Asthma
Asthma can cause symptoms which vary from a cough to wheezing or shortness of breath. Some patients will have tightness in the chest, and other patients have no symptoms at all. Asthma can also be induced by exercise, but is also very treatable. If you have exercise induced asthma, you are in good company. 16-21% of Olympian athletes also have exercise induced asthma!
Asthma occurs as a result of constriction of the airways in the lungs. Constriction typically occurs as a result of inflammation, and now the focus of treatment of asthma is to reduce the amount of inflammation in the lungs. This represents a dramatic change in the past several years – it used to be that we would just focus on trying to open the lungs, rather than treating the cause.
Inflammation can occur as a result of exposure to irritants such as tobacco smoke, pollution, ozone, infectious agents such as bacteria and viruses, and also allergens such as dogs, cats, horses, guinea pigs, feathers, wool, dust, pollens, cockroaches and foods. Sinusitis can also worsen asthma. Workplace exposures can also be a problem and so can the cold weather and cold water. Most people are surprised to learn that 60% or 70% of patients with asthma have what is called “extrinsic” asthma. In other words, it is typically made worse as a result of exposure to things they are allergic to. Some patients also have exercise induced asthma.
Treatment of asthma focuses on a multi-step approach. The initial step is to eliminate those items in the environment which cause problems such as allergens, tobacco smoke, etc.
The next step is to use an inhaler called a bronchodilator (Proventil, Ventolin, Maxair or Tornalate, et. al.) which immediately opens the lungs up, but should not be used more than twice a week without other asthma medications. If it is necessary to use the inhaler more than twice a week, treatment should proceed to the next step which may involve increasing the bronchodilator dose and also adding a drug which reduces inflammation.
These drugs are inhaled cortisone preparations (Vanceril, Beclovent, Aerobid, Azmacort, Flovent, Asmanex or Pulmicort). Some are now available in a dry powder formulation which are preferable for some patients if they cannot tolerate the propellant. These include Pulmicort and Flovent. They also have a built in counter so you can tell how many puffs are left. There is also a formulation called QVAR which contains the same drug as Vanceril and Beclovent in a metered dose inhaler, but does not contain any chlorofluorocarbons (CFC’s)(see below). In the near future all metered dose inhalers will not contain CFC’s. Pulmicort is also available as a liquid preparation which can be used in a nebulizer, which is useful for childen as well as situations when patients may have a hard time taking in a deep breath. Pulmicort has also been used as drops in the nose for patients with sinusitis.
The following article was published by a Pharmacy Without Prescription.
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