Asthma Treatment: Fast, Safe, and Doctor-Reviewed

This service is not suitable for you if you:

• Are less than 17 years of age
• Have never been diagnosed with asthma by a doctor
• Are pregnant
• Feel your symptoms are not controlled with your current treatment
• Are feeling unwell (shortness of breath/ cough/ wheeze/ chest pain/ high temperature)
• Are concerned you are having an acute asthma attack or have a chest infection
• Need rapid access to a prescription for inhalers (this is a next business day service)

If you are feeling unwell, are very short of breath, have chest pain or feel you are having an acute asthma attack, please seek urgent medical care – Call 999!

If you are concerned you may have a chest infection, please arrange a review with your local GP or book a video consultation with one of our doctors.

Asthma is a very common breathing condition that affects the smaller airways of the lungs (bronchioles). It can affect both children and adults causing:

• Cough
• Wheezing
• Shortness of breath
• Chest tightness

Symptoms can range from mild to severe, and last for an hour, days or until treated.

The exact cause of asthma is unknown but it involves an inflammatory response of the airway lining (this is what the steroid inhalers target and their regular daily use gives good asthma control).

Pollution, modern hygiene standards and genetics are all believed to play a role.

About 1 in 13 people in Ireland currently have asthma. While there is no cure, there are very effective treatments that if used correctly, can minimise your symptoms and thus limit the impact asthma has on your daily life.

With asthma, the airways are overly sensitive and react to things (triggers) that would not usually cause any problems. The immune system interprets these triggers as ‘an attack’ and launches an inflammatory response:

• The muscles of the small airways squeeze and spasm (contract), making the airways narrow and reducing the amount of air that can get in and out of the lungs. These changes are responsible for wheezing and breathlessness.
• The lining of the small airways produces more mucus, which leads to further blockage of the airways. This causes coughing.

Examples of common triggers include:

• Infections (especially viral colds and coughs)
• Allergies to animals, pollen, dust mites
• Emotions
• Exercise
• Smoking
• Certain medications e.g. ibuprofen, aspirin, beta-blockers
• Fumes/ chemicals/ pollution

We cannot avoid all of these things. If your symptoms are triggered by an avoidable cause e.g. smoking, then you should avoid this.

An asthma attack is a sudden worsening of your symptoms, caused by the tightening of muscles in your airways. This sudden onset of asthma symptoms can be brought on by exposure to a trigger. This can be life-threatening. Unfortunately, every year in Ireland 50-70 people die from poorly controlled asthma.

It is important to get to know your asthma symptoms and triggers, how to adjust your treatment and when to call for help.

Asthma is a variable dynamic illness which can vary with the weather or seasons. It can be ‘quiet’ over seasons/ years/ decades and then can become very unstable or even life-threatening over hours or days!

You should take an active role in the management of your asthma to reduce the impact of the symptoms on your daily life. Try to get into a good daily routine with your inhaler use so you don’t forget.

Managing your asthma well will reduce your risk of having a potentially serious asthma attack.

• Use your steroid preventer inhaler EVERY day, even when your symptoms are well controlled.
• Check your inhaler technique
• Have an asthma review with your doctor every year
• Carry your reliever inhaler with you at all times
• Check your asthma review plan for guidance if your symptoms change e.g. if you start to need your reliever inhaler more than 2-3 times per week
• If you smoke, stop
• Try to maintain a healthy weight
• Get the flu vaccination every year

This is a written plan that gives you clear advice on what changes to make to your inhaler doses, depending on your symptoms and when to seek medical advice.

If you do not have an asthma management plan, you can discuss this with one of our Irish-registered online GPs.

Well-controlled asthma is when:

• Daytime symptoms occur less than 3 times per week
• No waking at night due to asthma symptoms
• No symptoms during exercise or activity
• You use your reliever inhaler less than 3 times per week

If after reading this, you feel your symptoms are not well controlled, consult your asthma management plan for advice on how to adjust your treatment, contact your local GP, or speak with one of our GPs via video consultation.

