Medication and treatment for asthma: tablets and other treatments

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.

Steroid tablets

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]

Age at interview 52

Gender Female

Age at diagnosis 23

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I didn’t like it at the start because it’s almost like just, I mean I think in everybody’s head theres a kind of a, don’t go there factor with taking steroids because it feels like you’re, you know, polluting your body in some way. But I guess over time, I’ve come to, well, when I had the serious asthma attacks and I had to take serious doses of steroids so I would have been taking prednisolone and I would have been very aware that the prednisolone affected the body. You could you could feel it working in your system. You can feel your hands. You can feel it in your joints. It’s like a slightly burning sensation in your joints and your hands, like a, and it’s not a pleasant sensation. So you know that your body is processing some serious intervention when you’re on, when you’re taking that medication but you need it because you’re, you need that intervention to help you move on and get through the asthma attack. So if you balance that against taking a very metered low dose preventative on a regular basis. Well, you quickly work out by a process of elimination, I’d rather take this very low preventative dose. Obviously, intellectually, you’d rather be taking nothing, yeah, but, you know, when it comes to needing to be able to breathe and feel confident about your ability to shift oxygen and get on with your day, then the lesser of the two evils. So I suppose you just, you get your head around that after a while and it doesn’t become such a demon but I think a lot of people initially, when they realise that they’re dealing with a steroid of one or other form, they just have a kind of like a garlic and crucifixes, you know, I’m not putting that in my body. So and I’ve heard a lot of people say that, particularly when their children are diagnosed, yeah.

Worried about giving their children steroids?

Worried about giving their children steroids and feeling somehow some sense of that its theres something failing.

That they haven’t been able to create a situation where their child didn’t, this didn’t have to happen. I think people, in that situation, need a lot of reassurance.

You know, that this is a very effective medication. On a scale of one to ten, the type of doses that are normally given out, as I understand it, are not going to have huge detrimental effects.

And, you know, if your airways aren’t open, you don’t have much quality of life. So you’ve got to do that.

But I don’t know. Maybe that’s just sort of me my age and stage and maybe young, younger people wouldn’t I don’t know maybe, younger people being diagnosed would just, you know, accept it and go with it and have a different attitude.

And have there been any specific side effects of the steroids?

Just that sensation of burning in the joints and the hands but that would be when you’re taking, you know, prednisolone as an intervention.

When you’re already

Really bad?

Really in need of that. Obviously, that’s for me, that’s a twice in a lifetime experience, yeah.

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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…

Age at interview 48

Gender Female

Age at diagnosis 33

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Have you ever had to take a course of steroid tablets at all?

Yes. I’ve noticed now that I tend to need to do that, even when I’m prescribed antibiotics I need to take prednisolone and I’m prescribed six tablets every morning with breakfast of 5mgs. So 30mgs of prednisolone for a period of at least a week along with antibiotics. Because antibiotics are normally for the sore throat I get and the chest infection, it’s the prednisolone, I need on top of the preventer which is an added dimension of strength and control than I need with the asthma.

Okay. And are they, do you notice the difference? Are they effective? How do they work for you?

I’ve noticed the difference that within a few days I notice a difference in the less coughing or more control. However else I notice an increased appetite factor which is really, really a difficulty. As you can tell I’m not exactly a slim person in the first place, and that’s very hard to control, not wanting to eat more, and that’s something that I find very hard. But, it’s the lesser of the two evils. It’s better to have the prednisolone to have greater control when it’s got to the stage of a chest infection than not to have it.

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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]

Age at interview 31

Gender Female

Age at diagnosis 18

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When I saw the asthma nurse she said, Oh it’s you know you’ve got a bit worse again. And they gave me a tablet as well then which is not a steroid, it damps down the immune system a bit so that you don’t react as much too allergic triggers. Because I already had hay fever and eczema she said, Well you’ve probably got some allergic component to your asthma so this one might work. Because she said, It, in some people it works really well and in some people it’s completely, it doesn’t do anything. So just kind of like fingers crossed will it work for me? But it was really, really good.

And so I still take all of those. So I have the, the three inhalers and the tablets [laughs]. But it does work so I don’t have to take very much else. And I don’t use my blue inhaler unless I’m ill. And it’s a bit of a pain taking them all but at least you don’t have to worry about anything. Yeah so that’s kind of where we are now.

So those tablets you take daily?

Yeah.

Right.

Yes they’re once, once a day. You take them at night.

And did you say they’re non steroid based?

Yeah they’re like a, an anti-allergy. They’re not antihistamines but they damp down a particular part of the immune system…

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Peter takes Singulair every evening in addition to using his preventer inhaler twice a day.

Age at interview 62

Gender Male

Age at diagnosis 45

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The treatments that I now use although over the years I’ve used different things, but I now use something called Nasonex which is intended to treat rhinitis which is something which often goes along with asthma. It’s a different condition. But I have that as well. So I use that just in the morning. And then I use something called a – well a brown inhaler if I’m allowed to use it is Symbicort, which is a combined preventer reliever. I use fairly high doses of that morning and evening. Four inhalations morning and four evening. The strength of that is 200/6. And then in the evening I use something called Singulair I think they’re sort of the drug on the leaflet is something called montelukast and its intended to help reduce the inflammation of the airways. So those are the things I used regularly.

