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Trial of corticosteroids


All asthma sufferers presenting with a severe airflow restriction should undergo formal trials of steroids. Prednisolone 30 mg orally is usually given daily for 2 weeks with their lung function measured before and immediately after the course. A significant improvement confirms the benefits of this type of treatment for the asthma sufferer. If the trial is for 2 weeks or less, the oral steroids can be withdrawn without tailing off the dose, and should be replaced by inhaled corticosteroids in those people who have responded and are thought will benefit from this medication.

Blood and sputum tests
Individuals with asthma often have an increase in the number of eosinophils in peripheral blood. However the presence of large numbers of eosinophils in the sputum is a more useful diagnostic tool.

Chest X-ray
This has a slightly limited use as there are no diagnostic features of asthma on a chest X-ray, although during an acute occurrence or in chronic severe disease over inflation is a characteristic often found in a chest x-ray.

Skin tests
Skin-prick tests should be performed in all cases of asthma to help identify allergic triggers.

Asthma Treatment
Although there is no cure for asthma, effective management is available for preventing attacks and controlling and ending attacks soon after they have begun.

Asthma medications are taken orally or inhaled in vapour form using a metered-dose inhaler. This is a hand-held pump which delivers medicine directly to a person's airways.

There are two kinds of asthma medication: bronchodilators, which reduce broncho-spasms; and anti-inflammatory medications, which reduce airway inflammation.

Immunotherapy is another treatment option for asthma caused by allergens. This form of therapy modifies a person’s allergic response by repeated exposure to small amounts of allergens.

By breathing into a PEFR, a small hand-held device called a flow meter, an asthmatic can find out when their airways are first starting to narrow. When the PEFR falls, asthma medication is probably needed to prevent an attack.

Note:
PEFR and medication should only ever be used under a physician’s guidance.

There are two basic kinds of medication for the treatment of asthma:

Long-term control medications – These are used on a regular basis to prevent attacks and not to be used for treatment during an attack.

These include:

  • inhaled steroids (e.g., Azmacort, Vanceril, AeroBid, Flovent) prevent inflammation
  • leukotriene inhibitors (e.g., Singulair, Accolate)
  • long-acting bronchodilators (e.g., famoterol, Serevent) help open airways
  • cromolyn sodium (Intal) or nedocromil sodium
  • aminophylline or theophylline (This isn't used as frequently as it was in the past)
  • a combination of anti-inflammatory and bronchodilators, using either separate inhalers or a single inhaler (Advair Diskus)


Quick relief (rescue) medications – which are used to relieve the symptoms during an acute attack.

  • short-acting bronchodilators (e.g., Proventil, Ventolin, Xopenex, and others)
  • oral or intravenous corticosteroids (e.g., prednisone, methylprednisolone) which help to stabilize severe episodes of asthma.


People with mild asthma (infrequent attacks) can use their relief medication as needed, but those with persistent asthma problems should take their control medications on a regular basis to prevent their symptoms from occurring.

A severe asthma attack requires a medical evaluation and may even require hospitalization with oxygen, intravenous therapy and medications being required.

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