Five general classes of medications are used to treat asthma today: beta agonists, topical steroids, theophylline, cromolyn and nedocromil, and oral steroids. Properly taken, these drugs can be enormously helpful in controlling the wheezing, coughing and other symptoms of asthma.
Beta-agonists, such as Proventil, that relax the muscles of the bronchial passages, remain the mainstay of asthma treatment, particularly for those with mild, episodic asthma that doesn’t require continuous treatment. They are usually administered via a hand-held aerosol canister known as a metered-dose inhaler. (If one of these devices has been prescribed to you, be sure you know how to use it properly. If your physician didn’t demonstrate its use, ask your pharmacist to show you the right way to use it.) Hollow cylinders, called „spacer” devices, improve the delivery of metered-dose inhalers. You put the end of the inhaler inside one end of the spacer and put your mouth around the other end of the spacer, so that the spacer forms a tunnel between the inhaler and your mouth. Then you activate the inhaler to release the drug, and slowly inhale it through the spacer. A paper cup with the bottom cut out makes an effective, inexpensive spacer. The cardboard cylinder from the inside of a toilet paper roll also works well. More professional-and costly-spacing devices are also available, among them the Inspir-ease. Always take the cap off your metered-dose inhaler before using it to avoid propelling it into your mouth or airway. This occasionally does happened, with tragic results.
The most popular beta-agonists currently used in the United States are Proventil and Ventolin (both albuterol), Alupent (metaproterenol) and Maxair (pirbuterol).
Metered-dose inhalation is more effective and specific, but for people with moderate to severe asthma, as well as for young children who are unable to use inhalers, beta-agonists are available in a solution that is given by nebulization via a home air compressor such as the Pulmo-aide. These devices can be hooked up to a battery or plugged into a wall outlet or car cigarette lighter.
Topical steroids also can be administered via metered-dose inhalers. The most popular brands used are Vanceril and Beclovent (beclomethasone) and Azmacort (triamcinolone). Azmacort has the advantage of having its own built-in spacing device. Topical steroids can produce a significant cough, however, and should not be used as initial treatment during acute episodes of asthma. Topical steroids can and should be used as the primary treatment of asthma, especially when daily asthma medication is required.
The third class of drugs used to treat asthma are the theophylline salts. Theophylline (e.g., Theo-Dur) is widely used and is an important medication in the prevention and treatment of asthma. The disadvantage of theophylline is its narrow therapeutic index.
A fourth class of drugs are the chromone salts. Cromolyn sodium has been available in the U.S. for more than 20 years. It is particularly useful in individuals with allergies and in young children. A newer chromone, Tilade (nedocromil sodium), is now available in the U.S. as well.
Oral steroids are the final class of asthma medication. These potent antiinflammatory drugs are extremely useful for people with chronic asthma or acute, episodic asthma. In the past, steroids were reserved only for individuals with severe asthma. However, early use of oral steroids is now recognized as an effective way to prevent asthma symptoms from becoming severe. Ironically, despite all our advances in medical care, both the incidence and death rate of asthma have increased in nearly every Western nation over recent years. Early use of oral steroids can help prevent hospitalization and complications from asthma. Although oral steroids do carry significant and unpleasant side effects, they serve an important role in reducing asthma mortality. For people with serious, chronic asthma, a home air compressor is a good way to administer beta-agonists or cromolyn. Delivery is extremely effective-much more so than by metered aerosols. The method works particularly well for small children, the elderly and people with severe asthma. To use these durable and dependable devices, a solution of the medication is placed in a small cup attached to a face mask or a mouthpiece. When the machine is turned on, the solution is nebulized, or made into a fine mist, which is easily inhaled. Most units are about the size of a shoe box or smaller. Dura Pharmaceuticals sells three portable units. One, the Tote A Neb 1500, has a rechargeable battery and can be used almost everywhere. The best buy, however, is the Pulmo-Travel Mate by DeVilbiss.
Deaths do result from asthma, but many of the risks associated with this mortality can be avoided. For example, sedative agents increase the risk of death from an asthma attack. People with asthma often feel panic when they experience shortness of breath and may take or be given tranquilizing agents that have been prescribed for other family members or, sometimes, incorrectly prescribed for themselves.
Over-medication, especially with beta-agonists or theophylline, can cause an asthmatic crisis. Often, a person in the throes of an asthma attack thinks that more medicine will control the symptoms. However, increasing the dose too much only increases toxicity. At the other extreme, under-medication may also increase the risk of death from asthma. It is important to know the proper doses of medication and take them faithfully. Some drugs, such as topical steroids and cromolyn, are effective only when taken regularly. Other asthma deaths occur because oral steroids either are not taken early enough or in an adequate dose to control their symptoms.
Another risk factor involves failure to reduce exposure to allergens, such as cat dander or household dust. When asthma is triggered by certain allergens the misery and need for medication often can be improved by eliminating or reducing those allergens at home, particularly in bedrooms.
With proper treatment and avoidance of unnecessary risk, people with asthma can manage their symptoms and minimize the possibility of serious problems. Medications and delivery devices on the market today offer more options and better control than ever before.