Medicines and how they work
medicines are essential, it is important to remember that
they are not the only part of asthma treatment (see
leaflet "Allergy and Asthma").
medicines act be preventing or controlling asthma, so
people with asthma must take these medicines every day,
even when they are well - just like people with high
blood pressure or epilepsy or diabetes have to take their
medicine every day to stay well.
There are two
types of drugs used in the treatment of asthma - preventers
and relievers. There is no connection between the effects
of preventer and reliever drugs. They do separate things.
- Preventers build up a
protective shield in the linings of the breathing tubes
(call airways or bronchi) and thereby stop or reduce
swelling, mucus build-up and muscle tightening in your
airways caused by the triggers of asthma.
- They will not work unless
used regularly, so must be taken every day even when you
- They do not bring any relief
from symptoms (see Relievers below)
- They take about 14 days to
build up the protective shield. You will therefore not
see an immediate effect but after 1-2 weeks they will
make a big difference in the amount of asthma symptoms
- There are two families of
- Steroids - inhaled
- Preventers available in South
Africa are listed below. Drug names beginning with a
capital letter are their trade names (the ones you will
see in shops), and the ones beginning with a smaller
letter refer to their chemical names (used by chemists
- Steroids are a wide range of
chemicals made both by the body and artificially.
- One group of steroids, the corticosteroids,
are used to treat asthma.
- Corticosteroids are different
from the antibiotic steroids taken by some athletes.
Anabolic steroids are not used to treat asthma.
- They are the strongest
- They are used for moderate
and severe asthma.
- Your doctor should advise you
whether to decrease or increase the dose you are taking,
or stop these medicines where possible. Do not adjust
your doses without your doctor's advice.
- When inhaled they are usually
used twice daily.
- They can be taken in 3 ways:
- inhaled (breathing
them into the lungs),
- swallowed, either
tablets or syrup
- injected for acute,
- Inhalation is the preferred
- The drug goes
straight to the site where it acts, the lungs.
- The smallest dose
possible is used which results in fewer
- Side-effects are uncommon,
but can be:
- hoarse voice or oral
thrust, both of which can be prevented by mouth
rinsing with water after inhalation.
- growth suppression
(only when taken in high doses).
- Side-effects are reduced if a
spacer is used, so if you are using a high dose, it is
advisable to use a spacer.
- Children can take up to 400
micrograms per day (mcg/day) and teenagers up to 1500
mcg/day without fear of any side-effects.
Short-term (course) oral
- Are available as a syrup or
- Usually given to relieve an
acute attack of asthma.
- They are used when inhaled
steroids fail to control symptoms adequately.
- Usually given for 7-10 days.
- Many patients will keep such
a course at home which can be used when their asthma
worsens, as shown by increasing symptoms, especially at
night or with exercise, or by a fall in their peak flow
- When taking oral steroids
some people notice an increase in appetite and slight
Long-term oral steroids
- A small group of asthmatics
need to take low dose oral steroids on a long-term
basis because their symptoms continue to be significant
and their asthma uncontrolled, despite high doses of
- This is becoming less common
with the improvements in inhaled steroid therapy.
- Steroids can be injected only
by a doctor or nurse.
- They are usually only used to
treat acute, severe asthma when the patient cannot
swallow the oral steroids.
- Used in people with moderate
- Has mild side-effects of
irritation of the throat, coughing, hoarseness, dry
mouth, nausea and vomiting.
- Your child should continue
his treatment even if feeling well.
- Symptoms may not be relieved
initially and 2 weeks of continuous treatment may be
needed for maximal effect to develop.
- Children seem to respond
better than adults.
- This medicine may be taken as
powder inhaler (spincaps), nebuliser solution or by
- Tilade is non licensed for
use in children, over 6 years of age and is similar to
- One of the major causes of
cough, wheeze or tight chest that asthmatics experience
is bronchospasm which is tightening of the muscle
around the airways (see What is asthma?).
