Asthma; Treatment

Asthma; Treatment

Asthma requires continuous medical care, according to the American Academy of Allergy, Asthma, and Immunology (AAAAI). Asthma treatment today is focused on opening airways by reducing inflammation and swelling of the bronchial tubes-the lung structures affected by asthma. Once inflammation and swelling are reduced, the lungs may become less sensitive to environmental triggers. Many medications are now available to treat symptoms and prevent attacks from re-occurring. Non-medical management strategies also are recommended: asthma sufferers are encouraged to identify triggers in their environment and avoid them, when possible, or at least be prepared for them by having and using medication.

Two groups of asthma medications are available: bronchodilators and anti-inflammatory medication. They are available under many brand names and in a variety of forms: sprays, pills, powder, liquids and shots. Some are short acting and are administered directly to the lining of the lungs to immediately relieve symptoms; other medications are meant to have longer-term effects-preventing attacks from occurring, for example; these are known as “controller medications.” The longer-acting medications take awhile to help symptoms subside. Some asthma medications are meant to be taken daily, while others are intended only for symptom relief, as symptoms develop.

Bronchodilators are typically designed to be short-acting-they act quickly to stop an asthma attack once it has started by relaxing and opening-“dilating”-the bronchial tubes so more air is available. For this reason, they are sometimes called “rescue medications”, according to AAAAI. Coughing, wheezing and breathing difficulties are quickly relieved. Bronchodilators include beta-agonists, theophylline and anticholinergics. Beta agonists inhaled from a pressurized canister are the preferred products.

Salmeterol is a bronchodilator that is designed to be long acting. When used with an anti-inflammatory medication, it is used for controlling symptoms. Theophylline, another type of slow-acting bronchodilator, is prepared in a slow-release form taken by mouth. It is sometimes used for persistent asthma symptoms, particularly nighttime asthma. Side effects of bronchodilators can include nervousness, dizziness and insomnia. Because of these side effects, theophylline is used relatively infrequently today.

If you are using bronchodilators more than three times a day, you should consider notifying your health care professional because your asthma may not be under adequate control or could be getting worse. However, you may not be using your inhaler correctly for optimum relief. Although as many as 80 percent of all asthma patients use some type of inhaler, health care professionals insist as many as 30 to 40 percent of people who use them aren’t using the device correctly.

In August 2003 the FDA announced the addition of new safety information and warnings to the labeling for drug products that contain salmeterol. The new labeling includes a boxed warning about a small, but significant, increased risk of life-threatening asthma episodes or asthma-related deaths observed in patients taking salmeterol in a recently completed large U.S. safety study. This warning is particularly important for African-Americans, who seem be most affected. If Salmeterol is combined with an inhaled steroid, however, the risk is reduced.

Anti-inflammatory medications act to reduce inflammation and keep the airways open all of the time, thereby preventing an asthma attack from occurring. Cromolyn sodium, nedocromil sodium and corticosteroids are examples of anti-inflammatory medications currently available to treat asthma.

Once used only to manage acute symptoms, corticosteroid inhalants are now the preferred first-line therapy for children as well as adults with persistent asthma, according to updated guidelines issued in June 2002 by the National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung, and Blood Institute. The update stresses that inhaled corticosteroids are preferred for controlling and preventing asthma symptoms, and for improving lung function and quality of life. In addition, the update reflects new data that provide reassuring evidence on the safety of inhaled steroid use at appropriate doses in children. The report states that large clinical trials have shown the potential risk of delay in growth linked to inhaled corticosteroids is temporary and possibly reversible.

Corticosteroids are not the same type of steroids used by some athletes. These performance-enhancing drugs are called anabolic steroids. In inhaled form, there are few side effects from corticosteriods used to treat asthma, though the risk of side effects may increase if you take this medication orally (in liquid or pill form) over a long period of time. Side effects of inhalants may include hoarseness and thrush, a surface (throat) fungal infection, though rinsing the throat with mouthwash after inhaling reduces this risk.

Prednisone is one of the most commonly prescribed oral steroid drugs; it is available as a liquid or a pill for short-term use. Side effects include weight gain, menstrual irregularities, increased appetite and loss of energy, among others. Long-term effects of the drug include osteoporosis, cataracts and an increased risk for diabetes, as well as many other potential problems.

Cromolyn sodium and nedocromil sodium are non-steroidal treatments that may also be inhaled and used as “controller” medication rather than for treating symptoms once they’ve developed.

Anti-leukotriene medications are a new form of anti-inflammatory medication now used to treat chronic asthma and may also be used as an alternative therapy for treating mild-to-moderate persistent asthma or as combination therapy in moderate asthma, according to updated guidelines issued in June 2002 by NAEE. Leukotrienes are chemicals produced by the cells in the lung lining and are part of the chain reaction that causes inflammation and constriction of the airways. Anti-leukotriene medications fight this allergic response by blocking the lung’s response to leukotrienes and thereby decreasing inflammation. These medications are taken orally in pill form, rather than inhaled. Montelukast and zafirlukast are two examples of anti-leukotriene medications.

Findings published in the May 23, 2001 issue of the Journal of the American Medical Association may help further effective treatment of mild-to-moderate persistent asthma. The study addressed an ongoing controversy about whether long-acting beta-agonists (LABA) should replace or supplement inhaled corticosteroids (ICS). The research found that using LABAs alone is not as effective as using ICS alone in treating adults with mild-to-moderate persistent asthma. However, the study reported, when LABA are used regularly to supplement treatment with ICS, they can improve asthma control and substantially reduce steroid doses.

