When to be extra cautious: medication side effects, pregnancy and anaphylaxis

Side effects of asthma medications

It’s natural to have concerns when prescribed new medications or when changing your medications. Asking questions and being informed are two of the best ways to ensure you feel empowered to manage your asthma. This will enable you to live your life with asthma uninhibited.

All medicines can have side effects. Some side effects only occur when you first start using the medication, or if you increase your dose. Examples of common side effects from asthma medicines are a faster heartbeat from taking lots of your reliever puffer, or a hoarse voice from some preventers.

If you are worried about side effects, it’s important to discuss this with your doctor. There may be steps you can take to reduce the side effects, or there are often other medicines you can try which may not cause the same problems. Do not just stop taking your medication. Stopping your medication may cause you more problems than any side effects, and could lead to an asthma attack.

Some of the most useful things people do to reduce common side effects of their important asthma medicines are:

  •       Using a spacer with any medication that comes in a puffer form,
  •       Gargling, rinsing and spitting after taking preventer medication which contains corticosteroids.

Every prescription medicine has a Consumer Medicine Information Sheet that lists all known possible side effects This can look scary. Remember that while some side effects are common, many of the ones listed will be very rare and experienced by only one in 10,000 people, or fewer, who take that medicine.

Steroids in asthma medication

Many people with asthma, especially parents of children with asthma, worry that asthma medicine contains corticosteroids.

Corticosteroids are in many of the asthma preventer medicines, and are the most effective way of managing most peoples’ asthma. They are the best anti-inflammatory medicine for the type of inflammation involved in asthma. They improve asthma control, which means you go to hospital less, have a better quality of life and better lung function.

They’re not the same as body-building steroids. The steroid in the inhaled preventers is similar to substances produced in your own body, it’s just being provided in higher amounts and directed to where they need to work, via the inhaler, into your lungs. The inhaled corticosteroids are not as strong as the corticosteroid tablets and liquids – those are usually only used when you are really unwell.

The few common side effects of inhaled corticosteroids are a sore throat, hoarse voice, and sometimes oral thrush, You can mostly avoid these by using a spacer and/or gargling, rinsing and spitting after taking the medication. Other, less common side effects are unlikely unless you need to use high doses of this medicine.

The aim of asthma treatment is to use only enough to keep your symptoms in check.

If you feel you are using high doses of inhaled corticosteroids and feel your asthma is under control, talk to your doctor about whether you can reduce your dose. You may need to change inhaler.

When you have an asthma flare-up or attack, you may need to take a course of corticosteroid tablets or liquid for children. This is a much stronger form of the same medicine and works very well to reduce the inflammation in the airways.

Because you usually only take these occasionally and for short periods, they cause few side effects, most commonly sleeplessness, mood disturbance and gastrointestinal disturbance. Taking them with food and in the morning where possible can help reduce these temporary side effects. If you do need to take them for a long time, then talk with your doctor about any worries you have.

Pregnancy and asthma

When you are pregnant, you are breathing for yourself and your baby. It’s important to have good asthma control so your baby will have a good oxygen supply for normal growth and development, preventing low birth weight and premature delivery.

About half of Australian women with asthma find their asthma gets a bit worse during pregnancy, often between 17 and 36 weeks gestation.

The most important thing is that you do not stop taking your asthma medication – especially your preventer. You can put your baby at risk if you stop taking your asthma medications, because if you have an asthma attack, your baby may suffer from a reduced oxygen supply. Remember, if you can’t breathe then neither can your baby.

If you have asthma and are pregnant (or planning to be) then it’s worth talking with your doctor or a respiratory specialist to get a written Asthma Action Plan specifically for your pregnancy. They may also decide to change your medications and see you more regularly during your pregnancy.

Tips for asthma in pregnancy:

  •       See your doctor when planning a pregnancy to make sure you are on the best medicines
  •       Keep taking all of your asthma medicines
  •       Have regular check ups for your asthma during your pregnancy. The Australian guidelines recommend two weekly check ups
  •       Avoid smoking and breathing other people’s tobacco smoke as this increases the risk of your baby developing asthma and other breathing problems. It also increases the risk of stillbirth, spontaneous abortion, underweight babies, premature birth, ruptured placenta, sudden infant death, cleft palate, cleft lip and childhood cancers.2
  •       Work with your doctor to keep your written Asthma Action Plan up to date, follow it closely and tell your doctor if your asthma symptoms become worse.

For more information on medicines during pregnancy and breastfeeding call the NPS Medicines Line on 1300 MEDICINE (1300 633 424)

Anaphylaxis

Anaphylaxis is the medical term used for the most severe form of allergic reaction. An anaphylactic reaction usually happens less than 20 minutes after being exposed to a trigger and can very quickly become life threatening. It should always be treated as a medical emergency.

People who are allergic to a food and have a history of eczema and/or asthma are at a higher risk of anaphylaxis. You can only be diagnosed with anaphylaxis after you have had a reaction.

Early signs of a general allergic reaction are symptoms such as tingling in the mouth, hives or welts (red raised bumps on the skin), swelling of the face, lips or eyes and vomiting or abdominal pain. Anaphylaxis is when these symptoms then progress into a severe allergic reaction, with difficult/noisy breathing, swelling of the tongue and throat, difficulty talking, cough and/or a hoarse voice, pale skin, floppiness (particularly in young children) and loss of consciousness or collapse.

Anaphylaxis can occur after a person is exposed to an allergen, or trigger. The allergen is something the person’s immune system treats as a foreign object and reacts against. Ninety per cent of allergic reactions are caused by foods such as peanuts, tree nuts, egg, milk, sesame, seafood and soy, but insect venom or medications can also be triggers.

Talk to your doctor and if necessary, see an allergy specialist to help identify your trigger/s so you can avoid them. Your doctor should help you develop an anaphylaxis action plan, explaining how to recognise an anaphylactic reaction, what to do, medications to use (such as an adrenaline injector) and when to call an ambulance.

The doctor will also explain when to return for regular follow up visits.  It is also important that people around you, for example at work or at school, know about anaphylaxis and how to help if you have a reaction.

If someone has an anaphylactic reaction, they will need an urgent injection of adrenaline. This is most commonly given through an automatic injector. Anyone who is diagnosed with anaphylaxis should carry one of these injectors with them, or have it very close by. If you have one of these, make sure you and your family, friends or work colleagues know how to use it in a medical emergency.

Anaphylaxis Australia has more information, including advice, fact sheets, and information for kids.

Download an Anaphylaxis Action Plan from the ASCIA website