You can control asthma with the proper use of modern inhaled medications meaning that it has little to no effect on your day-to-day life.

There are 3 main types of asthma inhalers:

1. Rescue/Reliever inhalers
2. Preventer inhalers
3. Combination inhalers

1. Rescue/Reliever inhalers

Rescue inhalers (like salbutamol) work fast to relieve acute asthma symptoms by relaxing your airways so you can breathe more easily.
If your asthma is well controlled, you shouldn’t need it more than twice a week. That means 1 or 2 inhalers per year should be enough. 

Using it more often?

This could mean your asthma isn’t well controlled and you should talk to your doctor about your regular (preventer) inhaler medication.

The medical guidelines on the use of reliever inhalers (e.g.ventolin) have changed radically in recent times. It is now recommended that these inhalers are not used alone for asthma treatment. They should always be used in combination with an inhaled corticosteroid (preventer) treatment. 

You should have access to a reliever inhaler in case of an emergency but for reasons of patient safety, we are not able to provide prescriptions for these inhalers via our written prescription service. 

2. Preventer inhalers

These inhalers are usually brown, red or purple and contain an inhaled steroid medication. They are the foundation of good asthma management and many patients will need to use them every day.

The inhaled steroids control airway inflammation, and therefore reduce the symptoms of asthma and the risk of having an asthma attack (the aim is to prevent an attack – hence the name).

These inhalers can take days to weeks to have an effect on symptoms. In an emergency, focus on using the rescue inhaler for the management of acute asthma symptoms.

3. Combination inhalers

These inhalers contain both a reliever (long acting medication that relaxes the airways) and preventer (steroid) medication in the one device, which is more convenient. They can help to prevent symptoms and also provide symptom relief when needed. This reduces your risk of having an asthma attack.

Inhaled steroids are now considered essential for good asthma management and using these regularly is key to good asthma control.

Traditionally, reliever medications like salbutamol (e.g. Ventolin, Salamol) and terbutaline (e.g. Bricanyl) were used to manage asthma symptoms when they happened. However, we now know that using too much of these medications can make your airways less responsive over time. This means:

• The inhaler may not work as well to relieve your symptoms.
• You might need higher doses to get the same effect, which isn’t safe.

Why does this happen?

• Overusing reliever medications can cause your airways to become more sensitive or irritated and can cause airway spasm.
• These medications don’t treat the underlying inflammation in asthma, so symptoms can worsen.

What to do?

• Use reliever treatment only as prescribed for quick relief of acute symptoms
• Use inhaler steroids regularly (as directed by your Dr)
• If you need reliever treatment more than twice a week, talk to your doctor or asthma nurse so that your asthma management plan can be reviewed

You can see the latest guidelines on managing asthma here.

If you’re using more than 3 Ventolin inhalers a year, your risk of having a serious asthma attack doubles in the next 12 months. So it is really important that your symptoms are well controlled.

When used at the standard doses, preventer (steroid) inhalers do not usually cause significant side effects provided your inhaler technique is appropriate. Some people can experience a sore/ irritated mouth, oral thrush or a hoarse voice. Brushing your teeth or rinsing your mouth after you use this type of inhaler can help prevent these side effects.

Very rarely, if you use these inhalers at very high doses for a very long time, then you can have more serious side effects such as problems producing natural steroid hormones in your body (this is most unusual for patients using this service, as we will be prescribing within the standard doses, but please speak with your doctor if you are concerned about this).

When using a combination inhaler, you can potentially experience side effects as described for the reliever and the preventer inhalers.

For full information about the potential side effects of your inhalers, please read the Patient Information Leaflet (PIL) that comes with your inhaler.

The Asthma Society of Ireland is an excellent source of information about all aspects of this condition. We would strongly recommend you check out their website.