Asthma medications are classified as " reliever" and "controller" medications.
Is asthma management always a combination of the two types?
Dear Ramachandra,
Thank you for this interesting question.
As you describe, asthma management is a combination of these two factors, but it´s important to have in mind that the therapeutic options in both approaches are varied. But also, not only these medications are considered useful for the asthma management. Environmental control and health promotion programs for asthma are fundamental aspects of the control of this disease.
You can get more resources about this approach in the GINA Website.
Best,
Juan Yepes
http://ginasthma.org/
Asthma is a chronic inflammatory airway disease with frequent relapses . Therefore , it is essential to relieve symptoms with relievers & prevent relapses with controllers . It is essential to control the inflammation with steroid inhalers , even when the patient is asymptomatic .
Thanks Prof,
Does that mean the patient is always on controllers and at times of exacerbations he is on relievers?
This treatment protocol is for moderate & severe asthma , as measured by symptoms & PEFR . Moderate asthma would be frequent attacks > 2 attacks /week with expected PEFR of 60 - 80% & severe would be daily attacks with PEFR of < 60% . These patients would need controllers & relievers . Mild asthma would be infrequent attacks of < 2 attacks / week & would need relievers only .
Reliever therapy = Short action B2 agonist (e.g. Salbutamol). This is used only in acute crisis or previously to exercise.
Controller therapy = Inhaled steroid (e.g. budesonide) +/- long action B2 agonist (e.g. Formoterol). This is a long-term therapy, that is continued although the patient is asymptomatic.
You can´t use reliever therapy as a controller, but occasionally you could use controller therapy as a reliever therapy (see S.M.A.R.T study Ref.
Nelson HS, Weiss ST, Bleecker ER, Yancey SW, Dorinsky PM. The Salmeterol Multicenter Asthma Research Trial: a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol. Chest. 2006;129:15-26.)
Asthma is of two types:Intermittent and Persistent . Persistent asthma is again classified as mild moderate and severe.Releiver medication contains salbutamol or levosalbutamol.It is a smoothmuscle relaxant with immediate onset of action and effect lasts for few hours.Smooth muscle relaxation and expectoration of mucous plugging releives bronchial obstruction with immediate effect.Sudden asthma attacks can be treated with releiver medication.The aim of cure for asthma is good control.Control is acheived by inhaler corticosteroids.The main ingredient for controller medication is steroid plain or in combination with long acting bronchodilators.Persistent asthma patients should be on controller medication with doses and duration periodically monitered.Sudden exacerbations are managed with releiver medication as and when required. Therefor there is a specific role for both releiver and controller medication use in the management of asthma.Controller medication doses should be stepped up or stepped down depending on the degree of cotrol aheived .Reference:GINA guidelines.Regular use of releiver therapy ,intermittent use of controller medications are common mistakes committed by patients with poor control. Patients need to be educated regarding the differences in the need and usefulness of both categories .