Inhalers are the most common treatment for asthma, with different types to relieve symptoms and to prevent them from happening. There are a number of treatments that may be used in addition to inhalers, either for a short while, or as an additional measure for the longer term.
Here we discuss people’s experiences of the wide variety and combination of different therapies that they were using to help manage their asthma.
If asthma symptoms become severe, people may be prescribed a short course (between 3–14 days) of steroid tablets to take orally (by mouth). Steroid tablets work quickly to help to calm the inflamed airways. Short courses of steroid tablets are also used for essential emergency treatment of acute asthma attacks.
Many of the people we interviewed had taken oral steroids at times when their asthma was unstable and difficult to manage.
Dee had mixed feelings about using steroid tablets because of potential side effects but believes that there are unlikely to be huge detrimental effects. [AUDIO ONLY]
Andreane sometimes takes a short course of prednisolone tablets when she has a chest infection. She finds they affect her appetite, but she says it’s the lesser of two evils…
Recently Dee has been able to manage her asthma effectively using her inhalers, without needing any extra treatment. As both she and Andreane mention, there can be side effects with oral steroids, which is why they tend to be given only for short periods. These side effects can include increased appetite and weight gain, indigestion and mood swings.
Mark has been given them in the past but found them difficult to tolerate as they made him feel sick.
Not everyone will experience side effects from a short course of oral steroids.
Jane has had asthma for many years and, like some of the other people we talked to, keeps a supply of the oral steroid prednisolone at home to use when her asthma flares up, although she usually phones her GP for advice before she begins taking them. “I would take it when my asthma is bad and I’m vulnerable”. Some people stressed how important it was for them to have developed a good and trusting relationship with their GP.
Leukotriene receptor antagonists (preventer tablets)
Leukotriene receptor antagonists are a hybrid of an anti-inflammatory and bronchodilator drug, and they can be taken as a tablet once or twice daily. They are sometimes referred to as ‘preventer’ tablets, but unlike the preventer inhalers they do not contain steroid medicines. Preventer tablets are prescribed to be taken in addition to the usual preventer inhaler. They work by blocking one of the chemicals that is released on contact with an asthma trigger. They may be particularly effective if the asthma is triggered by exercise or allergies.
Mary Y and Eve both take montelukast (Singulair) every day because their asthma is often triggered by allergies.
Susan’s asthma nurse prescribed her some preventer tablets to try and said they work well for some people but not for others, but in Susan’s case they were very effective. [AUDIO ONLY]
Peter takes Singulair every evening in addition to using his preventer inhaler twice a day.
Theophylline and aminophylline
Theophylline (e.g. Slo-phyllin) works by relaxing the muscles that surround the airways. It is usually prescribed as a tablet and is generally taken twice a day. It is important that the doctor prescribes the dose of this medicine that is exactly right. Blood tests can help to monitor the levels of theophylline. If the blood level of theophylline is too low the medicine won’t work, but if it is too high it can cause unpleasant side effects, including indigestion. Other medicines can affect how well theophylline works. Smoking can also stop theophylline from working the way it should. Aminophylline is sometimes given as an injection to control an acute asthma attack.
Mary has chronic severe asthma and takes theophylline tablets to help stop her from wheezing.
Omalizumab (Xolair), mepolizumab (Nucala) & reslizumab (Cinqaero)
Omalizumab (Xolair) can be prescribed to help with difficult-to-control allergic asthma, where patients have an oversensitive immune system. It is one of a kind of drugs called monoclonal antibody therapies. It is a steroid-free medication given by injection every 2 or 4 weeks. Xolair can work to improve lung function and reduce asthma symptoms and so may help to reduce emergency admissions to hospital.
Jenny’s consultant has prescribed Xolair for her, but she says it can be difficult to get it funded. She looked it up on the internet to find out more about it. [TEXT ONLY]
There are other types of monoclonal antibodies given by injection, mepolizumab (Nucala) and reslizumab (Cinqaero), that can also help control severe asthma in some people (we have not interviewed anyone who has had these treatments).
A nebuliser is a machine that creates a mist of medicine, which is then breathed in through a mask or mouthpiece. Nebulisers are often used to give high doses of reliever medicine in an emergency situation, for example in hospital or a doctor’s surgery, although there is good evidence that multiple doses of a reliever inhaler via a spacer can work just as well. Some people also use nebulisers at home.
Mary Z has severe chronic asthma and takes her salbutamol medication every day using a nebuliser. Alice has a nebuliser at home and finds it easier to take her medication with it if she is struggling to breathe “because you can just put the mask over your face and breathe in”.
Jenny, who has severe brittle asthma as well as a number of other health problems uses a nebuliser every day, and when she is admitted to hospital during severe attacks is given her medication using a nebuliser.