Things have come a long way since I was a kid, prescribed a “blue puffer” by my family doctor who suspected I likely had asthma. I remember spraying the medicine from this puffer into my mouth, and trying to take a breath at the same time to get it into my lungs. There was no question that most of the medication ended up on the inside of my mouth! We can do much better these days, and I would like to talk to you about asthma and COPD and give you an overview of how we now look at inhalers and other medications.
Asthma is considered to be a reactive airways disease: meaning that, in a person with asthma, the way the lungs work can change very quickly and suddenly.
COPD, or chronic obstructive pulmonary disease, which is mostly caused by cigarette smoke or exposure to that smoke, is a disease that progresses more steadily and gradually as the lungs continue to get damaged, but flares up in what we call COPD “exacerbations”.
Both asthma and COPD belong in the category of “obstructive lung disease,” and to paint a picture of what this might mean, I would ask you to think of the lungs like a balloon that has lost some of its elasticity: it’s more difficult to fully inflate, and when deflated it looks thin and stretched out, having lost its original shape and ability to properly expel air.
Asthma is generally considered a lifelong condition and usually starts in childhood or adolescence. With proper treatment over those years, someone with asthma can maintain normal lung function most of the time, for most of their life. Once the damage is seen in COPD, however, it is thought to be more irreversible and progressive, and the goal is to prevent further decline: usually by quitting smoking.
The first concept I want to emphasize with asthma and COPD is the use of “rescue” inhalers. The two primary inhalers in this category are salbutamol, which goes by the brand name Ventolin, and terbutaline, which goes by the brand name Bricanyl.
Salbutamol, or the “blue puffer” as it is widely known, is generally dispensed as an L-shaped puffer that I described at the beginning of this video. This is the one where it often feels like you are spraying the inside of your mouth with the medicine. These L-shaped puffers are called “metered dose inhalers,” and they are meant to be used with an AeroChamber (a plastic tube that you should first release the medicine from the puffer into in order to aerosolize it). This is the only proven way to ensure you get the medicine from an L-shaped puffer into your lungs.
A “rescue” puffer is meant to be used exactly as it sounds: for emergency rescue use only. We treat asthma and COPD with “daily” puffers. These daily puffers are meant to help you control your symptoms, so that you don’t need to reach for that “rescue” puffer as often. If you are using this rescue puffer too much, that would indicate that your asthma or COPD is not under good control, and you should be seeking medical attention to try to get better control. How much is too much? This has changed recently, and it is now said that having to reach for the rescue salbutamol more than twice a week indicates poor control of your asthma. We used to say up to four times a week. So I want to highlight that, if you have well-controlled asthma, a single salbutamol blue puffer should last nearly a year! This may surprise some patients who are used to renewing these puffers every month or two. So, if that applies to you, I encourage you to reach out to the family doctor’s office to get help on achieving better control. Good control of your symptoms means rarely having fits or episodes of shortness of breath, or coughing.
The puffers used for asthma and COPD are similar but different, and I don’t want to get into the details of that in this video, but we are always happy to review the specific puffers being used, and why, with any of our patients with asthma or COPD, at any time. There has been an explosion of different puffers on the market over the last few years, and they now come in various shapes and sizes, with many not requiring an AeroChamber. They are even compact enough to carry around in your pocket more easily.
One of the other things that has changed in managing asthma and COPD is a greater appreciation of, and emphasis on, getting regular breathing tests. Most of you with asthma and COPD will already have had these breathing tests, and the simplest breathing test is called spirometry. This is particularly helpful in asthma as it is a fairly simple and straightforward test that can be done inexpensively and even in some outpatient settings.
As I mentioned above, people with asthma and COPD have trouble blowing all of the air in their lungs out, and one of the primary things we are looking at when sending you for spirometry is the FEV1, or “forced expiratory volume” in one second; in other words, how much air you can force out in one second.
It turns out that maybe as many as a third of people with asthma fit into a category where they think their asthma is well controlled, and only use their rescue puffers every once in a while, but perform poorly on the spirometry test. For this reason, we recommend that people with asthma and COPD get updated spirometry every few years.
For adults with COPD, every few years we would generally recommend that you get a more thorough pulmonary function test done at our local hospital to look at the size of the lungs and how that changes through the breathing cycle, to make sure we are keeping an eye out for any other possible diseases that might be contributing to breathing difficulties.
Aside from using spirometry or other breathing tests to figure out how your lungs are doing, and using controlling medication daily to keep breathing and coughing symptoms under control, the other area I want to emphasize in this video has to do with asthma or COPD “exacerbations”, or flare-ups. I want to make sure that everyone with asthma or COPD has an action plan with the family doctor’s office to treat these flare-ups promptly and effectively.
Generally speaking, with asthma, if there is a new or sudden worsening of shortness of breath or cough that continues despite the use of rescue inhalers, we would want to treat promptly with something like prednisone, a common steroid, to make sure that the asthma settles down as fast as possible, and at the family doctor’s office we would typically prescribe prednisone for a few days and closely monitor.
COPD exacerbations are treated a bit differently, and in addition to changes in breathing and/or coughing, we also look at how much phlegm is produced and whether the phlegm has changed colour. COPD exacerbations are also treated with several days of prednisone, but we sometimes decide to add antibiotics.
These action plans are essential to have in place before you get into breathing trouble, so if you are not sure what the plan is for when you have an asthma or COPD exacerbation, please make sure to review this with the family doctor’s office ASAP.
I cannot over-emphasize the importance of quitting smoking for both diseases. Smoking cigarettes has been shown for decades to accelerate asthma and to continue ongoing damage and COPD. It is never too late to quit smoking, as once you stop, you can generally slow down the progression of these diseases. Quitting smoking is probably the single most effective treatment for asthma and COPD. If you are considering quitting and are looking for additional help, please reach out to the family doctor’s office.
Thankfully, we have come a long way since my childhood, and with your cooperation, much can now be done to treat and manage your asthma or COPD.
