Bronchial asthma is a condition characterised by recurrent cough and breathlessness caused by the narrowing of air passages in the lungs. It can affect individuals of any age or gender. Some persons may suffer due to changes in climate or exposure to dust or cold air, whereas some persons have chronic asthma, i.e. they suffer from it almost daily. There is no cure for bronchial asthma because it occurs due to an inherent tendency in the body. It ensues after exposure of the person to certain substances to which the body is sensitive. This results in the narrowing of the air tubes (bronchi) causing difficulty in breathing. Secretions get trapped in the tubes causing cough with expectoration. Mostly, the attacks occur after midnight. The common asthma-producing substances are dust, droppings of insects, fungal spores, high-protein foods, strong smells, certain chemicals, et cetera. Many of these substances are such that exposure to them cannot be avoided. Given its chronic nature, treatment should offer immediate relief with minimal or no side effects. Using the medicines in inhaler form provides such an option. Various bronchodilator drugs (those which open up the narrowed air tubes) are available in inhaler form, i.e. the form in which the drug can be inhaled. Inhalers are portable hand-held devices that contain the medicine to be inhaled. It is an L-shaped metallic canister with a mouthpiece at one end and a top at another end which has to be pressed to push out the drug. The inhaler should be shaken before use. The mouthpiece should be placed firmly just inside the lips and the lips should close around it with no gap remaining. After taking a deep breath, one should press the top of the inhaler so that the medicine is released and inhaled. Breath should be held till a count of 10 to ensure that the maximum amount of medicine is reaching the lungs. Another puff can be taken after a gap of one minute. When an individual uses the inhaler correctly, they can feel the mist going inside and get immediate relief in symptoms of asthma. While inhaling, if one leaves a gap at the angle of the mouth, the medicine can leak out, thus reducing the efficacy. If the mouthpiece is inserted deep inside the mouth, the medicine will be dissipated inside the oral cavity and will not be effective. For people who have acute asthma episodically, inhalers are the best choice. In chronic asthma, instead of using drugs in the form of tablets, one can use inhalers, two to three times every day. If one takes two puffs of inhaler before sleeping, nocturnal attacks of asthma can be avoided. Once the pump is exhausted, one can feel the absence of the mist while inhaling, hence, can know that a new one is needed. Using an inhaler provides immediate symptom relief while eliminating the risk of systemic side effects. It is safe for pregnant women and side effects are minimal. However, long-term use of corticosteroid inhalers may lead to fungal infections in the mouth for some individuals. Various inhalers are available, containing different drugs alone or in combination for enhanced efficacy. Some asthma patients find inhalers expensive, but they are cost-effective over time, saving money on hospital visits and medications. There is no harm with inhalers and the advantages are multiple. Therefore, if one suffers from asthma, they can start using inhalers in place of tablets. Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital.