- Bronchospasm is relieved by
medicines called bronchodilators or relievers which help
open the airways and make breathing easier.
- Relievers produce
nearly instant relief and for this reason are used as
'first aid' treatment for asthma symptoms or attacks.
Always carry them with you!
- Relievers have no
effect on the swelling in the airways or the build up of
- Relievers are used
only when the person with asthma has symptoms. If you
need to use a reliever more than 3 times a week you
should also be on a preventer.
- Some asthmatics need to use relievers
before exercise even though their asthma is well
controlled by preventers.
- Shakiness and a fast heart
beat can occur when reliever medicines are first used, or
when larger than normal doses are used. These effects
disappear once the medicines have been used for a few
- Reliever medicines are
available in three forms: inhalants, tablets or syrups.
- Inhaled medicines are
preferred as they go directly and rapidly to the airways
allowing smaller doses than oral medicines to be used
- Inhaler or spacer devices
allow us to use asthma pumps in children of all ages.
- There are two types of inhaled
- Short-acting beta-agonists
are the reliever medicines already described
- Long-acting beta-agonists
have a duration of action of 12 hours and are used for
troublesome night-time and activity (exercise) induced
symptoms. They are always used with preventer medicines.
- They are available as syrups,
tablets or capsules.
- They take longer than inhaled
bronchodilators to work as they have to go the 'long
way round' before they act on the lungs.
- There are two types of oral
- Because higher strengths have
to be used than inhaled beta-agonists, side
effects such as shakiness, headache, sleeplessness and
simply a nervous feeling often occur.
- There are two groups of
- short-acting -
duration of action 4-6 hours
- long-acting -
duration of about 12 hours
- Rectally administered
theophyllines can be potentially dangerous and are not
- Over the last few years these
medicines have been prescribed less frequently, mainly
because they commonly produce side-effects such as:
- stomach upset,
indigestion, heartburn, loss of appetite, nausea
sleeplessness, excited or nervous feeling and
- Long-acting theophyllines
are started in low doses and are used once or twice a
- Your doctor will send you for
a blood test to measure the level of theophylline in the
blood to determine the correct dosage.
Choledyl, Nuelin, Solphyllin
Microphyllin, Neulin SA Tabs
Theo-Dur, Theoplus, Uni-Dur
- Homeopathic medicines
are not commonly recommended for asthma. If you do wish
to use these please do not stop your child's usual asthma
medicines as prescribed by your doctor.
- Antihistamines can be
used for other allergic conditions such as hay fever but
are not considered to be standard asthma medicines.
- Antibiotics are rarely
necessary as viral infections are by far the most
common triggers of asthma attacks. The decision to use or
not to use them will rest with the attending doctor.
- Cough mixtures offer
no benefit in asthma management as the cough is most
often a sign of poor asthma control needing relieving
- Tranquilisers are
dangerous as they may suppress the breathing process
especially in severe asthma attacks.
- Desensitisation is not
recommended as asthma treatment as it is not effective
and can be potentially dangerous.
- Ionisers are
5 key points to remember
- Inhaled steroids are the most
effective preventer medicines.
- Inhaled steroids are safe at
doses used most commonly.
- Spacers reduce the risk of
- Tablets may need to be used
in a short course for an asthma attack.
- Steroids used in asthma are
not anabolic steroids used by athletes.
- Relievers are a
measure of how well your asthma is being controlled. If
you need relievers regularly it means you are not getting
enough preventer medicine.
- Short-acting beta-agonists
should only be used when asthma symptoms appear or before
- Inhaled short-acting
beta-agonists act very quickly to relieve symptoms.
- Long-acting beta-agonists
are used for troublesome night-time and exercise induced
- Theophyllines are
uncommonly used because of side-effects.
Written by: Dr Sam Risenga, Dr
Bhadrish Vallabh, Dr Des Cohen, Dr Archie Mhlambi