DRUG USED IN TREATMENT OF ASTHMA
Asthma is a disease that affects the breathing passages of the lungs (bronchioles). Asthma is caused by chronic (ongoing, long-term) inflammation of these passages. This makes the breathing passages, or airways, of the person with asthma highly sensitive to various "triggers."When the inflammation is "triggered" by any number of external and internal factors, the passages swell and fill with mucus. Muscles within the breathing passages contract (bronchospasm), causing even further narrowing of the airways. This narrowing makes it difficult for air to be breathed out (exhaled) from the lungs. This resistance to exhaling leads to the typical symptoms of an asthma attack.
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Because asthma causes resistance, or obstruction, to exhaled air, it is called an obstructive lung disease. The medical term for such lung conditions is chronic obstructive pulmonary disease or COPD. COPD is actually a group of diseases that includes not only asthma but also chronic bronchitis and emphysema.Like any other chronic disease, asthma is a condition you live with every day of your life. You can have an attack any time you are exposed to one of your triggers. Unlike other chronic obstructive lung diseases, asthma is reversible. Asthma cannot be cured, but it can be controlled. You have a better chance of controlling your asthma if it is diagnosed early and treatment is begun right away. With proper treatment, people with asthma can have fewer and less severe attacks. Without treatment, they will have more frequent and more severe asthma attacks and can even die.
Asthma is on the rise in the United States and other developed countries. We are not sure exactly why this is, but these factors may contribute. We grow up as children with less exposure to infection than did our ancestors, which has made our immune systems more sensitive. We spend more and more time indoors, where we are exposed to indoor allergens such as dust and mold. The air we breathe is more polluted than the air most of our ancestors breathed. Our lifestyle has led to our getting less exercise and an epidemic of obesity. There is some evidence to suggest an association between obesity and asthma.Asthma is a very common disease in the United States, where more than 17 million people are affected. A third of these are children. Asthma affects all races and is slightly more common in African Americans than in other races.Asthma affects all ages, although it is more common in younger people. The frequency and severity of asthma attacks tend to decrease as a person ages.Asthma is the most common chronic disease of childrenAsthma has many costs to society as well as to the individual affected.Many people are forced to make compromises in their lifestyle to accommodate their disease.
Asthma cannot be cured, but it can be controlled with proper asthma management. The first step in asthma management is environmental control. Asthmatics cannot escape the environment, but through some changes, they can control its impact on their health.
Listed below are some ways to change the environment in order to lessen the chance of an asthma attack:
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Clean the house at least once a week and wear a mask while doing it
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Avoid pets with fur or feathers
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Wash the bedding (sheets, pillow cases, mattress pads) weekly in hot water
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Encase the mattress, pillows and box springs in dust-proof covers
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Replace bedding made of down, kapok or foam rubber with synthetic materials
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Consider replacing upholstered furniture with leather or vinyl
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Consider replacing carpeting with hardwood floors or tile
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Use the air conditioner
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Keep the humidity in the house low
The second step is to monitor lung function. Asthmatics use a peak flow meter to gauge their lung function. Lung function decreases before symptoms of an asthma attack - usually about two to three days prior. If the meter indicates the peak flow is down by 20 percent or more from your usual best effort, an asthma attack is on its way. The third step in managing asthma involves the use of medications.
