Given the number of people who have asthma, one could question whether Mother Nature has made a fundamental error in the airways of a large number of people. The truth is, it is quite likely she hasn’t and that asthma is quite simply a defence or protection mechanism. Removing the stimulants that activate this defence mechanism is the first step on the road to taking control of the condition.
Although medication occupies a very important place in the treatment of asthma everyone with the condition, regardless of age or severity of symptoms, should at least try natural measures to alleviate asthma. All drugs have side effects and every opportunity should be seized to minimise the dosage required. Natural measures such as contained in this book have been proven to reduce the amount of medication required and the very fact that you are reading this book indicates this is an approach you take seriously.
Medication for the treatment of asthma can be broadly divided into two groups namely reliever (bronchodilator) and preventer (steroid).
Reliever medication is taken, as the name would imply, to obtain relief from symptoms. This is an important distinction from preventer medication taken to stop the symptoms from arising in the first place. The most popular form of reliever medication is the inhaler which will be familiar to most people; however it can also come in the form of a tablet or syrup. Reliever inhalers are easily recognisable by their blue, grey or green colour.
There are two types of reliever medication and they vary by how long the drug keeps the airways open. The most popular type of inhaler, which is known to everyone with asthma, is a short-acting reliever inhaler known as a beta2Agonist. This is taken only when needed and the effects last for three to four hours. Commonly prescribed short-acting relievers are Ventolin, Salamol and Bricanyl.
The drug and brand names of short-acting relievers are: Salbutamol commonly known as Ventolin, Salamol, Aerolin and Salbulin as well as Terbutaline that is commonly known as Bricanyl.
The second type of reliever inhaler is longer acting and keeps the airways open for about twelve hours. It is taken at regular times, usually in the morning and at night, and is marketed as Oxis, Serevent and Spireva.
The drug and brand names of long-acting relievers are: Salmeterol, commonly known as Serevent, and Eformoterol, commonly known as Oxis and Foradil.
Short acting reliever guidelines
This medication should be taken on a need-only basis to overcome attacks.1 Try not to take reliever medication solely out of habit. Ensure that the inhaler is needed instead of instinctively reaching for it at the slightest hint of symptoms. If the symptoms are minor, try to stop the oncoming attack by using reduced breathing. If this does not stop the attack after five minutes, then take reliever medication. If the symptoms are severe, reliever medication should be taken immediately.
Try taking only one puff of the reliever inhaler each time. Professor Buteyko recommends taking one puff and waiting for the medication to take effect, which should happen within five minutes. If another puff is needed it should be taken at this stage. There is no point in taking two puffs of reliever medication when only one is needed. Steroids are different however and should be used according to the prescription and never altered without a doctor’s consent.
Long-acting bronchodilators (relievers)
These inhalers keep the airways open for several hours and are taken once every twelve hours. They are prescribed for use on a regular basis, two puffs at a time, but should NEVER be used for emergencies. People have been known to die from taking long-acting relievers for symptomatic relief.
One of the shortfalls of reliever medication (bronchodilators) is that it does not cure asthma. No matter what dose is taken today it will make no difference to what symptoms are experienced tomorrow.
Reliever medication also causes hyperventilation. It forces the airways open and because the underlying hyperventilation is not addressed, the body will mount an even greater defence to prevent a further loss of carbon dioxide. Tolerance develops and the amount of reliever medication required to maintain control increases as the person gets older.
The side effects of bronchodilators can include: hyperventilation, hyperactivity, muscle tremors (often felt as a shaking of the hands), restlessness, dizziness, headaches, palpitations or gastrointestinal upsets.
Preventer medication is predominantly steroid based and must be taken all the time, according to a doctor’s instructions. Preventers come in red, brown or orange inhalers. Commonly used preventer medications are Flixotide, Becotide and Pulmicort.
Steroids (preventers) are the most effective anti-inflammatory drugs but they do not give immediate relief and their true worth only emerges with continuous use. A common mistake is to completely stop taking the preventer medication when fewer symptoms are experienced. In this case the asthma will slowly worsen over seven to twenty-one days, the need for a reliever will increase and this can result in a serious, uncontrolled asthma attack.
Steroids reduce inflammation which is the main component of asthma 2 but they do not cure the underlying disease.
It is important to note that preventative medication should never be stopped or reduced without consulting a doctor first.
The drug and brand names of inhaled steroids are: Beclomethasone Dipropionate 50, 100, 200, 250, 400 micrograms, commonly known as Becotide, Beclazone, Becloforte, Aerobec, Filair and Qvar; Budesonide that is commonly known as Pulmicort 100, 200, 400 micrograms and Fluticasone Propionate that is commonly known as Flixotide 25, 50, 125, 250.
Fluticasone is as effective as Beclomethasone Dipropionate and Budesonide at half the dose when given by equivalent delivery systems.3,4,5
Side effects at regular doses can include: candida (oral thrush), inflammation of the tongue, a hoarse voice (dysphonia) or easy bruising.
To reduce the side effects from a steroid inhaler the mouth should be washed and rinsed after taking the inhaler with the rinse water spat out to avoid swallowing any further steroid. Using a large volume spacer that will reduce the likelihood of steroid being deposited in the mouth. This is also advised for children as they may have a poor inhaler technique.
What is a low or high dosage?
