2017 HCHB_digital

Asthma and COPD
Asthma
New Zealand has one of the highest prevalences of asthma in the world and over
460,000 people regularly take medication for asthma. An estimated one in seven
children and one in nine adults are affected, and only a small number of children
appear to grow out of the condition.
Common symptoms include wheezing (a whistling sound most obvious when
breathing out), shortness of breath, tightness in the chest, difficulty speaking, and
a persistent dry cough (usually at night or after exercise). Over time this cough may
become more productive. A cough may be the only symptom in young children.
These symptoms may occur suddenly as an asthma “attack”, or they can be
present most of the time. During an “attack”, breathing becomes very difficult
due to inflammation and contraction of the smooth muscle within the airway,
excessive mucous secretion, and swelling of the smaller airways. Permanent
damage of the airways can result from untreated asthma.
It is common for asthmatics to also suffer from hay fever or eczema, and/or to
have a family history of these conditions.
The cause of asthma is unknown; however, many common triggers have been
identified, including animal dander (especially cats), cigarette smoke, cold air,
exercise, house dust mites, pollen, stress, strong perfume, viral infections (eg, a
cold) and some medicines (eg, aspirin and NSAIDs). Asthma cannot be cured but
TREATMENT OPTIONS
Category Examples Comments
Relievers
(short-acting
bronchodilators)
Preventers
Short-acting muscarinic
antagonists (SAMA) or
long-acting muscarinic
antagonists (LAMA)
Symptom controllers:
long-acting beta2
agonists (LABA)
Combination therapy
Spacers
Beta2-agonists
[PRESCRIPTION MEDICINE]
eg, salbutamol inhaler (Asthalin, SalAir,
Salamol, Respigen, Ventolin)
eg, terbutaline (Bricanyl)
eg, salbutamol liquid (Ventolin)
Inhaled corticosteroids (ICS)
[PRESCRIPTION MEDICINE]
eg, beclomethasone (Beclazone, Qvar),
budesonide (Pulmicort), fluticasone
propionate (Floair, Flixotide)
Mast cell stabilisers and others
[PRESCRIPTION MEDICINE]
eg, nedocromil (Tilade), sodium
cromoglycate (Intal Spincaps/Forte),
montelukast (Singulair)
[PRESCRIPTION MEDICINE]
eg, ipratropium (Atrovent, Univent)
tiotropium (Spiriva), glycopyrronium
(Seebri), umeclidinium (Incruse Ellipta),
aclidinium (Bretaris)
[PRESCRIPTION MEDICINE]
eg, eformoterol (Foradil, Oxis), indacaterol
(Onbrez), salmeterol (Meterol, Serevent)
[PRESCRIPTION MEDICINE]
eg, eformoterol + budesonide (Symbicort
Smart, Vannair), glycopyrronium
+ indacaterol (Ultibro Breezhaler),
ipratropium + salbutamol (Duolin HFA),
salmeterol + fluticasone propionate
(RexAir, Seretide), tiotropium + olodaterol
(Spiolto Respimat), umeclidinium +
vilanterol (Anoro), vilanterol + fluticasone
furoate (Breo)
eg, e-chamber, Volumatic
Children aged six or less
eg, e-chamber mask
Reliever inhalers are used to treat the acute symptoms of asthma (ie, the difficulty in breathing). They provide
relief within a couple of minutes. Most reliever inhalers are blue.
Anyone using a reliever more than three times a week or waking at night with symptoms should go to the
doctor. If a person finds his bronchodilator has become less effective, it may indicate worsening asthma and
the need to initiate an action plan or to visit the doctor to review therapy.
Preventer inhalers contain ICS. They do not have an immediate effect, so nothing is felt after inhalation;
however, when used regularly they reduce the underlying inflammation of the airways and help reduce the
incidence and severity of asthma attacks and hospitalisations. Most preventer inhalers are either brown,
orange or dark red. Reduce risk of oral thrush by using a spacer and rinsing the mouth with water after using
ICS.
Mast cell stabilisers (ie, nedocromil, sodium cromoglycate) are not commonly used since they are less effective
than ICSs. May be useful for preventing exercise-induced asthma. Sodium cromoglycate needs to be taken
anywhere from four to eight times daily. They may take up to six weeks to take effect.
Montelukast is a leukotriene receptor antagonist that may be used in addition to ICSs for an additive effect.
Can be of benefit in exercise-induced asthma and in people who also have rhinitis. Special Authority needed.
Ipratropium reduces mucous secretions and relaxes airway muscle. It is short-acting and has a slower onset of
action than beta2-agonists so is used more in COPD, although certain asthma patients may benefit. Longer
acting antimuscarinic bronchodilators include tiotropium, glycopyrronium, umeclidinium, and aclidinium.
Long-acting bronchodilators. Do not treat the underlying inflammation but may be beneficial in mild to
moderate asthma instead of using higher doses of ICS. Used in conjunction with an ICS. Not useful for acute
asthma attacks since they do not open airways immediately. Do not exceed recommended dose.
Combination agents may aid adherence to recommended preventative regimens.
Please refer to detailed product information as well as asthma guidelines to distinguish when combination
inhalers should be used, and which combinations are recommended depending on the severity of the asthma
or COPD.
Dispense
Ventolin ®
The original blue inhaler
that Kiwis know and trust 2
Help to improve delivery of MDIs to the lungs, reduce adverse effects of ICSs. Wash once a week with warm
water and a squirt of detergent and allow to completely drip dry. This leaves a slight residue of detergent
on the inside of the spacer which reduces static and stops the medicine in the inhaler sticking to the sides.
Replace every six to 12 months (tiny scratches or abrasions can prevent the spacer working as effectively).
VENTOLIN
Asthma
Symptom Relief
doesn’t need to involve an
unpleasant aftertaste. 1
DISPENSE
ALCOHOL
FREE
VENTOLIN 2
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