Update on treatment options

Clinical update: COPD & Asthma – The main underlying problem with asthma is airways inflammation, which leads to asthma symptoms and reduced lung function. Inhaled steroids are generally the main initial therapy for many asthmatics.

However, the first-line treatment for patients with milder disease would be a short-acting reliever (blue inhaler) for breakthrough symptoms. All asthmatics should have a reliever available for such breakthrough symptoms.
If the patient needs to use this reliever inhaler more than twice weekly, consideration would be given to commencing an inhaled steroid. If that cannot be tolerated, then an anti-leukotrine such as Singulair or Accolate might be used. Anti-leukotrines often assist people with exercise asthma and those with nasal symptoms.
In general, patients are assessed initially for the degree of asthma control based on symptoms and simple breathing tests, such as spirometry and/or peak flow rates.
If not controlled, remedial action is then taken. “We usually start asthma therapy with inhaled steroids and then perhaps add in an antileukotrine or a long-acting reliever.
Patients are usually followed up again and re-assessed for control of symptoms after a short period of time,” said Dr Patrick Manning, Consultant Respiratory Physician at the Bon Secours Hospital in Dublin. Dr Manning is also Chair of the Asthma Society of Ireland’s Medical Committee.
Inhaled steroids are safe at the recommended doses. In addition, the combined therapies, involving bronchodilators and steroids have proven very useful for people with more severe disease. Seretide – primarily a twice-daily treatment – is Serevent (salmeterol xinafoate and fluticasone propionate) in one inhaler and Symbicort is similar, with pulmicort as inhaled steroid and formaterol as the long-acting reliever.
These inhalers can be recommended in patients where there are frequent exacerbations and uncontrolled symptoms on inhaler steroids alone.
Some patients may find using Symbicort as once-a-day therapy to be effective for asthma control and this can be discussed with their GP. Long-acting beta agonists (LABAs) salmeterol (Serevent) and formoterol (Oxis) should be taken in conjunction with inhaled steroids.
Spiriva, an anticholinergic, can be helpful for some asthmatics who smoke. It results in some bronchodilation and a reduction in sputum production.
Flu vaccines are very important in asthma patients. The Asthma Society of Ireland recommends that asthmatics get the H1N1 vaccine as well as the annual anti-flu vaccine for patients with more significant disease. The anti-pneumonia vaccine is very important in patients with a significant history of recurrent severe chest infections.