The following table gives an indication of the relative dosage of intake for Beclomethasone or Budesonide. As Fluticasone is double the strength of the amounts below, halve the figures to determine the relative dosage. For example, a moderate dose of Flixotide for adults is 250 to 400 mcg per day.
Adults and children over five years old Dosage of Beclomethasone or Budesonide
Low dose 100 to 400 mcg per day
Moderate dose 500-800 mcg per day
High dose More than 800 mcg per day
Children under five years old
Low dose Less than 200 mcg per day
Moderate dose 250-400 mcg per day
High dose More than 500 mcg per day
• Figures are taken from Asthma: The Complete Guide.
The drug and brand names of oral steroids include: Prednisolone 1, 5 and 25 mg tablets that are commonly known as Deltacotril and Precortisyl Forte.
The side effects of steroids taken at high doses for prolonged periods (oral steroids) can include: high blood sugar/diabetes, hunger, cataracts, glaucoma, psychiatric disturbances, stomach ulcers, the increased likelihood of infection, depression, sleeplessness, aggravation of schizophrenia and epilepsy, suppression of the adrenal glands, thin bones (osteoporosis), roundness of the face, high blood pressure, retarded growth in children, thinning of the skin (looking like stretch marks), excessive hair growth especially for females or a general feeling of being unwell.
To help counter some of the side effects of steroids take a mineral supplement which is high in calcium and Vitamin D and exercise regularly.
Combination of reliever and preventer medication
A combination of drugs containing both reliever and preventer medication is becoming more commonly prescribed. Possible side effects from combination drugs are similar to those from long-acting and preventer medication taken together.
The drug and brand names of inhaled steroids are: Budesonide and Formoterol commonly known as Symbicort and Fluticasone and Salmeterol commonly known as Seretide.
New developments with anti-inflammatory medication
A new class of preventer anti-inflammatory drugs commonly known as Singulair came on the market in the 1990s. The main action of these drugs is to inhibit the powerful effects of inflammatory mediators called Leukotrienes. They work differently to steroids and it will be some time before the true effects become known. History has been unfavourable to drugs for the treatment of asthma and often it is ten or twenty years before the side effects become known.
Singulair comes in five and ten mg tablets and the side effects can include: fever, respiratory infection, stomach upset, dry mouth, weakness, dizziness, severe allergic reaction, headache, sleeplessness and muscle or joint pain.
It is not advised that these tablets are taken by children under six years of age or by patients with Churg-Strauss syndrome.
Listed above are only the most commonly prescribed drugs for the treatment of asthma; there are other drugs used as preventers such as Sodium Cromoglycate (Intal for children or Tilade for adults), anticholinergics and bronchodilators known as Xanthines. Xantines tend to be used less frequently now due to the many side effects connected with them.
Buteyko Breathing and medication
While it is not known exactly how steroids work, it is accepted that they treat inflammation which is the underlying airway obstruction.6 Professor Buteyko regards steroids as the treatment of choice. His belief is that steroids work by reducing breathing and this occurs as quickly as one hour after being taken. By reducing the breathing, airways are opened without a further loss of carbon dioxide. Professor Buteyko believes that taking the correct dosage of steroids is fundamental to maintaining safe control but unfortunately many people do not take the correct dose. Some people take too low a dose with the result that the asthma is uncontrolled and the risk of a severe attack remains present. Alternatively, some people start with a too-high dose that is not tapered downwards in accordance with the improvement in their condition. The British Guidelines on Asthma Management 7 advocates that “there is evidence that all of the inhaled steroids are absorbed to some extent from the lung and hence will have some systemic activity. It is prudent therefore, as with all treatment, to give the lowest dose of inhaled steroid compatible with asthma control”. It is also advised to step down the dosage of steroids once the asthma is under control, although the Guidelines recognises that this “is often not implemented”. Any reduction in steroid intake should be slow and only in conjunction with your doctor because patients respond at different rates when their doses are tapered.
Other patients rely too heavily on reliever medication and are fearful of steroid medication. Patients who rely predominantly on large doses of reliever medication for many years will have continuous symptoms and feel debilitated. Reliever medication can also pose a risk to a person’s health and life. The management of asthma has changed over the years and people no longer need to rely on large amounts of reliever medication for their treatment.
Long-acting reliever inhalers which have become popular in recent years are very powerful and are taken at regular intervals regardless of whether they are needed or not. In addition, it has been reported that tolerance to long-acting bronchodilators may develop, meaning that the effect of the drug, especially when used as the mainstay of treatment, diminishes with constant use. Intermittent use would therefore be preferable.8
The ingredients of long-acting reliever inhalers are also present in a number of combination inhalers. For example the brand name Seretide is a combination of Serevent (long-acting reliever) and Flixotide (preventer).
Buteyko’s view is that regular intake of bronchodilator medicine via inhaler or nebuliser overrides the body’s defence mechanism. When the airways are forced open by bronchodilating drugs, hyperventilation is increased and the body will activate an even greater defence to prevent the further loss of CO2. This leads to deterioration with a greater amount of reliever medication necessary to maintain control and, for this reason, it is important that the amount of reliever medication taken is minimal. History has proved his view to be correct and now the death rate has begun to decline as the treatment of choice has switched from relieving the sufferer to a more preventative approach.