Doctors' Answers to "Frequently Asked Questions" - Asthma


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Asthma and allergy shots   [posted 1/4/99]
Question: I have severe chronic asthma and am curious to know of the dangers of allergy shots (if there are any). For years I have been told to begin them, but I am still quite hesitant.

Answer: Few dangers, although occasional patients will have severe reactions and rare deaths have been reported. Asthma usually doesn't respond very much to allergy shots. Seasonal allergies do and some asthmatics can, but most have little response. Deciding whether you would be the one is difficult. However, if you have severe asthma, which is not responding to treatment, it might be worth trying for a year or so.

Inhalers for Asthma   [posted 12/10/98]
Question: After exercise should I use the PROVENTIL which I try not to use often can I just take the INTAL inhaler and how often?

Answer: You can take Intal several times a day, but, it works before exercise, not afterwards. The Proventil will work at any time, Intal works better as a preventive.

Options for Asthma Sufferer [posted 12/02/98]
Question: I was diagnosed with Asthma in May of this year, and in the last two weeks, I have had VERY severe attacks. They decided to put me on Prednisone after I took 4 breathing treatments and my peak flow went up only 30 points and then it went right back down. Is there any other treatments that are effective, because I am not too crazy about taking a steriod? Could regular breathing treatments help, too?

Answer: Have you tried leukoktriene inhibitors? Are you using beta agonists?

Adult Onset Asthma [posted 12/02/98]
Question:  I have severe adult-onset asthma. Due to repeated high doses of steroids (prednisone &  solumedrol 250mg Q4) I have avascular necrosis of bilateral femoral heads and bilateral epicondyls. I have had a core decompression of the left knee two years ago which failed. Is joint replacement  my only recourse? If any of the joints collapse I know I will then have to replace it. There are periods of time when the joint pain is not too bad. Is that because I am stable right now? Will the   destruction continue to be progressive or are there periods of remission? I know steroids are a double edged sword. They mask the pain while creating destruction at the same time. However,when they are necessary because of the asthma, I must say there is temporary relief. Over the counter remedies do not work. If the bone collapses will the pain be severe, or a progressive in-  crease of pain. What is the criteria for joint replacement? I am a 48y old WF. I would like to delay this just as long as I can. I am a poor candidate for surgery due to the severity of my asthma. I am currently on theo-dur, singulair, calan, isodil, atrovent, intal, serevent, flovent 110,  ventolin prn, pepcid, and prednisone when needed. We try short bursts if we can get by with it. Thank you.

Answer: You should be on either Fosamax or Miacalcin for your steroid induced osteoporosis. This can occasionally head off further damage. Also, have your physician check your 25, Vitamin D levels to ensure you have enough Vitamin D available. This can be replaced by a drug called Rocalitrol and is also recommended in patients taking steroids.

Vitamin A & E Effects On Asthma [posted 10/28/98]
Question: Does Vitamin A & E assist in any way with keeping asthma under control. I have been taking up to 40,000 iu per day along Vitamin E and I feel it has helped. For many months I have also experienced pain in the back of my heel and sometimes it feels quite hot to touch. I was told that perhaps it is something called "bursitis" and that I should elevate my feel and apply cold packs. Is there anything else that I should do as I am going on a 5 week holdiay to the States and UK and am getting quite concerned whether I will cope with all the walking. Would appreciate your advice.

Answer: No obvious effect on asthma, although E would be no harm. Vit A can be toxic in large doses. As to the tendonitis(no bursa in the heel), taking non-steroidal anti-inflammatories like motrin and the like would be helpful. Double the over the counter dosage is usually close to prescription doses. Gi toxicity is the concern, stop with any nausea or heartburn.

Asthma - Accolate, Oral Steroids and Flovent [posted 8/13/98]
Question: My 16 year old son was recently hospitalized for an acute asthma attack. He was given Accolate, Prednisone, Flovent to continue taking at home. He completed the Prednisone and continued the with the other two medications, but when his behavior became uncharacteristically aggressive with bouts of crying and anger, all medications were immediately stopped. I am aware that these symptoms can result from steroids, but can these symptoms also be attributed to either Accolate or Flovent? Can side effects occur from abruptly stopping these medications? Within two days of discontinuing all medications, the aggressive symptoms disappeared, but he was very anxious and nervous. Within the next two days all symptoms seemed to disappear and he seems to be back to normal. What other options do we now have to treat his asthma?

