Drugs for Asthma
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ASTHMA IS A CHRONIC LUNG disease that inflames and narrows the airways, causing recurring periods of wheezing, chest tightness,
shortness of breath and coughing. It affects people of all ages, but most often starts in childhood. In the United States,
about 20 million people have asthma. Nearly 6 million of them are children, and asthma is now the most common chronic condition
among children. In recent years, asthma has been a growing problem in the United States. Experts blame several factors, including pollution,
secondhand smoke and rising obesity. In 2007, direct and indirect costs of asthma to the U.S. economy were $19.7 billion,
according to the National Institute of Allergy and Infectious Diseases.
To decrease airway inflammation, asthma symptoms, and the risk of death, inhaled corticosteroids should be used daily over
an extended period of time. They include Pulmicort (budesonide), Aerobid (flunisolide), Flovent (fluticasone propionate),
Azmacort (triamcinolone acetonide), Qvar (beclomethasone diproprionate), Alvesco (ciclesonide) and Asmanex Twisthaler (mometasone
furoate).
"Inhaled corticosteroids are the most effective long-term treatment for control of symptoms for mild, moderate or severe persistent
asthma, in all age groups," says Mark Abramowicz, MD, editor-in-chief of The Medical Letter on Drugs and Therapeutics, a non-profit newsletter that critically appraises drugs. "In randomized, controlled trials, they have been significantly
more effective than other medications such as leukotriene modifiers, long-acting beta2-agonists (LABAs), cromolyn or theophylline.
They act to improve pulmonary function, prevent symptoms and reduce the need for emergency department treatment."
Inhaled short-acting selective beta2-agonists (SABAs) increase airflow within three to five minutes, and they are the medications
of first choice to treat acute wheezing, chest tightness, cough and shortness of breath. However, they are not recommended
for daily use, Dr. Abramowicz says.
"If the patient is using short-acting beta2-agonists for symptomatic relief on more than two days per week, that suggests
inadequate control, and the need for starting or possibly increasing the dose of an inhaled corticosteroid," he says.
For patients with persistent asthma that isn't sufficiently controlled with low-dose inhaled corticosteroids, a LABA combined
with an inhaled corticosteroid improves lung function, decreases symptoms, and reduces exacerbations of the disease. However,
long-acting beta2-agonists should not be used to relieve acute asthma symptoms and are not recommended for use as monotherapy
in the treatment of asthma, Dr. Abramowicz says.
ASTHMA EDUCATION
A recent study published in The Journal of Allergy and Clinical Immunology found that asthma patients who spend time with a healthcare professional developing a personalized self-management plan develop
improved adherence to medications and better disease control.
Lead researcher Susan L. Janson, DNSc, RN, NP, professor of nursing at the University of California, San Francisco, notes
that many patients do not use inhalers properly and therefore do not benefit from the medication. About a year ago, she opened
an asthma self-management clinic.
"The hallmark of treatment in lung disease is using inhaled medications, and yet they're not that easy to inhale," she tells
MHE. "It's not an intuitive thing that patients would easily know how to do; it's a skill that requires practice and reinforcement."
Janson and her team found that many people don't breathe in enough of the medication, so they encourage people to first blow
out all the air in their lungs, then put the inhaler in the mouth and inhale deeply.
