Preventive Treatment of Asthma

These are anti-inflammatory drugs which damp down the swelling and reduce the mucus in the airways. The aim is not only to reduce the symptoms, but also to minimize the damage which occurs to airways which are almost constantly inflamed and twitchy (hypersensitive).

Most of the preventive treatments are derived from corticosteroids - known as steroids for short. These are quite different from the sex hormones (anabolic steroids) which are abused by some body-builders and athletes. Nevertheless, corticosteroids do have some side effects.

Inhaled steroids are usually taken twice a day; and you may find it easier to remember if you take them just before cleaning your teeth in the morning and evening. Rinsing your mouth out at this time helps reduce the risk of getting oral thrush, or a sore throat, which are both occasional but annoying side effects of inhaled steroids.

Steroids can take up to 14 days before they work their full effects so don't expect to see results straight away.

The commonest inhaled steroids include beclomethasone dipropionate (Becotide, Becloforte, AeroBec), budesonide ( Pulmicort) and fluticasone propionate (Flixotide).

There are some preventer treatments which do not contain steroids, e.g. sodium cromoglycate (Intal) and nedocromil sodium (Tilade Mint). They also work by reducing inflammation, but are not always as effective as steroid treatments.

Sodium cromoglycate is often used as a preventer treatment for children, but it is less useful in treating adults. It also works well as a reliever medicine in the treatment of any exercise-induced asthma.

The aim of modern treatments is to get asthma completely under control using preventer treatments alone. When this is achieved, it is tempting to assume that you are cured, and to simply stop taking the medication. However, this is not advisable as it exposes you to the risk of a sudden, uncontrolled asthma attack.

If your disease has been well controlled for several months, then you could ask your doctor if you can 'step down' by reducing your dose of preventer medicine. You should always do this under medical supervision, and, preferably, monitor your peak flow to check that the asthma is not about to flare up again.

When the standard dose inhalers fail to control asthma, a higher dose version is used. If this is also unsuccessful, doctors may prescribe steroid tablets, usually in the form of the drug prednisolone. This may be given as a short course to relieve the inflammation which has caused a severe asthma attack, or in smaller, daily doses. A typical child's short course may last three to four days, while adults may require a longer course of steroids for about two weeks.

Many doctors now give patients a short course of steroid tablets to be taken when their asthma gets worse, e.g. an increase in night-time waking, or falling peak flow readings.