Treatment of asthma: medication, exercises and nebulisation therapy

What is asthma?

Whether or not asthma is curable is currently a matter of debate. However, it is possible to remain productive when you have asthma. Well-managed medical treatment and an appropriate lifestyle help to keep the symptoms under control.

Bronchial asthma is the generic term for various chronic inflammatory diseases of the respiratory tract. People with asthma respond to certain external stimuli with a narrowing of the bronchi. This leads to whistling sounds when breathing, a dry cough and instances of respiratory distress. Asthma symptoms vary in terms of severity and frequency of occurrence.

Bronchial asthma is separated into allergic and non-allergic (intrinsic) asthma according to its respective triggers.

What happens during an asthma attack?

During an acute asthma attack, you will experience a sudden shortness of breath, contraction of the throat and hardly be able to breath. Asthma sufferers know this feeling but may still be afraid of suffocating. It is important to keep calm.

The person should inhale their emergency relief medication immediately. It is best to aid breathing by practising the body postures and breathing exercises you have learnt.

If there is no improvement after using these measures, an emergency doctor should be called.

Treating asthma with medication

The medication used to treat asthma can be divided into two groups.

Long-term medication providing a preventative effect, which are often referred to as ‘controllers’. Glucocorticoids are an effective long-term treatment method. They inhibit the inflammatory readiness of the bronchi and are preferably administered in inhaled form so that the dose reaches the respiratory tract immediately.

In the case of an acute asthma attack, soothing medication is available. These are also called ‘relievers’. Their aim is to dilate the bronchi as quickly as possible allowing air to flow again.

There are various types of asthma medication. The active ingredients are divided into different groups.

Corticosteroids for inhalation inhibit inflammation in the bronchi. These are the most important remedy in asthma therapy. The active ingredient is similar to the cortisone produced by the body. Over the long term, these reduce swelling of the bronchial mucosa, thus reducing mucus production and inhibiting allergic reaction.

Short-acting betamimetics (‘emergency relievers’) expand the respiratory tract rapidly when inhaled. These are used as needed, for example in the case of respiratory distress or a coughing fit. They should always be kept handy.

Long-acting betamimetics also have an expanding effect on the bronchi. They work more slowly than an emergency relief spray, but their effect lasts longer. These can be inhaled throughout the day but are only prescribed in combination with the inhaled corticosteroids.

Another type of medication is leukotriene receptor antagonists. These prevent neurotransmitters, which are involved in the development of an inflammation reaction, from being able to take effect. Leukotriene receptor antagonists are not effective in all patients.

Methylxanthines dilate the bronchi, but their effect is weaker than with the betamimetics. In addition, they stimulate the respiratory centre in the brain and the respiratory muscles. They also have an anti-inflammatory effect.

Anticholinergics also expand the bronchi. In uncontrolled asthma, these may be prescribed alongside inhaled corticosteroids and long-acting betamimetics.

Exercises for gaining control over asthma

The symptoms of asthma are relieved by means of targeted exercises and certain body postures help to improve breathing and broaden the lungs. (Source: German Allergy and Asthma Association)

Practice session 1: The pursed lip

This exercise is particularly important in the case of acute respiratory distress or significant exposure and forms the basis of all breathing exercises. Inhale air through the nose and then breathe it out again in a slow, controlled manner through a slightly opened mouth (with pursed lips). As described above, there should be a ‘sss’ or ‘pff’ sound when the air is exhaled. This method ensures that the respiratory tract remains wide open and the lungs are emptied and subsequently can be refilled with new, oxygen-rich air.

Practice session 2: The cart driver position

For this exercise, take a chair and sit upright towards the front of the seat. Then slowly allow your body to slump. Rest your forearms on your thighs and allow your hands to hang down loosely by your side. Your back should be like the arched back of a cat, i.e. slightly rounded and not cramped. The weight of the shoulders is removed from the ribcage. In addition, the muscles that normally bring the arms toward the body, when in this position actually help to expand the ribcage. This will enable you to breathe more easily.

Practice session 3: Variations of the cart driver position

As an alternative, you can use a table to rest your head on. For this exercise, your hands are not on your thighs, but rather on the table supporting your head. Breathe in and out through pursed lips.

Practice session 4: The goal keeper position

This exercise is performed while standing, with the knees slightly bent. Place your hands on your thighs, about a hand’s width above the knee, and start breathing in and out through pursed lips.

Inhalers and nebulisers

For asthma therapy, it is preferable to use medications which can be inhaled or nebulised, as this is a fast and effective way of administering the active ingredient. A comparatively small amount of the medication gets directly to the place where it is needed. There are various types of nebulisers and inhalers. The right device is chosen individually for each patient.

Various systems are available:

Metered dose inhaler: This system consists of a canister, with the active ingredient, and a mouthpiece. The canister is under pressure. Pressure on the valve releases the active ingredient in tiny droplets. This system requires good coordination – the active ingredient must be inhaled the moment the spray is triggered. That is why this system is less suitable for young children.

Spacer: A spacer may help if the asthma sufferer has problems with synchronous inhalation of the active ingredient from a dosage aerosol. Spacers are large, empty containers that are usually made out of plastic. You fix your inhaler on one end of the spacer, and use the mouthpiece or mask at the other end. When you press on your inhaler to release the medicine, the medicine collects in the chamber of the spacer, so you can then breathe in the medicine without needing to get the timing and speed exactly right.

Powder inhaler: For this system, the medication is released by inhalation. This is a great advantage because it does not require simultaneous spraying and inhalation. One disadvantage of the powder inhalers is that they require powerful inhalation. This may be difficult in some circumstances, particularly for children or in the case of an asthma attack.

Nebuliser: Nebulisers create a fine mist of active ingredient solution. This aerosol is under pressure and is created using a nozzle or mechanical vibrations. The active ingredient leaves the nebuliser more slowly and can therefore be inhaled more easily. When inhaling, it is therefore not necessary to inhale very deeply. This type of inhalation device is therefore particularly suited to children and the elderly, and also in cases of acute respiratory distress.

References:

German Allergy and Asthma Association (2018). Breathing exercises. Retrieved from www.daab.de/atemwege/atemuebungen/

Helmholtz Zentrum München (2018). How is asthma treated? Retrieved from www.lungeninformationsdienst.de/krankheiten/asthma/therapien/index.html

German Society for Pulmonology and Respiratory Medicine. What is asthma? Retrieved from www.lungenaerzte-im-netz.de/krankheiten/asthma-bronchiale/was-ist-asthma/

Kardos, P. (2015). Asthma. Retrieved from www.apotheken-umschau.de/Asthma#Was-ist-Asthma-bronchiale

Schmoller, T., Riedel, F. & Rabe, K. F. (2014). What is asthma? Retrieved from www.asthma-schule.de/index.php?id=413

Schmoller, T., Riedel, F. & Rabe, K. F. (2014). The therapy. Retrieved from www.asthma-schule.de/index.php?id=412