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 to four weeks before they reach their full effect.

Why might you need a preventer medication?

Preventer medicines work 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, your child, or someone you care for are using your blue/grey reliever more than two 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 or requiring a course of oral corticosteroids

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.
  • Symptoms or flare-ups occur at least 4-6 times weekly

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 suggests that only half of all Australians with asthma experience good asthma control.

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.

Single Preventer Inhalers

Alvesco  Flixotide Pulmicort Qvar Fluticasone Cipla

These inhalers are the most common preventers. They all contain a 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.

Most people with asthma who need to use a preventer will benefit from the regular use of this class of medicines.

Possible side effects include:

  • sore throat
  • hoarse voice
  • oral thrush.

Side effects 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

DuoResp Spiromax 200
DuoResp_200
DuoResp Spiromax 400DuoResp_400 Symbicort Rapihaler
Rapihaler
Spiriva Respimat
Spiriva_respimat
Seretide Accuhaler
Seretide-Accuhaler
Intal
Seretide-Accuhaler
       

These inhalers all contain two medicines within one inhaler, known as a ‘fixed-dose combination’ inhaler. The fixed-dose combination enables the accurate and safe delivery of the right dose of the two medicines in combination. The two medicines are a corticosteroid-based preventer, like those mentioned above in the ‘single preventer inhalers’ section, combined with a long-acting muscle relaxant that works similar to a reliever. Combination preventers reduce inflammation, sensitivity, and excess mucus, as well as relax tight airway muscles. They are usually recommended when symptoms and/or flare-ups occur despite the effective use of single inhaled preventers as a ‘step-up’ option.

For people who experience good asthma control using regular inhaled combination preventers, it is recommended to discuss the option of reducing the dose of your prescription with your doctor. The aim of asthma preventer treatment is to be on the lowest effective dose which works to control your asthma.

Symbicort Rapihaler and Turbuhaler can also be used as a symptom reliever as part of the ‘Symbicort Maintenance and Reliever Therapy’ (SMART) plan.

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

Side effects 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

Oral non-steroidal preventers

Montelukast & Singulair

Singulair

These non-steroid preventer tablets are often used to help exercise-related asthma and are sometimes used as the priority preventer for 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.

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. Even though these side effects are rare, they can be extremely worrisome. Asthma Australia recommends parents watch for mood, behaviour or sleep changes in their children after commencing this treatment. Usually, these will be seen in the first two weeks and if so, it is recommended to visit your doctor. If the symptoms are severe, like suicidal thoughts or self-harming behaviours, seek medical attention urgently

Montelukast is usually commenced as a trial prescription and is recommended to be reviewed after four-six weeks of starting. We recommend discussing your concerns with your doctor at the point of prescription. You can also visit this website Therapeutic Goods Administration to get more information.

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,
  • abdominal pain and nausea, and
  • unpleasant taste.

Side effects might be reduced by using a spacer with the device. Rinsing, swilling and spitting may also help reduce side effects.

Inhaled muscle-relaxing preventers:

This is a non-steroidal preventer which can be prescribed as an ‘add-on’ to the treatment regime in case of continued symptoms and recurrent flare-ups. It will usually be in addition to regular inhaled combination preventer use. Asthma Australia recommends discussing the option of a specialist referral if you are prescribed Spiriva for control of your asthma.

Spiriva respimat

Side effects of Spiriva are uncommon. Dry mouth can commonly occur.

 

 

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.