FACT: You may be surprised to know that the blue inhaler may be causing more harm than good if used too frequently. Using the blue inhaler alone (ie. without preventors) is no longer recommended for patients above the age of 12, even for those with mild asthma. 

“The preventor is like a fire extinguisher that puts out the airway inflammation. The blue inhaler is only blowing cool air so you might feel less heat temporarily. Worse, if you continue to just take the blue inhaler alone, the fire gets bigger and that is when you get a severe asthma attack,” says Dr Lim. 

When used without preventor therapy, the blue inhaler can actually worsen airway inflammation and excessive use can lead to severe asthma attacks. Don’t forget that the orange/red/purple inhalers (or “preventors”) are just as important in your treatment. They help in reducing and preventing inflammation over a longer period of time. Using them regularly over the course of a few weeks will help control your symptoms.

What is the recommended treatment for asthmatic children below 12 years old?

A preventor to be used as needed and the blue inhaler as intermittent use. For children with mild and very low risk asthma, they might be prescribed a blue inhaler as needed or with a preventor. This is because the diagnosis of asthma in very young children can be difficult to ascertain, especially when they are infrequent.

FACT: You cannot get addicted to steroids because it is naturally produced by the body. In fact, Dr Chiang says that patients with asthma need more steroids to control the increased airway inflammation.

Though some steroids can be absorbed into the bloodstream via inhalation, side effects are minimal in most patients. In fact, the dose of steroids in preventor inhalers are much safer and lower compared to the large doses given via oral or injection. In order to reduce risks and the long term side effects from oral steroids, it is important for asthmatics to take their preventor inhalers.

(Note: This section has been edited for clarity on May 18, 2020.)

FACT: It is only natural to be worried about the effects of steroids on young children, especially when they are in their growing years. Oral steroids used during attacks can affect a child’s physical growth but only very slightly, limited to only about a two-cm difference of the child’s eventual adult height. 

The best way to help your child is to help them control their asthma with the appropriate use of inhaled steroids so they can continue to grow normally, perform better in school activities and take less MCs. Continue working with your child to control it well and their asthma might not develop persistence to adulthood.  

FACT: Asthma attacks are not the same as having a normal cold. Instead, think of them more as “lung attacks”. Attacks are considered severe when they require emergency treatment like nebulization and high doses of systemic steroids. Recurrent systematic steroid courses could lead to side effects like weight gain, muscular wasting, lowered immunity, osteoporosis and diabetes. 

It’s best to work with your doctor to reduce to the lowest inhaled steroid dose and develop an action plan to prevent attacks.

FACT: If you have asthma, chances are you are on maintenance inhalers which need to be taken daily, even if you feel well. This helps to prevent future flare ups. These inhalers are not the same as rescue inhalers like the blue Salbutamol inhalers that are used when feeling breathless. Because of this, many patients continue to rely on the blue inhaler because the rapid relief it provides is mistaken as adequate control.

But for you to properly control asthma, preventors are still needed. If you are unsure of what treatments you should be using, it is always best to consult with your doctor.

FACT: Even if you are diagnosed with mild asthma, there is still a chance of a severe attack occurring. A local study found that 46.5 per cent of patients who had life-threatening asthma attacks fell under the mild asthma category, with 30 per cent of these patients relying solely on their blue inhalers.

Relying on the blue inhaler only when your symptoms flare up can actually cause you to become “tolerant” to the Salbutamol. At this stage, emergency treatment fails to work and the attack could become life-threatening, even fatal. Prevention is always better than cure, so if you can control your asthma from an early stage, even if it is severe, the risk of attack would be reduced.

FACT: When pregnant, hormonal changes lead to 30 percent of women with asthma experiencing worsening symptoms. If you decide to stop asthma treatment at this juncture, you could put yourself at a higher risk of suffering from an asthma attack.

It also puts your foetus at a higher risk of miscarriage, oxygen deprivation and steroid exposure due to emergency treatment. So it is still best to continue with asthma treatments as prescribed. For a better peace of mind, consult your doctor on treatment measures and care.

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FACT: People with asthma can exercise and lead a normal life. Being active is not only good for you or your child’s overall health, it helps you breathe better and keeps your weight down.

If you are asthmatic, speak with your doctor before starting any exercise programme. There are many professional athletes like swimmers who have asthma which is under control.

FACT: Asthma can affect people of all ages. Some children (about 10 to 30 per cent) do outgrow their asthma over time and they may need a period of step up care with the preventers during periods when their lungs are responding too dramatically to the inciting infections, allergens etc.

The preventers will hopefully calm down this inflammation and reduce the frequency and severity of the asthma attacks. The symptoms of asthma might disappear in adolescence and young adulthood but recur during life changes such as national service, pregnancy, weight gain, smoking or aggravated by new medications given for middle-age disease (like hypertension, heart disease and gout).

Even in these tough times, continue to maintain asthma treatments so that you can stay healthy and quickly adjust to your usual pace of life when the pandemic is over. Access to medicine and effective control of asthma might be limited by the pandemic, so here are some simple tips from Dr Lim for asthmatics to follow:

1. Continue using your preventor (ICS) inhaler to keep asthma under control. Many specialist outpatient clinics and polyclinics have allowed tele-consults, easy self-collection or home delivery of medicine. You can conveniently get your maintenance treatment refilled from the comfort and safety of home.
2. Be aware of signs pointing to poor asthma control. These include intermittent coughing, chest tightness, shortness of breath, wheezing or using your blue inhaler more than twice a week, especially at night. Any of these are signs that you are at risk of an attack. 
3. Use your Asthma Action Plan promptly during an asthma attack to prevent severe consequences. You can first increase their preventor therapy along with the blue inhalers. If there is still no improvement, the second step is to take your standby oral prednisolone for a severe attack. Should you develop worsening symptoms despite these measures, immediately see a doctor for emergency treatment.

By Tan Gin Yee and Elizabeth Liew

This post was first published on October 31, 2016, and updated on May 14, 2020.