthma
  • salbutamol and terbutaline liquid, nebulisers and injections are only available on prescription

Preventer inhalers (for long-term control of symptoms)

Corticosteroid inhalers

[PRESCRIPTION ONLY]
e.g. beclomethasone (Qvar), budesonide (Pulmicort), fluticasone (Flixotide), ciclesonide (Alvesco)

  • these medicines reduce inflammation in your airways and help reduce the number and severity of asthma attacks
  • they must be used every day, even if your asthma seems better, and they take a few days to start working properly
  • they should never be used to relieve breathlessness or an asthma attack in place of a reliever as they do not give immediate relief from symptoms
  • rinse mouth out with water, gargle and spit out following use since corticosteroids can sometimes cause oral thrush or hoarseness in your voice. Using a spacer device can also reduce your chances of getting oral thrush
  • oral corticosteroid tablets, such as prednisone, may need to be taken short-term by some people with severe asthma in addition to their corticosteroid inhaler. These tablets must be taken with food. If you can, take them as early in the day as possible, ideally before 3 pm, then they are less likely to interfere with your ability to sleep at night. Depending on how long they are needed for, the dose may need to be reduced slowly; check with your pharmacist or doctor

Other preventer medicines

[PRESCRIPTION ONLY]
e.g. nedocromil (Tilade CFC-Free), sodium cromoglycate (Cromese Inhalation Solution, Intal CFC-Free Inhaler, Intal Forte CFC-Free Inhaler)

  • these types of asthma preventer are not commonly used because they are less effective than using corticosteroid inhalers
  • they are sometimes helpful for preventing exercise-induced asthma
  • they may take six weeks or more to improve symptoms, but your doctor may assess your response after 2-4 weeks
  • they should never be used to relieve breathlessness or an asthma attack in place of a reliever, as they do not give immediate relief from symptoms
  • the inhaler device requires daily cleaning to prevent blockage and reduce infection

[PRESCRIPTION ONLY]
e.g. montelukast* (Singulair, Lukair, Respikast)

  • this is a tablet taken to prevent day and night symptoms of asthma
  • it is sometimes used for people whose asthma is not well controlled by other treatments
  • *montelukast is only subsidised on the Pharmaceutical Benefits Scheme for children with frequent episodic or mild persistent asthma. Otherwise, both are private prescriptions

[PRESCRIPTION ONLY]
e.g. ipratropium (Aeron, Atrovent Metered Aerosol (CFC-free), Atrovent Nebulising Solution), Ipratrin)

  • these medicines are used only in conjunction with other asthma medications for severe asthma
  • do not use them for immediate relief of breathlessness or an asthma attack
  • take care when using the nebuliser and inhaler; it is important not to let the medicine get into your eyes
  • if you develop a dry mouth from ipratropium, rinse your mouth out after each inhalation or see your pharmacist for ‘saliva substitutes’
  • tell your doctor if you develop any eye problems or changes in your vision

Long-acting symptom controllers

[PRESCRIPTION ONLY]
e.g. formoterol (Foradile, Oxis Turbuhaler), salmeterol (Serevent Accuhaler)

  • these medicines can be added to your treatment if your symptoms are not controlled by a preventer inhaler
  • you must continue using a preventer inhaler as well
  • do not take more than the doctor has told you
  • these medicines should never be used to relieve breathlessness or an asthma attack in place of a reliever, as they do not give immediate relief from symptoms
  • from time to time, you should consider asking your pharmacist to check that you are using your inhaler correctly to ensure you are getting the best outcome from the medicine

[PRESCRIPTION ONLY]
e.g. theophylline (Nuelin)

  • these medicines are used in the maintenance treatment of severe asthma
  • they should be taken with food to minimise stomach upset
  • it is important not to crush or chew the controlled release tablets
  • tell your doctor if you start or stop smoking while taking theophylline because your dose may need to be changed

Combination preventer inhalers

Some inhalers contain more than one type of medication. They help some people by reducing the number of inhalers needed.

[PRESCRIPTION ONLY]
e.g. formoterol + budesonide (Symbicort Turbuhaler, Symbicort Rapihaler, DuoResp Spiromax), salmeterol + fluticasone (Seretide, Pavtide, SalplusF), formoterol + fluticasone (Flutiform), fluticasone + vilanterol (Breo)

  • these medicines combine a symptom controller and a preventer medicine
  • they must be used regularly to work properly so continue to use this medicine daily even if you feel better
  • since they contain a corticosteroid, rinse mouth out with water following use to prevent oral thrush from developing
  • only Symbicort 400/12 and Symbicort 200/6 devices and DuoResp 400/12 and DuoResp 200/6 devices can be used to treat an asthma attack if advised that you can do so by your doctor, otherwise these inhalers do not give immediate relief from symptoms, and a reliever inhaler should be used
  • from time to time, you should consider asking your pharmacist to check that you are using your inhaler correctly to ensure you are getting the best outcome from the medicine

Biological Preventers

These are new medications which are used to reduce the defence systems of the body which are responsible for your asthma symptoms.

[PRESCRIPTION ONLY]

e.g. benralizumab (Fasenra), mepolizumab (Nucala), omalizumab (Xolair)

  • these medicines are injections which are usually administered to you in a medical facility every 4 weeks
  • you will be monitored for some time afterwards to make sure that you can tolerate the medicine and do not experience any allergic reaction

More Information

Availability of medicines

  • GENERAL SALE available through pharmacies and possibly other retail outlets.
  • PHARMACY ONLY available for sale through pharmacies only.
  • PHARMACIST ONLY may only be sold by a pharmacist.
  • PRESCRIPTION ONLY available only with a prescription from your doctor or other health professional.

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Last Reviewed: 18/07/2019

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References

1. Asthma Australia. Your Asthma Medicine. Retrieved from Asthma Australia: https://www.asthmaaustralia.org.au/national/about-asthma/manage-your- asthma/your-asthma-medicine
2. National Asthma Council Australia. (2019, March). What is asthma? Retrieved from The National Asthma Council Australia: https://www.nationalasthma.org.au/understanding-asthma/what-is-asthma
3. Australian Medicines Handbook. 2019.
4. Pharmaceutical Society of Australia. Australian Pharmaceutical Formulary. APF24.