• You probably have a mild but chronic inflammation in the inner lining of the bronchioli, and this inflamed mucous membrane is swollen and red, decreasing the diameter of the lumen of the bronchioli. The inflammation can be mild, but chronic. Using only a bonchodilator is not enough. The bronchodilator cannot reduce the inflammation. You need treatment to reduce the chronic inflammation, probably due to an allergen or allergens. The only way to reduce chronic inflammation is to treat it daily with an anti-inflammatory drug. In the case of inflammation of the bronchioli, the best and most effective treatment is corticosteroid (an anti-inflammary) administered directly to the lungs by inhaling it in aerosol form. In summary: You need to take your inhaled corticosteroid every day (once or twice a day, as prescribed by the doctor.)
 
• The circular muscles around the bronchioli sometimes go into spasm, probably triggered by some or other allergen or event, and this can narrow the inner, already swollen, lumen of the airways even more. This further narrowing will make your chest feel tight, you will feel as if it is difficult to breathe, and you may have a dry, chesty cough and symptoms of asthma. Whenever you feel these symptoms, you need to use your bronchodilator inhaler. This medication will relax the constricted circular muscle and the whole muscle wall will relax, opening the lumen again. It is best and safest to use the aerosol inhaler. Beta-2-agonists can also be taken as a dry powder inhaler, or orally for patients who cannot manage the inhaled route, or as nebuliser solutions (with quite a risk of exceeding the dosage and which should be avoided if possible), or intravenously only in severe asthma attacks.

Helpful tips for an action plan

• Carry your bronchodilator inhaler with you and use when you need to. If you get no relief from the prescribed dosage, or if you need it more frequently, consult your doctor. You may be advancing to the next category, but with correct and diligent treatment, you may soon be well controlled. The doctor may prescribe a pulse dosage of oral steroids for seven to fourteen days to gain rapid control of your asthma.
• Use your daily inhaled corticosteroid diligently as prescrided. You will experience the benefits within 10 to 14 days.
• Determine the cause of your asthma, and if it can be avoided (such as allergens or house dustmites), avoid it.

Read more:
Xplanations
National Asthma Education Programme (NAEP)
Allergy Society of South Africa (ALLSA)
 

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