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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.

Age at interview 73

Gender Female

Age at diagnosis 6

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I’ve had just about every different kind of asthma. I was very allergic as a child, then it became gradually more chronic over the years, but I’ve had brittle asthma at times, and I’ve now got chronic severe asthma.

Plus I have tablets as well. So I have theophylline tablets. I have two kinds of inhalers. So, and another tablet, Singulair, I take at night. So yes.

Are those the steroid tablets?

No the steroid tablets when, only if I get bad.

If you have an infection or something?

Yes, I’ve always got some, yes.

So what are those other tablets?

Well theophylline, theres a type of aminophylline used to be injected into the vein 50 years ago, they now have it in tablet form, and it was for a long time, the only real treatment for asthma. Theophylline, aminophylline and adrenaline. Adrenaline has become Ventolin inhaler in the new make up if you like, a form of, and theophylline are kind of the new injection of aminophylline. So it’s changed.

So, why do you take that in combination with the steroid inhalers as well?

Because the theophylline tablets actually open up the lungs, they are called Phyllocontin. They open up the airways, or help to open up the airways, and anything that can make you stop wheezing quite so much is a good thing.

Yes, I’ve heard that said before.

And the Singulair that I take came out as montelukast and that is an anti-allergy thing, because I’m still allergic to a lot of things.

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Omalizumab (Xolair), mepolizumab (Nucala) & reslizumab (Cinqaero)

Omalizumab (Xolair) can be prescribed to help with difficult-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]

Age at interview 34

Gender Female

Age at diagnosis 18

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I’ve recently been started on a, on a new medication, which this year, seems to be doing me an amazing amount of good. It’s a new injection, I have it once a month, it costs a lot of money and the PCT don’t like funding it, but they, they do because my consultant has put forward the case and they do fund it and this year I have only had one hospital admission, whereas, at this time last year, I’d already had five; so, one admission in six months will do me fine, thank you very much. Also my consultant has now said that if I can remain stable for six months, we can A, possibly start reducing some of my other medications but also B, he might even think about letting me work part-time, which is an amazing.. Step forward because I’m 34, nearly 35 and being at home I mean, yes, I do an awful lot of stuff. I’m studying, I do voluntary work, you know, but the voluntary work I do is basically sitting at computer doing things for people rather than actually going out. So if I’m allowed to start thinking about going to work, it would be amazing.

This injection that I’m currently having called Xolair, they actually have a website, and I went and had a look at it and it’s one, it’s an injection you have to have in hospital. You can’t have it at your GP’s or you can’t have it at home and I couldn’t understand why, you know, and they’d say, Oh, because you might react to it. Well then, I went on to the, the website and they’d got in there the research paper, you know, when it was pre-clinical, the drug, and it explained in about how reactions to the drug that had occurred after one or two injections but also after like after 30 or 40 injections.

So that’s why you have to have it in hospital. But the people at the hospital were just saying, Oh, it’s because of the reactions, because they’ve just read what it says in their protocol. So for me to be able to go and find it and I then actually told the pharmacist at the hospital about this website and she said, Nobody has ever told us about that, you know, they’d, they’d been on training sessions about this drug and you know, and about how to store it and preserve it and give it and whatever, because you have, it’s a, it’s a powder that has to be made up, and it’s all, it’s got quite a complicated way of making it and stuff, but so they’ve been given all the technical information but they haven’t been given the background.

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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).

Nebuliser

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.

Jenny has to use her nebuliser on a daily basis because her asthma is very severe.

Age at interview 34

Gender Female

Age at diagnosis 18

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It’s a routine.

I have what’s called a dosset box, it’s got, I do a week’s medication in it, and I’ve now managed to with a bit of manipulation and a bit of help from my consultant, weve got it now that I take medication three times a day, roughly; I take tablets three times a day, breakfast, lunch and bedtime, sorry breakfast, supper and bedtime, and then I’ve got my nebulisers are twice a day. So I try and leave the middle of the day as free as possible. I mean, I still have inhalers and things I can use and all if I need to in the day, but weve, weve, weve manage to, again, it’s part of his helping me become more normal, you know, having more of a life, is we get the tablets at various times of the day so the middle bit is free and but it’s a I can’t be spontaneous.

I can’t, you know, if someone says to me, Oh, were going out, oh, do you want to stay over? I can’t, I, because the med, the type of medication I take, I can’t miss a day. I mean, yeah, I do get sick of taking it, you know, after breakfast, ah, I’ll just take my medicine, I jokingly say it’s my second breakfast, you know, all the pills, takes, takes one and a half mugs of tea to take all my pills [laughs] in the mornings, you know.

Gosh.

And then I have the pills I take at suppertime and then I have the ones I have to take before I go to bed, you know, and then my nebuliser.

But things like my nebuliser, I have to buy myself. I’ve got two, I’ve got a portable one that I can carry around in my handbag and I’ve got my big one, compressor one upstairs, that I use at home. I had to buy it and pay for it myself.

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(Also see Medication and treatment: inhalers, Asthma attack and emergencies, Dealing with health professionals, Triggers and Managing asthma: reviews and action plans).