Preventers

Preventer medicines make the airways less sensitive, reduce redness and swelling and help to dry up mucus. They are the mainstay of asthma treatment because they treat the underlying cause of the symptoms. Preventers need to be taken every day to prevent symptoms and reduce the likelihood of asthma attacks. It may take two-four weeks before they reach their full effect, and occasionally up to 12 weeks.

Why might you need a preventer medication?

Preventer medicines treat inflammation by making the airways less sensitive, reduce redness and swelling and help to dry up mucus. They are the mainstay of asthma treatment because they treat the underlying cause of the symptoms. Preventers need to be taken every day to prevent symptoms and reduce the likelihood of asthma attacks.

Most people should have preventer medication to manage their asthma.

If you are using your blue/grey reliever more than 2 days per week it may mean your asthma is not as well managed as it could be. Take the Asthma Control Test today to determine your level of asthma control and see your GP for an asthma review and discuss whether you would benefit from preventer treatment.

Preventer medication is usually prescribed for most adults and adolescents with asthma when they have:

  • experienced asthma symptoms twice or more during the past month, or
  • been woken at night due to asthma symptoms once or more during the past month
  • had a flare-up requiring an urgent visit to a GP or emergency department in the past 12 months

Preventer medications for children is determined on how often and how severe their asthma symptoms are. Discuss preventer medications if your child is experiencing:

  • Symptoms which occur at least once per week and frequently disrupt child’s sleeping or play.
  • Flare-ups are generally severe enough to require a visit to the Emergency Department or requires oral corticosteroids.
  • The child has had a flare-up that required hospitalisation or ICU.

If you have been prescribed a preventer medication, it should be taken every day, even if you feel well.

How controlled is your asthma?

Poor asthma control (frequent symptoms and/or flare-ups) is a common problem in both adults and children. Research has found that for almost half of people with asthma, there is a gap between the potential control of their asthma symptoms and the level of control they currently experience. [i]

What is does good asthma control look like?

Most people with asthma can achieve good asthma control. This means that you:

  • Have asthma symptoms on no more than two days a week
  • Need your blue/grey reliever no more than two days a week, or even not at all
  • Experience no limitations on your activities due to asthma and
  • Don’t get any asthma symptoms at night or when you wake up

Even if you think you are in control of your asthma, ask yourself, “Am I needing my reliever on more than 2 days a week?” If the answer is yes, your asthma might be controlling you.

Take the Asthma Control Test today to determine your level of asthma control and see your GP for an asthma review.

 

Alvesco 

Flixotide

Pulmicort

Qvar

These inhalers are the most common preventers. They all contain medicine called corticosteroid, delivered by an inhaler device. They can help airway cells repair and return to normal by reducing airway inflammation, sensitivity and reducing excess mucus. The great advantage of these medicines is that they are inhaled and therefore work only in the lungs, precisely where the inflammation occurs.

Possible side effects include sore throat, hoarse voice and/or oral thrush.

These may be reduced by using a spacer if your preventer is in a ‘puffer’. Rinsing, gargling and spitting after each dose is also important and effective at reducing side effects.

Combination Preventer medicines

Breo

Flutiform

Fluticasone + Salmeterol Cipla*

Seretide

Symbicort

These inhalers all contain two medicines within the one inhaler, a preventer like and a long-acting reliever. Combination preventers reduce inflammation, sensitivity and excess mucus, as well as relax tight airway muscles. 

Possible side effects include sore throat, hoarse voice, oral thrush, shakes, rapid heartbeat and/or headaches. 

These may be reduced by using a spacer if your preventer is in a ‘puffer’. Rinsing, gargling and spitting after each dose is also important and effective at reducing side effects

Other preventer medications

Montelukast & Singulair

These non-steroid preventer tablets are often used to help exercise-related asthma, and are more commonly used as the main choice preventer in children. Some brand names include Singulair, Respikast, T Lukast, Lukair, Montair. 

Possible side effects are uncommon but may include muscle or joint pain, gastrointestinal disturbances, headache and/or psychiatric effects such as agitation, sleep disturbance and depression. Montelukast is usually commenced as a trial prescription and is recommended to be reviewed after four-six weeks of starting.

In an April 2018 safety review, Australia’s Therapeutic Goods Administration concluded there was an association between Montelukast and psychiatric side effects (such as agitation, sleep disturbances and depression) including, in rare cases, suicidal thinking and behaviour. 

These side effects are rare. It is usually a very safe preventer medication for children and teens with asthma. Overall it is a useful first line treatment for mild to moderate asthma.

We advise parents and carers to be aware of the potential side effects, and to closely monitor children and teenagers taking Montelukast. If you have any concerns speak to your doctor or read more about the side effects of Montelukast on the Department of Health, Therapeutic Goods Administration website.

Intal

Tilade

These are non-steroid preventer inhalers that work by reducing histamine (which promotes inflammation) in the airways. They are most often used in mild allergic and exercise-related asthma. They are quite powdery and can block the inhaler, so it is very important to wash the plastic casing of the inhaler frequently to make sure you are getting the full dose.

Side effects are rare, but may include headache, throat irritation, nausea and cough. About 20 per cent of people find Tilade has an unpleasant taste.

References

[i] Reddel HK, Sawyer SM, Everett PW, Peters MJ. Asthma control in Australia: a cross-sectional web-based survey in a nationally representative population. Med J Aust 2015; 202: 492–7.