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Asthma warning

Posted Jun 30 2009 5:54pm

Asthmatics should consider their medication regimens and take note of their risks and benefits

There are two main medicines that asthma sufferers use for relief and a third medicine which is often used but carries a substantial risk.

For fast acting relief of cough,wheeze and shortness of breath due to asthma, albuterol is the medicine to use.  Albuterol is a short acting beta agonist which relaxes the bronchioles allowing air to flow freely through the lungs.  Albuterol can be ingested (as a liquid), inhaled using a metered dose  inhaler or inhaled using a nebulizer.  Younger children often use a nebulizer machine although spacers can be effective with an inhaler. Risks of albuterol include a rebound effect when too much inhaler use. In this scenario, asthma symptoms worsen. Jitteryness is another potential side effect.

For moderate or severe asthma, an inhaled steroid should be used.  Some examples include Pulmicort ® and Flovent ®. The inhaled steroids suppress the immune reactions in the lungs decreasing mucus production and bronchiole constriction. With inhalers (or nebulizers), the steroids focus at the lungs with little medicine released into the blood stream thus decreasing systemic side effects like elevated blood sugar or adrenal gland suppression. Some clinicians and patients have been concerned with retardation of growth in children who use inhaled corticosteroids long term. There seems to be some evidence to delayed growth but most children catch up over time. Inhaled steroid users are advised to rinse their mouth after inhalation to prevent oral thrush (a yeast infection).

More recenty in asthmatic care, long acting beta agonists(LABA) have been used for asthmatic relief. The benefits including less reliance on the albuterol short acting inhalers and better asthma control. However, the FDA has released a warning that long acting beta agonist when used alone (without inhaled corticosteroids) may be associated with an increased risk of asthma-related death. This risk is lessened when the LABA is used in combination with corticosteroids e.g. Advair ® or Symbicort ®.

For further discussion of risks and benefits of asthma medication, see your family physician or email

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