Misunderstanding between controller and reliever medications in asthma

Asthma is one of the most common chronic respiratory diseases. It affects as high as 334 million people in the world according to the most recent data from the Global Burden of Disease study undertaken in 2008-2010. In our country, the data from the National Nutrition and Health Survey showed an overall prevalence rate of 8.7 percent for adult asthma.

Although asthma is multifactorial in origin, airway inflammation is believed to be a cornerstone of the disease and this inflammation is associated with airway hyperresponsiveness to various stimuli. During asthma attacks, the airways undergo changes which include airway narrowing due to the swelling of the airway muscles and mucus plugs. These changes in the lungs cause the characteristic asthma symptoms of wheeze, shortness of breath, chest tightness and cough that varies over time.

The goal of asthma treatment is to achieve good control of symptoms while maintaining normal daily activity. Inhaled preparations are preferred more than the oral formulations because their effects are targeted to the lungs and cause less side effects. Asthma medications can be grouped into two main categories: 1) Controller medication is used as regular maintenance therapy. Because airways can be inflamed even in between flare-ups, long-term control medicines might be needed to prevent unexpected asthma flare-ups. These medicines are slow-acting and can take days to weeks to start working. They act by reducing inflammation, controlling asthma symptoms and decreasing frequency of asthma flare-ups, eventually causing improvement in lung function and decreasing asthma-related deaths.

2) Reliever medications are drugs which provide immediate, short-term relief of symptoms (20-30 minutes), but don’t control symptoms or prevent asthma attacks. Reducing and eventually eliminating the need for these rescue medications is a measure of success in asthma treatment.

Low adherence to controller therapies is an important factor for poor asthma control. This problem may be due to lack of understanding of their condition and benefits of each asthma medications. Studies have shown that controller therapies is associated with improvement in the quality of life and 30-percent reduction of asthma attacks. Educating patients on their disease condition and indications of their medications helps greatly in improving adherence to these medications, thus improving asthma control.

Finally in asthma treatment, we have two categories of medications working hand in hand to achieve control: controllers (preventer) and relievers.

Dr. Maria Janeth Tangcuangco Samson chairs the Council on Diagnostics and Therapeutics, Philippine College of Chest Physicians. The A to Z of Health Information Advocacy is a joint initiative of a group of medical specialists and supported by AstraZeneca Philippines aimed at raising public awareness on various diseases and providing health information and updates to the healthcare community.