Your go to guide on Asthma

Did you know?

A “puffer’ is referred to as a metered dose inhaler (MDI) in pharmacy and medical land.

If you use a “puffer” without a spacer only 20% of the dose actually reaches the lower lungs which is where we need the medication to go in order to work properly. That leaves 80% of the medication in the mouth or throat! These statistics are from people that have had their techniques assessed as good technique first! If you haven’t had your technique checked, chances are it could be slightly wrong which limits the amount of medication reaching your lungs!

That is why as pharmacists we continuously love checking all our asthma patients' inhaler technique as this is such a simple way to reduce the amount of medication you need and reduce potential side effects!

If you would like some guidance on your inhaler technique you can send us a video or we can arrange a home visit or video call! By using a spacer correctly you can improve the amount of medication reaching your lungs and therefore feel relief quicker and potentially not need to use as many puffs as previously used!

On the left is a normal lung, on the right is an asthmatic lung.

What is asthma caused by?

Asthma can be caused by many different things in different people. It is a hereditary condition which means that there is a genetic component to the disease. It can also be caused by autoimmune conditions, this means that your body's immune system gets triggered somehow and causes your body to create mucus and inflammation in the airways, hence asthma. Allergic rhinitis or hayfever is also closely linked to asthma.

What is asthma?

Asthma is a long term inflammatory condition that affects the airways. This inflammation produces mucus and tightens the muscles of the airways and results in wheezing, coughing and shortness of breath. Symptoms may not always be present in someone who has asthma but this does not mean that the asthma is “gone”.

There are many links that increase someone’s likelihood of developing asthma:

- Having other allergic conditions such as allergic rhinitis or eczema

- Having a family member with asthma

- Early exposure to tobacco smoke or air pollution

- Being overweight

Many individuals with asthma have “triggers” which when exposed to cause inflammation and result in asthma symptoms. Triggers can include things such as:

- Night or cold air

- Exercise

- Pollens or dust

- Viral infections - colds and flus

- Aspirin or nonsteroidal anti-inflammatory drugs

- Fires, particularly wood fires and cigarette smoke

- Strong scents such as perfumes

- Pets

(this isn’t exhaustive list, it is just an example, finding your own triggers is a really important part of good asthma control and prevention)

Asthma in children less than 5

A clear diagnosis of asthma in children less than 5 cannot be made as they are unable to correctly perform the test required to diagnose asthma and in addition to this, it is difficult to determine a clear pattern to their symptoms. Many children in this age bracket will experience a recurrent wheeze that may not necessarily be asthma. Talking with your GP is important to determine which respiratory symptoms need further investigation.

We also recommend logging a diary of wheezing and recording your child so that you can provide this really useful information to your doctor.

What are the types of asthma?
Asthma is often categorized according to an individual’s triggers. Some examples include:

Thunderstorm asthma
Exercise-induced asthma
Allergic asthma
Seasonal asthma
Nocturnal asthma

Asthma can also be categorized according to severity - either mild or severe.

It can also be described as childhood asthma or late onset (adult) asthma.

What are the top symptoms of asthma?

Symptoms of asthma can vary from person to person however the most common symptoms include:

Coughing that does not resolve and may be triggered by laughing, physical activity or only present in the evening/early morning
Wheezing or squeaking noises when breathing
Chest tightness
Feeling breathless

What triggers asthma attacks at night?

This has not been definitively determined however it is thought that in susceptible people, there is an increase in inflammatory molecules overnight which is closely linked to our circadian rhythms. It is this increased inflammatory response that is thought to be a trigger for nocturnal asthma attack. Another factor that may contribute is the sleeping environment if an individual is exposed to certain triggers such as house dust mite or cigarette smoke and cold air.

What does asthma cough sound like?

This is a hard thing to describe in writing and every person with asthma can have a different sound. Asthma can be aggravated by cold and flu and commonly allergic rhinitis. People have described asthma as having more of a wheezing sound however, definitely not always the case.

What is the first stage of asthma?

Asthma can come on suddenly within minutes or build slowly into what we call an asthma flare.

It is the shortness of breath and the difficulty breathing, of trying to suck in air.

The first time this happens can be scary and catch the person experiencing shortness of breath of guard and lead to panic which rapidly escalates the shortness of breath.

Knowing asthma first aid can save people not only from an asthma attack but their life.

We recommend the Asthma councils first aid course!

How do you treat asthma without an inhaler?

Inhalers are currently considered the best treatment for asthma as it allows the medication to go directly to the lungs! However there are a number of specific types of asthma that require oral medication, especially for those that are caused by their own immune system, and at times when asthma attacks or flares occur additional oral steroids may need to be used.

Just under 2.7 million (10.7%) Australians had asthma in 2020-21
One in three people with asthma (34.6%) had a written action plan
One in three people with asthma (34.9%) used asthma-related medication daily

How does ventolin work?

Ventolin is the brand name for a drug called salbutamol. This medication works directly on your airways (pipes that lead to lungs) and lungs to decrease the mucus and shrink the cells quickly which then opens up your airways and lungs allowing air to flow through more easily so that your body can utilise oxygen that is inhaled.

Salbutamol is what is referred to as a reliever. Its job is to relieve symptoms quickly, however it is not a long term medication used for the management of Asthma! That is, it will make you feel better for a period of time, but does nothing to prevent these symptoms from occurring.

If you only use this medication to control your asthma we suggest taking this little test to see if you may need further intervention in helping you gain better control of your asthma!

Why is good control of your asthma important?

Poor asthma control, means you are relying heavily on your reliever ( more than twice a week is the current guide). If this is the case then you are also putting yourself at greater risk of severe asthma attacks that can require hospitalisation and also allowing your body to build a tolerance to the reliever, which in time means you are going to need more and more medication to provide the same relief.

How do I get good asthma control and what does this mean?

Firstly, you need an asthma plan and a chat with your GP. You also need to be on the appropriate “preventer/s” for your asthma. These preventer medications (usually in the form of an inhaler) help your body respond, over time, less severely to your asthmatic triggers.

Monitoring is a really important part of good asthma control. Knowing your triggers, reporting your flares and attacks and knowing how much of your reliever you are needing across a week all help!

Currently only 1 in 3 people with asthma have an action plan, our goal as a pharmacist is to improve this! That is why each time you ask for a ventolin we will ask a few more questions about your asthma! We are not trying to be annoying! We want the best for you and your health!

Asthma First Aid

Here is a little guide for understanding asthma control!

Per the eTG

Air quality app to help prevent being triggered!

If your asthma is triggered by air contaminants such as pollution, smoke or pollen, get this app! It provides you information on the air quality so you can better manage your asthma and avoid being triggered!

Apple

Google

EMERGENCY ASTHMA TIP!

FOUR PUFFs every FOUR minutes!

Help managing an asthma attack can save someone's life!

Reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004521/

https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical

AMH

https://asthma.org.au/about-asthma/understanding-asthma/asthma/

https://ww.who.int/news-room/fact-sheets/detail/asthma

Therapeutic Guidelines