There are two major groups of medications used in controlling asthma - anti-inflammatories (corticosteroids) and bronchodilators. Anti-inflammatories reduce the number of inflammatory cells in the airways and prevent blood vessels from leaking fluid into the airway tissues. By reducing inflammation, they reduce the spontaneous spasm of the airway muscle. Anti-inflammatories are used as a preventive measure to lessen the risk of acute asthma attacks. The corticosteroids are given in two ways - inhaled via a metered dose inhaler (MDI) or orally via pill/tablet or liquid form. The inhaled corticosteroids are flunisolide (AeroBid), triamcinolone (Azmacort) and beclomethasone (Beclovent and Vaceril). The oral corticosteroids (pill/tablet form) are prednisone (Deltasone, Meticorten or Paracort), methylprednisolone (Medrol) and prednisolone (Delta Cortef and Sterane). The oral corticosteroids (liquid form) are Pedipred and Prelone. These liquid forms are used for asthmatic children. Three drugs, zafirlukast (Accolate), montelukast (Singulair) and zileuton (Zyflo), are part of a newer class of anti-inflammatories called leukotriene modifiers. Taken orally, these drugs work by inhibiting leukotrienes (fatty acids that mediate inflammation) from binding to smooth muscle cells lining the airways. They also reduce the recruitment of inflammatory cells to the airways. These drugs both prevent and reduce symptoms, and are intended for long-term use.
Other inhaled anti-inflammatory drugs include cromolyn sodium (Intal) and nedrocromil (Tilade). Bronchodilators work by increasing the diameter of the air passages and easing the flow of gases to and from the lungs. They come in two basic forms - short-acting and long-acting. The short-acting bronchodilators are metaproterenol (Alupent, Metaprel), ephedrine, terbutaline (Brethaire) and albuterol (Proventil, Ventolin). These drugs are inhaled and are used to relieve symptoms during acute asthma attacks. The long-acting bronchodilators are salmeterol (Serevent), metaproterenol (Alupent), and theophylline (Aerolate, Bronkodyl, Slo-phyllin, and Theo-Dur to name a few). Serevent and Alupent are inhaled and theophylline is taken orally. These drugs are sometimes used to control symptoms in special circumstances, such as during sleep or when intensive exposure to a particular irritant can be predicted (i.e. pollen season). Atrophine sulfate (Atrovent) is another highly effective bronchodilator. This drug opens the airways by blocking reflexes through nerves that control the bronchial muscles.
Some people cannot control the symptoms by avoiding the triggers or using medication. For these people, immunotherapy (allergy shots) may help. Immunotherapy involves the injection of allergen extracts to "desensitize" the person. The treatment begins with injections of a solution of allergen given one to five times a week, with the strength gradually increasing.
Asthma is a major cause of work and school absence and lost productivity. Asthma is one of the most common reasons for emergency department visits and hospitalization. Asthma is a long-term disease that can't be cured. The goal of asthma treatment is to control the disease. Good asthma control will:Prevent chronic and troublesome symptoms such as coughing and shortness of breath ,Reduce your need of quick-relief medicines ,Help you maintain good lung function ,Let you maintain your normal activity levels and sleep through the night ,Prevent asthma attacks that could result in your going to the emergency room or being admitted to the hospital for treatment To reach this goal, you should actively partner with your doctor to manage your asthma or your child's asthma. Children aged 10 or older-and younger children who are able-also should take an active role in their asthma care. Taking an active role to control your asthma involves working with your doctor and other clinicians on your health care team to create and follow an asthma action plan. It also means avoiding factors that can make your asthma flare up and treating other conditions that can interfere with asthma management.
An asthma action plan gives guidance on taking your medicines properly, avoiding factors that worsen you asthma, tracking your level of asthma control, responding to worsening asthma, and seeking emergency care when needed. Asthma is treated with two types of medicines: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or "rescue," medicines relieve asthma symptoms that may flare up.Your initial asthma treatment will depend on how severe your disease is. Followup asthma treatment will depend on how well your asthma action plan is working to control your symptoms and prevent you from having asthma attacks. Your level of asthma control can vary over time and with changes in your home, school, or work environments that alter how often you are exposed to the factors that can make your asthma worse. Your doctor may need to increase your medicine if your asthma doesn't stay under control. On the other hand, if your asthma is well controlled for several months, your doctor may be able to decrease your medicine. These adjustments either up or down to your medicine will help you maintain the best control possible with the least amount of medicine necessary. Asthma treatment for certain groups of people, such as children, pregnant women, or those for whom exercise brings on asthma symptoms, will need to be adjusted to meet their special needs.
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