What You Don't Know About Asthma Could Kill You

During my 29 years as a registered pharmacist, I believe I have seen the worst compliance with patients taking asthma medications. Asthma is a chronic disease that can be life threatening. Asthma patients can often have laid back attitudes about their disease and their treatments. This is especially heartbreaking when parents don't realize how dangerous asthma can be to a child. Parents are solely responsible for refilling the child's asthma medications and insuring that the child takes them correctly. Assuming that the child is okay, and can stop his maintenance medications, just because he doesn't appear to be having an asthma attack at the moment can be a deadly mistake.

How an Asthma Attack Can Be Life Threatening

Asthma attacks cause the passages that allow air into the lungs to become inflamed, causing them to swell and narrow. When the narrowing is severe enough, coughing and wheezing occurs. As the swelling increases, and the air passages close to a greater degree, the body receives less air. If the narrowing of the airways continues to the point of complete blockage, the body literally suffocates.

For the Sake of Simplicity

For the sake of keeping this article as easy to understand as possible, it is not an exhaustive list of possible asthma medications. Instead, I have tried to list the asthma medications that are used most commonly in the United States. I have intentionally omitted medications that may be more commonly used for chronic obstructive airway disease (COPD), where damage to the lungs is not considered fully reversible with treatment.

If your medication is not listed below, find out about it. You should be well educated about all of your asthma medications. Especially, you need to find out which of the categories below each asthma medication falls into and use each one properly.

1. Rescuers: Asthma medications to be used to relieve asthma attacks by quickly reversing airway narrowing.
2. Controllers: Asthma medications to be used regularly as maintenance to help prevent asthma attacks.
3. Short-term Treatments: Some asthma medications are used short term to decrease the airway inflammation and swelling that occurs with asthma attacks.

Know Your Asthma Medication for Rescue

If your asthma is mild, you may only have been prescribed a rescue medication.

The following are names of rescue asthma medications that may be prescribed in the form of a metered dose inhaler (MDI):

1. Albuterol* (a generic name)
2. Proventil HFA (a brand of albuterol)
3. Ventolin HFA (a brand of albuterol)
4. ProAir HFA (a brand of albuterol)
5. Xopenex HFA (a brand name of levalbuterol)
6. Maxair (a brand name of pirbuterol)

Children, and some adults, also use their rescue asthma medications in the form of a solution that is inhaled through a face mask attached by a tubing to a machine called a small volume nebulizer (SVN). The following are names of liquid rescue medications that may be prescribed for inhalation using SVN.

1. Albuterol
2. Proventil
3. Accuneb (a brand of albuterol)
4. Ventolin
5. Xopenex

If Your Asthma Worsens

Asthma is treated in a step-wise approach based on how well your asthma is controlled. It is critical that you keep track of how often you are using your rescue inhaler and let your doctor have that information. As your asthma worsens, other medications can be added to keep your symptoms under control.

Know Your Asthma Medications for Control

If your rescue asthma medication is not controlling your symptoms, you may receive a controller medication or medications. Controller medications are not for treating asthma attacks, but are used only as preventives to help lessen the frequency of attacks.

Asthma controllers may be in the form of inhaled corticosteroids. They work to help prevent, on an ongoing basis, inflammation that causes air passages to swell and narrow. You will be instructed to rinse your mouth with water and spit it out after each use. This is done in order to prevent the formation of mouth ulcers.

The following are names of corticosteroid controller asthma medications that may be prescribed in the MDI form or in other delivery systems that contain powder to be inhaled:

1. Beconase AQ (a brand of beclomethasone in MDI form)
2. QVAR (a brand of beclomethasone in MDI form)
3. Pulmicort Turbuhaler or Pulmicort Flexhaler (these are brand names that contain a powdered form of budesonide for inhalation)
4. Aerobid (a brand of flunisolide in MDI form)
5. Flovent (a brand of fluticasone in MDI form and also in a powdered form called a diskus)
6. Asmanex Twisthaler (a brand of mometasone in powdered form for inhalation)
7. Azmacort (a brand of triamcinolone in MDI form)
8. Alvesco HFA (a brand of ciclesonide in MDI form)

Your doctor may discontinue one of your corticosteroid controller inhalers and substitute a controller called Advair or one called Symbicort.

Advair is a combination of a corticosteroid (fluticasone) and a long-acting asthma medication that acts to keep your airways open (salmeterol). Advair is available as a diskus (powder for inhalation) and also in the MDI form. Advair should not be used as a rescue inhaler.

Symbicort is also a combination of a corticosteroid (budesonide) and a long-acting asthma medication that acts to keep your airways open (formoterol). Symbicort is available in the MDI form. It is not approved in the United States for uses other than as a controller.

Since Advair and Symbicort contain a corticosteroid, you will be instructed to rinse your mouth with water and spit it out after each use.

Doctors may prescribe other asthma controllers, called mast cell stabilizers, to be inhaled. Intal is a brand of cromolyn sodium for inhalation. It works early in the inflammation process to prevent swelling and narrowing of the airways.

Other controller asthma medications, such as Singulair, Accolate, Zyflo, or long-acting theophylline may be taken by mouth.

All asthma controllers, are to be used regularly exactly as your doctor has instructed and should not be discontinued without your doctor's advice.

Other Treatments Used to Decrease Inflammation and Swelling During Acute Asthma Attacks

Medications such as prednisone or prednisolone may be given by mouth to treat acute asthma attacks. These are usually taken only for relatively short courses to bring symptoms under control.

Monitoring Your Asthma

Your doctor may give you a peak flow meter for you to monitor how well you are doing. It measures your airflow. If you are given a peak flow meter, you will also be given an action plan that tells you exactly what to do based on your peak flow readings. It is critical that you clearly understand how to use the peak flow meter and the action plan. If you don't, ask your doctor or pharmacist for help.

A Final Word

It is absolutely necessary that you understand your asthma medications and how to use them properly. It is critical that you always keep a supply on hand. You should never run out. Since your pharmacist can only refill medications according to your doctor's orders, it is your responsibility to plan ahead for authorization of new refills before you run out.

*After December, 2008, albuterol and other metered dose inhalers will only be available as brand names that contain hydrofluoroalkane (HFA).

DISCLAIMER:

This article is provided for information only. This information is not a substitute for professional medical care by a qualified doctor or other health care professional. I am not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by the information.

The information regarding the names of available asthma medications is not exhaustive and can change as new products are introduced and/or older products are removed from the market. I have intentionally omitted products that, according to my sources, are not commonly used asthma medications. This article is for reference only for the United States and availability of products may vary depending on the state in which you live. Other brands and generics and uses may be available in other countries. The above information is given only as a reference to educate you about asthma and the general use of asthma medications. Never substitute anything you read anywhere on the Internet for the advice of a qualified doctor!

SOURCES: I am a registered pharmacist and I have presented these facts as a drug expert.

I have verified some of my facts by consulting: Facts and Comparisons, pages 641-696, published by Wolters Kluwer Health, Inc. This is a loose-leaf drug reference for which updates are received as information changes.

I also verified some of my facts by consulting: Pharmacist's Letter, Vol. 24, No. 9, September, 2008, page 52, and Vol. 23, No. 8, August, 2007, page 48, published by Therapeutic Research Center. This is a monthly subscription-based newsletter for health care professionals.