Answer: I'd restart his Accolate first. I doubt that this would cause the mental disturbance that you are seeing. Steroids are notorious for this (mainly high dose systemic steroids - not inhaled). Consequently, secondly start an inhaled steroid after you ensure that Accolate isn't doing it, but start with a low dose steroid first and work up slowly.

Asthma and Bronchodilators [posted 8/13/98]
Question: My doctor suggested that I go to a nearby hospital to have a PFT pre and post bronchodilator done. Exactly what is this procedure and what does it involve? I have had asthma for approximately 4 years.

Answer: This involves breathing/blowing into a tube and measuring lung volumes. Then one is administered a bronchodilator and the test is repeated to see if these produce any change. There are several measures of lung volume/compliance that are achieved from the computer read pulmonary tests. It basically tests whether you respond to bronchodilators at all with your asthma.

Asthma Medication [posted 8/11/98]
Question: My 4 year old grandson has just started taking Vanceril (Beclomethasone Dipropionate) 84 mcg double strength inhalation aerosol, 2 times daily for treatment of coughing and wheezing diagnosed as asthma. Please give us any comments or advice as to the effects of this drug on him (especially since he is so young). Does it have any effect on the personality (irritability) or growth or any other effects that we should be aware of.

Answer: Inhaled steroids are generally not absorbed into the body and as a consequence the systemic side effects are few. However, about 1% of patients will experience the systemic side effects of inhaled steroids - worsening as the dosage or frequency is increased. Steroids can definitely have effects in children, changing their growth patterns, etc. On rarer occasions they would affect the personality of an individual, but theoretically possible. It should be well tolerated if not used excessively, however, it is a great asthma drug and one needs to balance the risk of the steroid against the problems of not being able to breath. Patients still die from asthma, it is not a benign disease.

Asthma and Aerobic Oxygen [posted 8/10/98]
Question: I would like to know a little about it. Can it help a person with asthma that only has 26% of a lung.

Answer: In general, oxygen would not help asthma - only supplement the body during low levels due to asthma exacerbations. Whether it would help depends a great deal on the arterial oxygen levels, not the amount of lung left.

Asthma Medications [posted 7/27/98]
Question: My doctor has me on 5 Inhalers, an updraft machine and accolate. Is that too much to be on or not?

Answer: It depends a lot on the severity of your asthma. What are the medications in the 5 inhalers? Also, how often and how long have you been on steroids? When was the last time in patient with asthma?

Asthma Inhalers
Question: I recently tried to get my prescription filled for my Terbutaline (Brethaire) Inhaler and was told the manufacturer has stopped making it. Could you suggest a similar (a substitution) Inhaler that does not contain steroids?

Answer: This is new to me. It also comes in tablets. However, the drug has not been used extensively in the last few years due to better drugs coming on the market. Maybe you should investigate these and different ways to treat your asthma.

Asthma
Question: Why isn’t there a cure for asthma? Is there hope that a cure will ever come about?

Answer: Asthma is a disease of the airways to the lung. It is due to spasm or narrowing of the airways after stimulation by one of many factors. It is usually reversible so that the airway returns to normal after a period of time. It is one of the more common medical problems and is a leading cause of loss of work and school time. In severe cases, it can lead to death and often limits an individual's activities. Asthma is classified in several ways, but generally falls into allergic and non-allergic types. Allergic is generally seen in young children and teen-agers. Non-allergic is typically seen in older individuals, although there is a wide spectrum of distribution. However, both are due to the hyper-irritability of the airways. Different common triggers include allergens, exercise, cold, chemicals, aspirin, beta- blockers, infections, emotional triggers, and work exposures. Treatment centers on reversing the spasm of the airways. This can be accomplished by one of several drugs. Preventive medications prevent the cold, exercise or whatever from triggering the asthma. These are drugs like cromolyn sodium, occasionally steroid, and occasionally drugs like Valium. Other drugs are used during a spell while the spasm is present. These fall into beta-agonists (inhalers or pills like metaproterenol, etc.), adrenergic drugs like epinephrine etc., methyxanthines like theophylline (caffeine is a weak methyxanthine), and lastly steroids. Steroids have been used in increasing amounts over the last few years as the element of inflammation has been more clearly recognized as a component in asthma. Steroids are usually given as an inhaler, but can be used as system pills in severe disease. These have long term side effects when given as pills. Unfortunately, I doubt that there will ever be a cure for this disease, but there may be better treatments in the future.

