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Asthma - About Asthma
Treatment of asthma
Last updated: Friday, March 14, 2008
While asthma can’t be cured, it can be controlled in the vast majority of cases. It is a chronic disease and may need long-term treatment and even lifelong management. In most cases good control can be achieved and there is little reason why an asthma sufferer cannot lead a perfectly normal life.

 
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Today asthma medication is usually extremely effective. Your asthma medication, complemented by your lifestyle and the accurate early identification of asthma symptoms, will assist in optimising your asthma control.

Asthma is the result of two factors, bronchoconstriction and inflammation in the airways.

The most effective treatment now consists of a two-pronged approach treating both these factors at the same time, and thus addressing asthma more holisticly.

In summary: The approach to treatment of asthma (in adults and children) depends on the severity of the asthma, but it consists mainly of the daily (long-term) treatment with an inhaled corticosteroid (often at least six months, in many cases for two years, and even lifelong if necessary), or a leukotriene inhibitors (tablets; also suppressing the inflammatory reaction) plus the use of a bronchodilator in the case of acute attacks.

Control of inflammation

Research has shown that in almost all cases of asthma, the sufferer shows signs of chronic inflammation of the airways. It is essential to treat this chronic inflammation with long-term use of inhaled corticosteroids. If the inflammation is controlled, the risk of acute attack diminishes, and a brochodilator can be used only when acute attacks arise.

Inhaled corticosteroids inhibit the whole inflammatory process underlying asthma by reducing the chronic swelling and redness (as part of the inflammation) in the brochioli. By reducing the swelling, the airway passages are kept more “open”. With the mucous membranes not inflamed, they are less sensitive to triggers, and the frequency and severity of attacks are reduced.

Leukotriene inhibitors are the latest drugs developed to treat asthma. They are currently used as add-on therapy to inhaled corticosteroids, when single therapy with the inhaled corticosteroids is insufficient to gain symptom control. Leukotriene inhibitors may also help treat patients with allergic rhinitis, exercise-induced asthma or ASA (aspirin sensitive asthma). Being a tablet (some taken once a day, some twice a day) makes it easier to give to very young and very old patients - or to those with poor spacer co-ordination.

Leukotriene inhibitors work by blocking the action of leukotrienes, one of the many potent chemical classes which promote the damaging airway inflammation characteristic of asthma.

Leukotriene inhibitors may reduce the need for high doses of inhaled or oral corticosteroids, inhibit the inflammtory reaction.

These medication (inhaled corticosteroids with leukotriene inhibitors as add-ons) will put out the “fire” of inflammation in asthmatic airways. It needs to be taken on a daily basis - even if you’re feeling well and your asthma is under control.

People often stop taking their medication when they’re feeling great, but once you start skipping doses, the “fire” is allowed to rekindle and symptoms arise.

In the past, doctors concentrated only on the use of bronchodilators, but growing recognition of the inflammatory basis for asthma has shifted the focus to long-term therapy as the first step for all patients. This treatment of inflammation is undertaken to prevent permanent damage to the airways known as re-modelling.

Control during an acute asthma attack

Bronchodilators are used to provide instantaneous relief when your chest begins to tighten at the onset of an attack. They act by relaxing the constricted smooth muscles surrounding the bronchioles, so allowing the airways to widen. The airway passage, already very narrow due to inflamed and swollen mucous membranes, can almost close completely if the airway muscles start constricting.

The bronchodilator can relieve this muscle constriction, and thus open the airway passage again. This reduces the symptoms of breathlessness and enables sufferers to breathe more freely but will do little to douse the underlying inflammation. They may be taken prior to exercise in patients who experience exercise-induced asthma.

Both types of drugs are usually administered by inhalation but some can be given orally or intravenously in the case of an emergency.

Doctors recommend sufferers to identify the possible asthma trigger and eliminate it as part of the holistic approach to treatment and living with asthma. Allergy tests can be conducted on babies from as young as six months. No need to wait till they are three years old, as doctors previously believed.

Read more:
Treatment guide: Mild Intermittent Asthma (Adults)
Parents miss some asthma steps

National Asthma Education Programme (NAEP)
Allergy Society of South Africa (ALLSA)
 
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