What to do during an Asthma attack

·             Stay calm. Family members or caregivers should be calm, positive and encouraging.

·             Use 2 puffs of your reliever inhaler immediately as previously instructed by your doctor.

·             If asthma symptoms are not relieved or wheezing returns within 4 hours, give another 2 puffs of the reliever AND consult your family doctor immediately. If necessary, go to the nearest hospital for help

Medicines Used in Asthma
There are two main categories of medicines used to treat asthma. Over the past few years, inhalers are generally recognised to be the preferred route of delivering these medications. This is because they are delivered directly to the airways. Their action is therefore faster than oral medications. The likelihood of side effects is also reduced.

These two main categories of asthma medicines have different, but complementary, actions. These are:

• Relievers
  These medicines are taken only as and when necessary to provide quick relief of asthma symptoms. They act to relax the muscles around the airway. This will relieve the obstruction to airflow rapidly and make breathing easier. They do not modify the underlying disease, hence will not influence when the next attack will come. They should be kept available with an asthmatic at all times.
  • Short-acting beta-agonists
    They are available in the inhaled or oral forms, and should be taken only as and when necessary to provide quick relief of asthma symptoms. They are best taken via the inhaled route so that they are delivered directly into the airways and their effects are felt quickly, within 10 to 15 minutes. Their effects last 4 to 6 hours. Common side effects are shakiness (tremors), rapid heartbeat and headache. Some inhaled forms of short-acting beta-agonists include Salbutamol (Ventolin, Respolin, Buventol), Fenoterol (Berotec) and Terbutaline (Bricanyl).
  • Anti-cholinergics
    Anti-cholinergics are presently available only in the inhaled form. The main agent currently available locally is Ipratropium Bromide (Atrovent). Anti-cholinergic agents are sometimes used in combination with the short-acting beta-agonists for quick relief of acute symptoms. Side effects are not common but may include dryness of the mouth and throat.
  • Oral steroids
    Oral steroids are very potent medicines usually given at high doses for about a week or so to quickly gain better control of asthma. Side effects usually do not result if used less than 2 weeks. A common oral steroid preparation is prednisolone. Long term usage may result in bruising and thinning of the skin, obesity, hypertension, osteoporosis and cataracts...etc.
• Preventers
  These act to reduce the inflammation or swelling of the airway lining and reduce mucous production. They do not provide immediate relief of symptoms but treat the underlying disease, making the airway less sensitive to triggers and irritants in the environment. Preventer medications need to be taken on a daily and long-term basis to prevent the occurrence of asthma symptoms (minimum of few months). Some of the newer preventer medicines may appear expensive but will be more cost effective in the long term because good control of the asthma will reduce costs from repeated medical visits and hospitalisations.
• Inhaled steroids
  Inhaled corticosteroids are currently the most effective treatment for the prevention of asthma symptoms. They need to be taken regularly, on a daily and long-term basis. When you first start using an inhaled steroid, it will take a few weeks before you notice any effect. It is important not to stop taking the medicine or to reduce the dose without consulting your doctor, as symptoms of asthma may return.
  Examples of Inhaled steroids include Beclomethasone (Becotide, Becloforte, Respocort, Clenil, Q-Var), Budesonide (Pulmicort) and Fluticasone Propionate (Flixotide). Common side effects of inhaled steroids are yeast infection (thrush) in the mouth, sore throat and some change in your voice. To help prevent these, you should always rinse your mouth and gargle with water after using your steroid inhaler. Using a spacer device with the inhaled steroids also helps in reducing these side effects.
• Long-acting beta-agonists (LABA)
  Long-acting beta-agonists act to relax the muscles of the airways. Their effects are maintained over 12 hours, in contrast to short-acting beta-agonists (4 to 6 hours). LABAs are usually used with inhaled steroids in asthmatics who suffer from chronic symptoms of asthma or those who mainly have symptoms mainly at night. They are available in the inhaled or oral forms, and are usually taken once or twice daily, with the doses at least 12 hours apart. Inhaled forms include Salmeterol (Serevent) and Formoterol (Foradil, Oxis). Common side effects of these medicines are shakiness (tremors), rapid heartbeat and headache. Recently some LABAs have become commercially available combined with inhaled steroids in a single preparation, eg Seretide accuhaler and evohaler (Fluticasone and Serevent) and Symbicort ( Budesonide and Formoterol).
• Cromolyns
  These are inhaled anti-inflammatory medicines, which work by making the walls of the airways less sensitive to irritants and triggers. They are useful mainly for children, especially if their asthma is triggered by allergens or exercise. Regular dosing is essential, so it is important not to stop taking the medicine or reduce the dose without consulting your doctor. Examples include Na cromoglycate (Intal) and Nedocromil (Tilade).
• Leukotriene Inhibitors
  The leukotriene inhibitors are the latest asthma drugs available. They prevent narrowing of airways induced by exposure to known trigger factors. They are mainly used as preventer medications for mild asthmatics, but may also be given as add-on therapy (with inhaled steroids) in more severe asthma. They are currently only available as oral tablets and have few side effects. Examples of leukotriene inhibitors are Montelukast (Singulair) and Zafirlukast (Accolate).
• Theophyllines
  Theophylline is available in the oral form, as short-acting or sustained-release preparations. Theophylline is useful for asthmatics, who have chronic symptoms mainly at night. The sustained-release theophyllines are taken once or twice daily. They should not be given for immediate relief of symptoms. Examples of sustained-release theophylline preparations are Neulin SR, Theodur and Theo-24. Common side effects of theophylline are tremors, headache, nausea, restlessness, rapid heart beat and stomach upset. The risks of side effects are increased when they are taken with certain other medications. Hence it is important to let your doctor know if you are on Theophylline