Inhalers
Question: Can a patient be on three types of inhalers? For example, Beclomethasone valerate (2 puffs), Terbutaline (2 puffs) and Ipratronium Br.(2 puffs).

Answer: These are three different types of medication. The inhaler is merely a delivery system to deliver these medicines to the lung. These are common medications used in asthma and are complimentary medications-- many asthmatics would take this combination.

Asthma
Question: As an adult asthma sufferer, I am wondering if asthma can cause permanent damage to the lungs.

Answer: Asthma, by definition, is a reversible airway disease. Consequently, asthma will not cause permanent lung damage. Other lung conditions can.

Asthma
Question: Can the hormones in birth control pills have an adverse effect on asthma?

Answer: Not usually, but occasionally the binder or coloring can cause allergic reactions. Companies usually test these so that they do not produce allergic or asthmatic response, but there are occasional problems with these materials.

Asthma
Question: My 2 1/2 year old son has been diagnosed with asthma and we have been told it is critical that we have air conditioning available to him for the summer. We live in Southeast Michigan and occasionally the temperature reaches the mid 90's. Is central air actually required? I have had many friends (who have asthma) tell me otherwise.

Answer: The earlier that asthma arrives usually the more severe it will be. I have not seen your son, but I suspect that you will see a large difference with air conditioning. There is no absolute way anyone can say with absolute certainty that it will help.

Asthma
Question: I use ventolin, intal, and beclovent inhalers two to three times a day. I am experiencing hoarseness, irritation occasionally in the throat. Should I be concerned with this constant irritation? It can be especialy bothersome if I drink alcohol.

Answer: It is not very common to hear of hoarseness with these inhalers. The exception would be your steroid inhaler,beclovent. It is common to develop thrush-usually a mouth soreness- which can he prevented by rinsing the mouth with water and spitting after the beclovent. Hoarseness is usually due to post-nasal drip, acid reflux or other causes. I'd recommend a course of anti-histamines at bedtime as well as an H2 Blocker like Tagament or Axid. If you get no improvement in 2-3 weeks consult your physician.

Vasotec
Question: For 15 years, I have used a broncodilator (4-6 puffs a day) and steroid (2 puffs a day) for asthma. I recently had a stroke and was put on Vasotec (20mg per day) for hypertension. I also lost weight and reduced my salt intake. As a side effect, I no longer use the steroid spray, and only need the broncodilator about 1 puff per WEEK. Is Vasotec a cure for asthma?

Answer:Vasotec is not a treatment or a cure for asthma. However, there are some patients who have mild heart failure and wheeze or cough. This is referred to as cardiac asthma. Without knowing your previous cardiac function it is difficult to assess this. Also, some patients will continually aspirate small amounts of food and acid while asleep-as a cause for asthma. A time tested remedy for this type of asthma trigger is losing weight. Possibly, your losing weight has reduced your nocturnal aspiration and the asthma trigger.

Acute Asthma Complications
Question: I am a 26 year old white male suffering from acute asthma and its' complications. I was born 11 weeks premature and weighed in at a mere 1 lb. 8 oz. I have had asthma problems since day one. I didn't use my first inhaler until the age of 13 (the age I was told I'd "outgrow it"). I have tried many different asthma therapies to no avail, limited only by my pocketbook. I really started suffering from asthma around the age of 19. I tried Maxair, Alupent, Ventolin & Proventil, Primatine Mist (like inhaling sand), Azmacort, and Serevent. At 19, I had 2 episodes where Maxair didn't work and I had to go to the ER I started on Ventolin and Azmacort simultaneously with moderate success...but I was inhaling 24 puffs of Azmacort daily. The doctor suggested I take even more! (no thanks). I then got off Ventolin and Azmacort, and went to Proventil. Not much better and still had to take the maximum dosage to stay alive. When I heard of a drug study for Zileuton, I volunteered for the study. After several days, I broke out into a very itchy rash from my abdomen to my scalp. I was done with Zileuton. I read about this marvelous drug Serevent, and when it was FDA approved, I started on it with great success. The max. dosage is 2 puffs twice daily. I use it only 1 puff once daily...it works so well! The only major problem is severe migraines...ouch! Mainly, if I have to take more than one puff in a 24 hour period. Anyway, now Accolate is out in the world, but it's hard to find trusting info...and that's why I'm here. I would like to know if I should try the new Accolate, and use it along-side Serevent. Or stick with the very potent (but working) Serevent, or use Accolate alone. If Accolate works well, should I use Ventolin in acute cases too? Lastly, I was taking Hisminal and Ventolin at the same time with quite a bit of relief from my allergies, but I was told not to take Hisminal with Serevent. Is it safe to take Hisminal with Accolate?

