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Inhaled therapy for asthma

02 July 2020
Volume 31 · Issue 7


Andrew Booth explains why this is the preferred − and more successful − method when managing asthma

Inhaled therapy is key to the successful treatment of asthma. National guidelines provide us with the aim of asthma management, which is to maintain control of the disease. The correct combination of drug and device can be individually tailored to the patient. Drugs consist of bronchodilators and anti-inflammatories. Devices consist of aerosol inhalers, also known as pressurised metered dose inhalers, and dry powder inhalers. Both the drug and the device need to be prescribed if the treatment is to be clinically effective. A combination of inhaled steroid with long-acting B2 agonist is one of the most clinically effective ways of delivering asthma treatment. This can be prescribed either as a fixed daily dose with a concomitant short-acting B2 agonist as a reliever, or as maintenance and reliever therapy, which has been shown to improve asthma control and reduce exacerbations.

Asthma is a disease of the airways, characterised by airflow obstruction that varies over time, with symptoms including an unproductive cough, chest tightness, breathlessness, and wheeze that is detected by chest auscultation. Symptoms are brought on by triggers such as cold weather, respiratory virus, exercise, allergens, and stress (British Thoracic Society (BTS) / Scottish Intercollegiate Guideline Network (SIGN), 2019).

When exposed to a trigger, the smooth muscle that surrounds the airway contracts (bronchoconstriction) and the inside mucosal lining becomes inflamed (Kudo et al, 2013). Treatment involves bronchodilator and anti-inflammatory drugs, which are mostly delivered straight to the lungs via an inhaler device (National Institute for Health and Care Excellence (NICE), 2017; BTS/SIGN, 2019; Global Initiative for Asthma (GINA), 2020).

When compared to oral medication, inhaled therapy works faster, requires lower doses, and has fewer side effects (Allen et al, 2003). Effective inhaled therapy requires knowledge and ability to use an inhaler device, and the patient should be shown how to use this and have their technique checked by a healthcare professional who is competent to do so. Treatment relies on evidence-based inhaled therapy, with both drug and device being prescribed. Diagnosis and management is largely undertaken in primary care, with complex cases supported by secondary care and ‘difficult asthma’ services (NICE, 2017; BTS/SIGN, 2019; GINA, 2020).

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