Asthma

What is asthma?
Asthma is characterized by inflammation of the airways, which leads to narrowing, increased mucus production, swelling, and increased airway hyperreactivity (twitchiness). Symptoms of asthma include chronic cough, shortness of breath, wheezing and chest tightness.

What "triggers" asthma?
Asthma can be provoked by many different events; "triggers" of asthma include:

• Allergies
• Viral infections
• Exercise
• Emotions
• Cigarette Smoke
• Drugs
• Aspirin
• Sinusitis
• Weather changes

Which medications are used in asthma therapy?
Asthma medications are important in reversing asthma episodes and preventing recurrence of symptoms. The medications are divided into two groups: relievers and controllers.

Reliever medications include beta-adrenergic agents such as albuterol, Proventil®, Ventolin®, Maxair®, Alupent®, Atrovent®, etc. They work by opening the airway by relaxing the muscles around the airway. These medications should be used on an as needed basis. Using your reliever medication more than 2-3 times per week indicates poor control and a need to adjust your medications or add a controller. If you are using your reliever more than 4 times a day or refilling more than one canister per month, you need to consult your doctor in the next few days or less.

Oral corticosteroids (Prednisone, Medrol®) are usually reserved to treat asthma flare-ups. They are very effective in controlling asthma but are restricted in their use because of their high level of side effects.

Controller medications include the anti-inflammatory agents, which include inhaled corticosteroids and inhaled non-steroidal agents. The inhaled corticosteroids include Aerobid®, Azmacort®, Flovent®, Pulmicort®, and Vanceril/Beclovent®. These are very effective and can be used on a daily basis. They do not remain in the body for very long, so they have fewer side effects than oral steroids. Sometimes, inhaled corticosteroids may cause oral thrush, a yeast infection of the mouth and throat, that looks like a whitish film. Using a spacer device and swishing your mouth with water after their use will help prevent it.

The non-steroidal inhaled agents include Intal®, and Tilade®. These medications are very useful for patients with mild asthma symptoms. They have an excellent safety record with very few side effects.

Newer medications include the leukotriene modifiers that include Accolate®, Singulair®, and Zyflo®. These medications are oral pills that help control the inflammation of asthma.

What is the goal of therapy?
The goal is to control symptoms and allow the patient to lead a normal life without restriction. Educating patients and their families allows them to control the asthma instead of the asthma controlling them. Early warning signs that the asthma is worsening include and often warrant a phone call to the physician:

• Awakening at night with trouble breathing
• Drop in peak flows
• Increased breathing difficulty with exertion or exercise
• Increased use of asthma reliever medications
• Less relief from the use of asthma medications

The earlier an asthma flare-up is controlled the less medication needed and less risk of hospitalization.

Your allergist can provide you with more information about asthma.

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