Immunotherapy is another treatment option for individuals who cannot easily avoid asthma triggers, nor find available asthma medications effective or usable for some reason. Immunotherapy, also called allergy desensitization shots, involves injecting small amounts of the allergen to which you are allergic into your body. Gradually, the amount injected is increased, allowing your body to build up an immunity to the allergen. Following treatment, when you are exposed to the allergen, you will have only minor symptoms, if any. According to AAAAI, immunotherapy works best for allergies to pollen, mold, cat dander, insect stings and dust mites. This is the only therapy that can induce permanent remission-when symptoms disappear and don’t ever return.

Antihistamines and decongestants are medications available both by prescription and over-the counter to treat allergy symptoms that could trigger an asthma attack. Antihistamines work against histamine, chemicals produced by the body in response to an allergen. Antihistamines relieve symptoms such as watery and itchy eyes, sneezing and other allergy symptoms. Side effects include drowsiness and dehydration, among others. These medications are available in pill, liquid and injection forms.

Decongestants relieve nasal congestion and sinus pain by helping to shrink blood vessels in the nasal passageways and decreasing inflammation. Decongestants may be pills, sprays or drops. Medications combining pain relievers and decongestants also are available. Side effects of decongestants include sleeplessness and elevated blood pressure. Always check the labels on these and other medications for additional potential side effects.

Neither antihistamines nor decongestants are specifically indicated for use in asthma.

Alternative medications. Asthma and allergy sufferers should be cautious about herbal treatments for their conditions because of the potential for allergic responses. Any type of treatment should be discussed with a health care professional before trying it.

A novel, recently approved medication, omalizumab (Xolair), is showing promise in treating both children and adults with moderate to severe asthma symptoms, triggered by allergies. Clinical trials have shown that the drug decreased the risk of serious asthma exacerbations, allowed asthma patients to reduce their reliance on steroid medication and improved allergy symptoms in those who were unresponsive to other treatments. The new treatment targets an antibody called IgE that causes allergic reactions. The treatment binds to IgE and neutralizes it. The drug was approved for use in those 12 and older with moderate to severe asthma in May 2003.

Coping With Asthma While Pregnant

You can have a safe and normal pregnancy, as long as asthma symptoms are kept under control. Uncontrolled asthma in the mother can, however, cause oxygen levels to decrease in the blood and can impact how much oxygen the baby receives.

It’s possible that the severity of your asthma may change during pregnancy. For about one-third of pregnant women, asthma symptoms generally seem to worsen, while one-third may be lucky and see an improvement. Another third seem to have no change in the severity of their asthma.

Most medications prescribed to control asthma are safe for pregnant women to take. Medications administered with inhalers generally are considered better for pregnant women than oral medications because inhaled medications go straight to the lungs and are less likely to get passed along to the baby. In more serious cases, oral medications may be necessary to control symptoms of asthma. Asthmatic mothers who receive treatment for their symptoms are more likely to have healthier babies, according to AAAAI. Ask your health care professional treating your asthma to consult with your obstetrician before developing a treatment plan for you.

References

“Executive Summary of the NAEEP Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma – Update on Selected Topics 2002.” National Asthma Education Program, National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov. Accessed June 2002.

“Asthma.” American Academy of Allergy, Asthma, and Immunology. http://www.aaaai.org. Accessed May 2001.

“Your Asthma Can Be Controlled: Expect Nothing Less” (Patient Education Pamphlet) National Heart, Lung and Blood Institute. http://www.nhlbi.nih.gov. Accessed May 2001.

Lemanske, Robert F. Jr, MD; et al. “Long Acting Beta-Agonist Monotherapy vs. Continued Therapy with Inhaled Corticosteroids in Patients with Persistent Asthma,” and “Inhaled Corticosteroid Reduction and Elimination in Patients with Persistent Asthma Receiving Salmeterol.” Journal of the American Medical Association 285:2594-2603, May 23/30 2001.

“What is Asthma?” Asthma and Allergy Foundation of America. Copyright 20002-2003. http://www.aafa.org. Accessed Nov. 2003.

“Asthma.” American Lung Association. http://www.lungusa.org. Accessed May 2001.

“Anti-IgE Antibody Gets High Marks From Patients and Physicians.” Respiratory Reviews.com. Volume 6, No. 2, February 2001.http://www.respiratoryreviews.com

U.S. Food and Drug Administration New and Generic Drug Approvals: 1998 – 2003. http://www.fda.gov. Accessed Nov. 2003.

Major Recommendations From the Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. National Heart, Lung, and Blood Institute.http://www.asthmainamerica.com. Accessed Nov. 2003

MedWatch: The FDA Safety Information and Adverse Event Reporting Program. Revised Nov. 2003. http://www.fda.gov. Accessed Nov. 2003.

“Asthma Prevalence, Health Care Use, and Mortality, 2000-2001,” National Center for Health Statistics, Centers for Disease Control and Prevention. Reviewed Jan. 2003. http://www.cdc.gov. Accessed Nov. 2003.

“Morbidity & Mortality: 2002 Chart Book on Cardiovascular, Lung, and Blood Diseases,” National Heart, Lung, and Blood Institute, National Institutes of Health, May 2002. http://www.nhlbi.nih.gov. Accessed Nov. 2003.

Keywords: asthma, asthma symptoms, triggers, bronchodilators, anti-inflammatory medication, asthma medications, asthma attack, inhaler, inhaled corticosteroids, corticosteroids, children, immunotherapy, antihistamines, pregnant women

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