Answer: Accolate is chemically much different from Zileuton. I'd certainly try it, knowing that you might have the same itching. However, I'd had much better luck with Accolate vis a vis side effects. It can be used with Serevent. I'm not sure why you stopped Azmacort(or equivalent) since the side effects here are usually fairly minimal. This also can be used with Serevent and or Accolate.

New Inhaler
Question: Do you know when a new asthma inhaler which I believe to be called pulmacort will be available to the public? I've heard that it has been approved by the FDA and that the side affects are quite limited as opposed to other inhalers.

Answer: This will be a steroid inhaler-a little more potent than current steroid inhalers. This drug is to decrease the inflammation of the pulmonary tree and reduce the thickening that is caused by uncontrolled inflammation. Side effects are less than systemic steroids but are similar. That is, potential diabetes mellitus, bone loss, cataracts, advanced hardening of the arteries. In addition, yeast infections of the mouth called thrush. I doubt that it will be a major advance; but may be of use in selected patients.

Antileucostirenes
Question: I saw a short article on antileucostirenes (spelling?) in a magazine. This was called the only new medication in years and was touted as being effective. I can't find any information locally. Please send me a brand name(s)and generic name.

Answer: Leukotriene inhibitors are one of the newer types of treatment for asthma. They work by focusing on decreasing the inflammation in the bronchial tree. Leukotrienes are substances secreted by white blood cells as mediators of inflammation. Consequently, by decreasing the amount of leukotriene there will be an improvement in the severity of the asthma. Since steroids are also directed at the inflammatory part of asthma, it is hoped that concurrent use will decrease the need/reliance on steroids. These drugs take a while to work and should be taken at least a month before your decide if they are helpful. They sometimes take up to three months. There are two different drugs approved currently. That is Accolate(zafirlukast) and Zyflo(zileuton).They work on different parts of the leukotriene system; but seem to have similar effects. I would discuss the particular medications with your physician since there is a little variation especially in potential side effects. In general, I use the Accolate due to less potential side effects(especially hepatic).

Outgrow Asthma
Question: Can you out grow your asthma?

Answer: No. But, there are times in one's life that there appear to be more episodes than others. Typically, as one ages you may experience times with minor symptoms. However, given the right triggers(dust, infection, etc.) you will probably have asthma later in life.

Moderate Asthma
Question: For a twenty year old female with moderate asthma conditions what would be the best therapy? She is currently on theophylline and has heard of the effects of salmeterol-what should a pharmacist prescribe?

Answer: Many physicians are increasing the amount of inhaled steroids(not systemic) to treat asthma. Other possibilities include some of the newer agents the leukotriene inhibitors. Steady use of beta-agonists is helpful;but we are using more and more steroid inhalers as initial therapy. Occasionally, a patient will really benefit from cromolyn sulfate or equivalent also.

General Information
Question: My 10 month old son has been diagnosed with asthma. He's been breathing with great difficulties for 3 days. Please is there any advice you can give me?

Answer: Asthma in one so young is very ununusal;but, occurs occasionally. More commonly it is due to a bronchial infection that needs to be addressed. Aspiration of gastric fluid is also seen as a trigger. Ensure that you and your wife stop smoking if you are since any inhalant will exacerbate the problem. If it was my child I would see a Pediatric Pulmonary specialist to ensure that the diagnosis is correct.



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