Definitions & Treatment

Definition of Asthma | Exercise-Induced Asthma | Diagnosing Children | Pulmonary Function Tests | Allergy Testing | Treating Allergies & Asthma | Environmental Controls | Asthma Injections | Medications Conclusions


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Office: 440-333-2003

Answering machine:
440-356-7806

20455 Lorain Road, Suite T3
Fairview Park, Ohio 44126

Treating Asthma

The three basic ways of treating allergies and asthma are (1) Environmental Controls; (2) Allergy Injections; and (3) Medication.


Medications

There is a wide variety of medications that can be individually tailored to take care of a patient's asthma. It has become quite clear that pharmacologic management — that is, the use of drugs — is the most important modality of treatment in managing the patient with asthma.

Steroids

Inhaled steroids such as Azmacort, Vanceril, Beclovent, Aerobid, and Flovent, are frequently used to control asthma even in milder asthmatics. The current thinking is that inflammation in the bronchial tubes plays a significant role in causing symptoms. The beauty of these drugs is that they are inhaled into the lung and work there with very little absorbed; thus it is a form of a steroid that can be used daily without the side effects of long-term daily oral steroids.

Rarely in medicine has a medication been abused and also misunderstood. Steroids such as Prednisone and Medrol frequently work very well in a variety of illnesses. They also work quite well in asthma. The problem with steroids is that unfortunately, they have been abused by physicians as well as patients. Since the medications work so well, they would frequently be used for months or even years. If steroids are used daily in this way, many of the nasty side effects you have heard about can occur: This varies from weight gain to stunting of the growth, weakening of the bones, skin rashes, diabetes, cataracts, etc. Because of the way steroids have been abused, patients as well as physicians have gone to the other extreme and have frequently withheld this potentially life-saving and very valuable medication (steroid phobia). The facts are that if used appropriately, steroids will rarely cause permanent side effects. If any side effects do occur, they are usually quite transient, that is, they go away. For example, with the onset of a severe attack where all the previous medications have not worked, a burst of Prednisone, that is, three, four, or five tablets for four or five days may prevent the attack from getting owrse and keep the patient out of the hospital. After a short burst of Prednisone, it can either be stopped abruptly or tapered over several days. A recent breakthrough several years ago has shown the use of steroids in an every-other-day regimen works almost as well as daily steroids and was almost completely without the side effects of the daily steroids. Some patients, in fact, in spite of all other medications, do require every-other-day steroids to achieve a certain quality of life where they can participate in sports, keep out of the hospital most of the time, and stay in school or work regularly. On every-other-day steroids, there would be very little weight gain, children would grow normally and there was really no great concern for any serious side effects. The most common side effect from four to five days of Prednisone in children is the cheeks may look a little red and the appetite might increase a little. Both of these side effects are in general welcome by most parents.

Sympathomimetic Bronchodilators

These medications include another group of bronchodilators which attempt to keep the bronchial tubes open and dry up the secretions. There are two forms — inhaled medications and pills. The inhalers include Ventolin, Proventil, Alupent, Brethaire, Bronkometer, Tornalate and Maxair. A new long-acting inhaler is Serevent. This is used twice a day to prevent attacks. The pills include Alupent, terbutaline, Ventolin, Proventil, Proventil Repetabs, and Volmax. The inhalers must never be used more than five times in a 24 hour period without notifying his physician. If the patient is still having problems, we may have him obtain an aerosol machine at home. This is a machine that can blow medication directly into the lungs to keep the bronchial tubes open.

Intal and Tilade

These are inhaled medications which can be used regularly to prevent asthma attacks. They are not useful if one is already coughing and wheezing. These medications are particularly useful for exercise-induced and allergy-induced asthma.

Theophylline

This is another type of bronchodilator that comes under a variety of names such as Theo-Dur, Slobid, Slo-Phyllin, Choledyl, and Theolair. Generally, we try to avoid the use of generic Theophylline preparations. Everyone metabolizes, that is, breaks down Theophylline at different rates. Theophylline levels, that is, the amount of Theophylline in the blood, can be measured several hours after the medication is taken to determine how much is actually in the blood and if the level is low and the patient is not doing well, then we can safely increase it.

Antihistamines

Patients with asthma frequently have hayfever and other nasal problems. Antihistamines are quite effective for nasal symptoms. It was formerly believed that because of the drying effects of antihistamines, they were not to be used in asthma; however, recent studies have shown that if there is a significant nasal problem, antihistamines will rarely worsen the asthmatic symptoms.

Antibiotics

Asthma symptoms frequently present as an infection or what seems to be an infection. In fact, an upper respiratory infection which is usually triggered by a virus can set off an asthma attack. When one listens to the chest, it is at times difficult to tell whether pneumonia is present. We see many patients who have repeated episodes of what sounds like pneumonia but in fact, are having episodes of asthma so that in general, we do not use antibiotics for the average asthma attack unless there is a strep throat, ear infection, or x-ray-documented pneumonia or sinus infection.