Written by Kylie Lucas, Pharmacist.
1 in 9 Australians have asthma – that’s around 2.5 million of us1. Chances are you would know someone within your circle of family or friends living with this condition – or perhaps you experience asthma yourself.
But how often do we dismiss this condition as “just a bit of a cough” or assume that “they’ll be right once they use their puffer”? As a pharmacist, I help people with their questions about asthma every day. Here are the answers to some questions I often get asked.
Asthma is a condition in which the actual symptoms can vary from person to person. The World Health Organisation describes the key characteristics of asthma as:
“Recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. Symptoms may occur several times in a day or week… and for some people become worse during physical activity or at night2”.
If you (or someone you know) periodically experiences wheezing, breathlessness, chest tightness and/or a cough, you should see your GP for a proper assessment. These symptoms should not be ignored.
There is wide variation in what specifically triggers asthma symptoms in different people, and science does not yet have all the answers for all factors that can cause an asthma flare-up. However, generally, the issue is an inhaled airway irritant, which then leads to the lungs developing asthma symptoms in response to this irritation. Common triggers include pollens, molds, house dust mites, pet dander, chemical fumes, cold air and air pollution3.
Viral infections such as the common cold or influenza can also lead to an asthma flare-up; as well as some medications including prescription, over-the-counter and herbal. If you think this applies to you, please speak to your pharmacist or GP for more specific information.
Asthma may even occur out of the blue. For example, the thunderstorm asthma event in Melbourne in 2016 caught many people by surprise, even those who considered themselves to only have “mild” asthma or had only experienced symptoms in childhood.
Hay fever (also known as allergic rhinitis) often co-exists in people living with asthma, as they are both primarily allergic conditions. In fact, around 80% of people with asthma live with both conditions4 which can have a big impact on their quality of life.
As hay fever affects the upper airways, it can then have a flow-on effect to trigger inflammation in the lower airways (the lungs) – hence leading to a flare-up of asthma. People who experience both asthma and hay fever have more asthma flare-ups, and research shows that managing hay fever, in turn, reduces asthma-related emergency department visits and may help improve asthma symptoms5.
There are many different treatment options available for hay fever. If you experience this condition, it’s a good idea to have a chat with your pharmacist to make sure you are on the most effective (and most economical) treatment for your particular symptoms.
An asthma attack is when the lining of the airways swell, leading to reduced ability to get air in and out of the lungs2. A person experiencing an attack may have increased shortness of breath, they may not be able to speak without stopping for breath and they may not get the usual relief from their usual reliever medication.
If you suspect someone is having an asthma attack, it is important to act early. Knowing the correct first aid steps can be life-saving. For more information, refer here.
There are many different medications available to help manage asthma symptoms. They can be broadly grouped into two main categories:
Reliever inhalers are for quick symptom relief. They work to relax the muscles around the airways and hence open up the airways to help you breathe easier. They start to work within a few minutes but may wear off after around 4 hours.
Reliever inhalers should not be relied upon for ongoing symptom management – using a reliever inhaler more than two days per week is a sign that asthma may not be well controlled6. However, they are very useful in emergency situations and people with asthma should carry a reliever inhaler with them and use it as instructed by their doctor and their Asthma Action Plan.
Preventer medicines are used long-term, and they help make the airways less sensitive to asthma triggers. They reduce the amount of inflammation and mucus in the airways and so help prevent asthma symptoms and lung damage. Preventer medicines usually come in the form of inhalers, although some are available in tablet form. It is important to use preventer medicines regularly, even when you feel well.
If you have recently been diagnosed with asthma you may be wondering “where do I start?”. Your local pharmacist will understand how daunting this can feel and is well trained to help you in this area. Your pharmacist can help you practice your asthma inhaler technique and can reinforce key information given to you by your doctor.
More than 90% of people living with asthma don’t use their inhaler correctly7 so it can be a good idea to run through with your pharmacist how to use your inhaler every few months. Over time, it becomes easy to forget key steps and correct inhaler technique is important for the best management of your symptoms.
Most people who use the aerosol-type inhalers (“puffers”) will also benefit from the use of a spacer. A spacer helps more medicine reach the small airways of the lungs and can decrease the chance of some common side effects associated with puffers8.
Your pharmacist is also well placed to provide you with some hints and tips on ways to remember to use your preventer medicines regularly. You may decide to create a habit to help you remember such as using your inhaler before you brush your teeth each day. Many people find the MedAdvisor app to be invaluable for asthma medication management, as you are able to set a reminder to take your dose and it also notifies you when your supply is running low. It is easy to forget to refill a prescription when you are feeling well, however running out of preventer medication runs the risk of experiencing an asthma flare-up.
Your doctor may offer you a written, personalised Asthma Action Plan, which is proven to be one of the best ways to achieve good control of your asthma9. It’s a good way to keep a written record of what to do as your symptoms change.
Always remember to follow your doctor and pharmacist’s advice with the use of your asthma medicines. The vast majority of people living with asthma will be able to achieve good control of their symptoms10, and your local pharmacy is the perfect place to support you on that journey.
This post was written by Kylie Lucas. Kylie has been a pharmacist for over 10 years and works in a country town pharmacy in the south west of Western Australia. She lives on a farm with her husband, daughter and lots of pet animals.