Controller medication is used to prevent the symptoms of asthma occuring.
Controller medication reduces the inflammation of the airways over time and lowers the risk of a severe attack occurring. It does not provide any instant relief of symptoms but builds up protection and reduces symptoms over a longer period. With proper use of their controller inhaler, many people will be totally symptom free and need to use their reliever very rarely.
It can take up to 2 weeks for the effects of controller medication to kick in, or up to 2 months in children. Because of this, it’s important to continue using your controller inhaler as prescribed, even if you feel no immediate improvement. Gradually your symptoms should become less and you will notice that you don’t need to use your reliever inhaler as frequently.
Normally, you will be started on a dose high enough to get your symptoms under control; once this has been achieved the treatment is steadily reduced to the lowest possible dose that maintains your asthma without symptoms. Controller medication usually comes in a brown inhaler.
You may be prescribed a controller inhaler if you have regular symptoms and/or use your reliever more than twice a week.
Symptoms that suggest you might need a preventer include:
- Tight chest during daily activities more than twice a week
- Disturbed sleep from the same
- Bad attacks of breathlessness when you are ill or in a smoky atmosphere.
Controller medication must be taken every day, as prescribed, even when you’re feeling well. It is an essential part of keeping asthma symptoms under control.
Examples of controller medication:
- Beclomethasone (e.g. Becotide)
- Budesonide (e.g. Pulmicort)
- Fluticasone (e.g. Flixotide)
For people with poorly controlled asthma, combination inhalers are another medication option. These inhalers contain a mixture of controller medication with a form of slow-acting reliever medication. People requiring a combination inhaler should be reviewed regularly by their health care professional.
Reliever inhalers relax your airways, which help breathlessness, but they do not treat airway inflammation. As well as the relaxing effect of a reliever inhaler, you need the anti-inflammatory effect of a preventer. A combination inhaler provides both forms of medication in one go. Once the airways are less inflamed, they are less sensitive to triggers such as cigarette smoke and viral infections.
Examples of combination medication:
- Fluticasone & Salmeterol (e.g. Seretide: can be used for ages 4+)
- Budesonide & Formoterol (e.g. Symbicort: can be used for ages 6+)
Possible Side Effects of Combination Inhalers
As with standard controller inhalers, combination inhalers can occasionally cause hoarseness, sore throat or oral thrush. These side effects can be reduced by using your inhaler correctly; using a spacer device, rinsing your mouth and wiping your face after taking your medication.
Why is My Reliever Inhaler Not Enough?
Reliever inhalers relax your airways, which help breathlessness, but they do not treat airway inflammation. As well as the relaxing effect of a reliever inhaler, you need the anti-inflammatory effect of a preventer. Once airways are less inflamed, they are less sensitive to triggers such as cigarette smoke and viral infections.
Do I Really Need to Take My Controller Inhaler Every Day?
Yes – very definitely. To work properly, preventers need to be taken every day, usually morning and evening, even if you are feeling well. The protective effect of the preventer medicine builds up gradually.
Once this protection is working, occasionally forgetting to take your inhaler will usually not have any major effects. But forgetting or stopping for several days at a time will mean you lose your protection
Possible Side Effects of Controller Inhalers
Combination inhalers can occasionally cause hoarseness, sore throat or oral thrush. These side effects can be reduced by using your inhaler correctly; using a spacer device, rinsing your mouth and wiping your face after taking your medication.
Concerns About Steroids
Many people are anxious about the side effects of steroids used in preventer treatment. Here are some key points to remember:
The steroids used to treat asthma are called corticosteroids.
Corticosteroids are identical to those produced naturally in the body.
They are completely different to the anabolic streoids used by body builders and athletes. Most people with asthma use low dose inhaled steroids, which go straight down to the airways, so very little is absorbed into the rest of the body.
You doctor will prescribe the lowest possible dose to get your asthma under control.
There is a small risk of a mouth infection called thrush, and hoarseness of the voice. You can avoid this by using your inhaler before brushing your teeth, and by rinsing out your mouth well afterwards. Using a spacer device also helps reduce the possibility of thrush.
Top Tip: Leave your preventer inhaler beside your toothbrush to remind you to take it morning and evening before you brush your teeth.