As Olympic gold-medalist Florence Griffith-Joyner sprints to another victory, it’s difficult to imagine that she suffers from asthma. But she does, as do millions of other people, from high-powered athletes to school children. They don’t let it stop them from enjoying life or pursuing everyday activities. Nor should you.
Asthma remains one of the most common health problems seen by doctors today. Although scientists have made considerable advances in knowledge about the causes and development of asthma, the prevalence of the disease and the number of deaths due to asthma are on the increase. Fortunately, most people with asthma have mild symptoms that mostly can be prevented with a combination of education and medical treatment.
History and Examination
The treatment of asthma begins with a careful history and thorough physical examination to identify what triggers your attacks. All treatment programs must be individualized based upon your specific needs and problems. For example, your doctor may discover that your asthma is worse with colds, or when you’re around tobacco smoke, animal fur, or house dust. Prevention of asthma symptoms is always easier than treatment. Your doctor also might ask you to measure your lung function with a peak flow meter. Use a diary to record twice-a-day measurements of your breathing fluctuations.
Medications are part of an asthma treatment program. Several different classes of drugs are appropriate, including beta agonists, inhaled or oral steroids, cromolyn salts, and theophyllines.
Beta agonists are the first class of drugs to be used in the management of most asthma cases. For mild and periodic symptoms, the use of over-the-counter beta agonists, such as Primatene Mist, can be very successful. On the other hand, for daily symptoms and anyone with moderate problems, prescription beta agonists, such as Proventil, are recommended.
There are three widely used methods of taking beta-agonists: by inhaling, orally, or by nebulization.
The first and most effective method is to use a hand-held aerosol canister that delivers a predetermined (metered) dose with each spray. Activating the canister as you inhale causes a puff of medication to go directly into your lungs, thus quickly relaxing airway muscle spasms. Beta agonist metered-dose inhaler (MDI) canisters are conveniently carried in your pocket or purse.
Effectiveness depends upon your ability to use the inhaler correctly and upon how long each dose will last. Some of the newer beta agonist sprays (e.g., Serevent) last longer than the older medications and are used only twice a day. Serevent has become extremely popular and is most effective when used in a regular preventive program. It is not recommended for acute asthma attacks.
Be aware that any medication can cause side effects. Beta agonists can cause irregular or rapid heart beat, nervousness, muscle tremors, nausea, vomiting, dizziness, weakness, sweating or chest pain. If any of these symptoms appear, you should discontinue the drug and call your doctor or, if necessary, go immediately to an emergency room.
Using a MDI isn’t difficult or complicated. Even very young children can be taught to use them by having parents carefully press on the canister of the inhaler while the child takes a breath. Whether administered by children or adults, correct aim and breath coordination are important. If the MDI is aimed incorrectly, the medicine is likely to land uselessly on the roof of the mouth. If activation is not coordinated with inhalation, the medicine will fail to reach the lungs. Spacing devices are a great help in improving the delivery of the medication to the airways (see Using an Inhaler: Do’s and Don’ts). Some inhalers (e.g., Maxair) have a self-actuating device that facilitates proper coordination between the release of medication and inhalation. While some people like this automatic device, many do not like the self-actuator.
Other Delivery Systems
Another method of delivery is the self-activated inhalation of a powdered form of medication. The most common kind is the Rotahaler. Despite its effectiveness, the Rotahaler is not popular because people find it difficult or inconvenient to use.
Certain cautions accompany the use of spray canisters. For example, if the cap of an inhaler is left on by accident, it can be propelled into the mouth or even the airways, causing choking. Newer aerosols have hinged tops to prevent this. In addition, the mouthpiece of any inhaler can become contaminated with foreign objects, especially dirt, that could be inhaled into the lungs. Careful attention prior to each use is mandatory.
Other medications (e.g., Proventil) are available in solution for nebulization via a Pulmo-Aide. Nebulization means the liquid is dissolved into a spray. This is by far the most effective way of delivering beta agonists. For people with moderate to severe asthma or for very young children, the use of the Pulmo-Aide is strongly recommended.
Steroids, drugs in the cortisone family, used to be reserved only for individuals with very severe asthma because they can cause toxic complications. Side effects include weight gain, water retention, hypertension, easy bruising, carbohydrate intolerance, osteoporosis and cataracts. One way to administer steroids without these side effects is to use inhaled preparations (e.g., Beclovent or Vanceril, AeroBid and Azmacort). Inhaled steroids are not absorbed into the body in significant amounts and are extremely effective in preventing asthma. Recent studies suggest that inhaled steroids are an important early and, perhaps, first-choice treatment of asthma. Oral doses of cortisone are absorbed into the body and therefore are prescribed carefully and only when absolutely necessary.
Theophyllines are drugs that are chemically similar to caffeine. Although once drugs of first choice, their unfortunate side-effect profile includes nausea, vomiting, and central nervous system stimulation. Some deaths have been reported in children who used theophylline. Nonetheless, it remains an important drug in the management of asthma. It is prescribed only if beta agonists and inhaled steroids are ineffective. Taking the correct dose of theophylline is crucial; other drugs (e.g., erythromycin) can interact with theophylline and increase toxicity. Always tell your doctor about all drugs you may be taking.
Cromolyn sodium, a synthetic chemical originally isolated from an Egyptian weed, is also used to control or ward off symptoms in chronic asthmatics with moderate to severe symptoms. It is entirely a preventive measure and needs to be taken for several weeks before it begins to work.
A new asthma medication, Tilade is extremely effective for asthmatic cough, helping hyperactive airways become less twitchy. Tilade can also be useful in preventing asthma symptoms from exposure to cold air and air pollutants. Like cromolyn sodium Tilade is preventive and does not relieve an asthma attack once it has started. Unlike other asthma medications, it carries few and minor undesirable side effects and does not interact with other drugs. A significant number of people can control their asthma with Tilade and cromolyn drugs. For most people, however, Tilade and cromolyn remain an important but ancillary treatment.
Another drug, namely Atrovent, should be mentioned. Atrovent is a drug that blocks certain nerve pathways in the airways, thus reducing the tendency for them to spasm. It comes packaged as a metered-dose inhaler and is especially effective for relieving coughing due to chronic bronchitis and emphysema. It is not indicated for use in the primary management of patients with asthma; however, many physicians have found that administration of Atrovent together with a beta agonist produces an additive and beneficial effect on the airways.
Asthma is a life-long problem. Unfortunately, children do not outgrow their asthma. Irritable airways that constrict and cause symptoms will never go away. Educate yourself, see your doctor, and take the appropriate medications for prevention. Taking personal charge of the problem will allow you to live your life with confidence.