Preventers

Preventers are used to prevent attacks or daily symptoms. It should be used as directed by your doctor to help reduce the frequency and severity of attacks. However, it does not give rapid relief of the asthma symptoms and therefore cannot be used for acute attacks.

When used over a period of time (minimally two weeks) preventers reduce the inflammation of the airways and also the production of mucus. You must not stop using them without the advice of your doctor as they keep the condition at bay. They should be used even though you have not had an asthma attack for some weeks.

Examples of preventers are anti-inflammatory agents such as budesonide, beclomethasone or fluticasone.

Oral Corticosteroids

Sometimes a short cause of oral steroids (e.g. prednisone) is also needed, particularly if the asthma attack is bad. The purpose of this is to bring the asthma patient's condition back under control. The oral steroid is usually stopped after a short period of time.

Relievers

Relievers act quickly and are used to relieve the symptoms of an attack. These are given when the asthma patient begins to cough and wheeze. They act by relaxing the muscles in the airways, thereby, allowing the air to flow more normally into the lungs. Your doctor will advise you how often you need to use the reliever ( usually once every 3 to 4 hours).

In cases of more severe asthma, it may be used more frequently. You are advised to inform your doctor if you find that you are often needing extra doses. Relievers are also used before exercise or sport for children who get symptoms such as cough, wheezing or shortness of breath when they play. The medication is taken just before the activity begins, and during it if needed.

Examples of relievers (bronchodilators) are salbutamol, fenoterol, ipratropium bromide or terbutaline.

Delivery devices

There are a variety of devices available to ensure that patients are given an inhaler they can and will use. This is important as the right choice would mean the medication can get to work in the airways as soon and as effectively as possible. Each device has its own advantages and some suit some people more than others. Your doctor will help you choose the device most suitable for you or your child.

• Metered dose inhalers (MDIs) Of all the devices available MDIs are the most commonly prescribed by doctors. These inhalers use a small aerosol to deliver a measured amount of drug directly into the airways. The advantages of MDIs are that if used correctly they are effective, small and portable, and relatively cheap. However it requires good coordination between activating the device and inhalation. MDIs are therefore considered generally unsuitable for children below 6 years and for many elderly patients or those with problems such as arthritis

•  Spacer devices ( e.g. Aerochamber, Volumatic)
  
  If your child is below 6 years of age, a metered dose inhaler used with a spacer is probably the best method. Spacers are essentially holding chambers that are connected to the MDI.
  
  The medication is released from the MDI into the spacer .The spacer holds the medication until the patient is ready to breathe and allows the patient to breathe at a slower and more effective rate. Spacers are available with face masks, which makes them suitable to use with babies, younger children and older people.
  
  Anti-inflammotory agents such as inhaled steroids can occasionally lead to thrush in the mouth and throat. The use of spacers or holding chambers can help prevent this. Patients are also advised to rinse their mouths after using the inhaler.

• Breath actuated MDIs (e.g. Autohaler )
  
  This type of inhaler releases the medication when the patient breathes in through the mouth piece. This is much easier to use than the conventional MDIs and children will find this easy to handle. It is however much more expensive than a MDI.

• Dry powder inhalers (e.g. Diskhaler, Spinhaler, Turbohaler, Rotahaler )
  
  These inhaler devices rely on the inspiration of a dry powder. These are particularly suitable for children above 5 years of age as they are extremely easy to use.

• Nebulisers

Nebulisers devices have the advantage of delivering a much higher dose of medication than any of the other inhalation devices. What the nebuliser does is convert a solution containing medication into a fine mist which can be inhaled into the lungs . These are especially useful during a bad attack of asthama when the patient may be affected to such an extent that the usual inhaler is not able to deliver the medication as effectively. Nebilisers are not usually necesary and you should only buy on eon the advice of your doctor.