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Archive-name: medicine/asthma/general-info
Posting-Frequency: monthly
Last-modified: 13 Dec 1994
Version: 3.2
alt.support.asthma FAQ: Asthma -- General Information
======================================================
Introduction:
------------
Welcome to alt.support.asthma! This newsgroup provides a forum for
the discussion of asthma, its symptoms, causes, and forms of
treatment.
Please note that postings to alt.support.asthma are intended to be
for discussion purposes only and are in no way to be construed as
medical advice. Asthma is a serious medical condition requiring
direct supervision by a physician.
Please be aware that the information in this FAQ is intended for
educational purposes only and should not be used as a substitute
for consulting with a doctor. Many of the contributors are not
health care professionals; this FAQ is a collection of personal
experiences, suggestions, and practical information. Please remember
when reading this that every asthmatic responds differently; what is
true for some asthmatics may or may not be true for you. Although
every effort is made to keep this information accurate, this FAQ
should not be used as an authoritative reference.
Comments, additions, and corrections are requested; if you do not
wish your name to be included in the contributors list, please state
that explicitly when contributing. I will accept additions upon my
own judgement -- I'll warn you right now that I'm a confirmed skeptic
and am not a great believer in alternative medicine. All
unattributed portions are my own contributions. For more
information about asthma medications, there is also an Asthma
Medications FAQ that is posted as a companion to this one.
* = not added yet
+ = added since last version
& = updated/corrected since last version
======================================================================
Table of Contents:
-----------------
General Information:
1.0 What is asthma?
1.0.1 What is emphysema?
* 1.0.2 What is COPD?
1.0.3 What is status asthmaticus?
1.0.4 What is anaphylactic shock?
1.1 How is asthma normally treated?
1.1.1 How is an acute asthma attack treated?
* 1.1.2 What is a peak flow meter?
* 1.1.3 What is a spirometer?
* 1.2 How is asthma diagnosed?
* 1.3 What are the common triggers of asthma?
1.4 What are some of the most common misconceptions about
asthma?
Medications:
2.0 What are the major classes of asthma medications?
2.1 What are the names of the various asthma medications?
2.1.1 Are salbutamol and albuterol the same drug?
2.1.2 Are some asthma drugs banned in athletic
competitions?
2.2 What kinds of inhalers are there?
2.2.1 Which kind of inhaler should I use?
2.2.2 What is a spacer?
2.2.3 What is "thrush mouth" and how can I avoid it?
2.2.4 Is Fisons still making the Intal Spinhaler?
2.2.5 What's the difference between Spinhalers and
Rotahalers?
2.2.6 Should I use an inhaler or take pills?
* 2.2.7 How can I tell when my MDI is empty?
2.3 What kinds of tablets are there?
2.3.1 Why do I need a blood test when taking theophylline?
2.3.2 Why are combination pills not commonly prescribed?
2.4 What is a nebulizer?
2.5 What medications should I avoid if I have asthma?
Allergen Avoidance/Environmental Control:
3.0 What does HEPA stand for?
+ 3.1 What are some cheap ways to reduce my exposure to dust?
Miscellaneous:
4.0 What resources are there for asthmatics?
======================================================================
1.0 What is asthma?
--------------------
Asthma is defined as *reversible* obstruction (blockage) of the
airways inside the lungs. The 'reversible' part is important;
if the condition is NOT reversible, either with medication or
spontaneously, then the diagnosis is not that of asthma, but of
some other condition, usually chronic obstructive pulmonary
disease.
Quickly reviewing the structure of the lung: air reaches the
lung by passing through the windpipe (trachea), which divides
into two large tubes (bronchi), one for each lung. Each
bronchi further divides into many little tubes (bronchioles),
which eventually lead to tiny air sacs (alveoli), in which
oxygen from the air is transferred to the bloodstream, and
carbon dioxide from the bloodstream is transferred to the air.
Asthma involves only the airways (bronchi and bronchioles),
and not the air sacs.
Although everyone's airways have the potential for constricting
in response to allergens or irritants, the asthmatic patient's
airways are oversensitive, or hyperreactive. In response to
stimuli, the airways may become obstructed by one of the
following:
- constriction of the muscles surrounding the airway;
- inflammation and swelling of the airway; or
- increased mucus production which clogs the airway.
Contributed in part by:
Ruth Ginzberg rginzberg@eagle.wesleyan.edu
1.0.1 What is emphysema?
-------------------------
Emphysema is the disease in which the air sacs themselves, rather
than the airways, are either damaged or destroyed. This is an
irreversible condition, leading to poor exchange of oxygen and
carbon dioxide between the air in the lungs and the bloodstream.
1.0.2 What is COPD?
-----------------------------
- to be added in a future version
1.0.3 What is status asthmaticus?
----------------------------------
Status asthmaticus is defined as a severe asthma attack that
fails to respond to routine treatment, such as inhaled
bronchodilators, injected epinephrine (adrenalin), or
intravenous theophylline.
1.0.4 What is anaphylactic shock?
----------------------------------
Anaphylactic shock is defined as a severe and potentially
life-threatening allergic reaction throughout the entire
body. It occurs when an allergen, instead of provoking a
localized reaction, enters the bloodstream and circulates
through the entire body, causing a systemic reaction.
(There may also be an intrinsic trigger, as some cases of
exercise-induced anaphylaxis have been reported.)
The symptoms of anaphylactic shock begin with a rapid
heartrate, flushing, swelling of the throat, nausea, coughing,
and chest tightness. Severe wheezing, cramping, and a rapid
drop in blood pressure follow, which may lead to cardiac
arrest. The treatment for anaphylaxis is intravenous
epinephrine (adrenalin).
1.1 How is asthma normally treated?
------------------------------------
Treatment of asthma attempts to alleviate both the constriction
and inflammation of the airways. Drugs used for relieving the
constriction are called bronchodilators, because they dilate
(open up) the constricted bronchi. Drugs aimed at reducing
inflammation of the airways are called anti-inflammatories,
and come in both steroidal and nonsteroidal forms. If the
asthma is triggered by allergies, then reducing the patient's
exposure to the allergens or taking shots for desensitization
are other alternatives.
There are two main classes of bronchodilators, beta-agonists
which are usually taken in an inhaled form, and xanthines,
which are chemically related to caffeine. The major xanthine,
theophylline, is present in coffee and tea, and is taken
orally. Beta-agonists are chemically related to adrenalin.
The inflammation component is treated primarily with steroids,
which are a type of hormone. The steroids used in the treatment
of asthma are corticosteroids, which are not the same as the
anabolic steroids that have become notorious for their abuse by
muscle builders and athletes. Up until fairly recently, doctors
did not usually prescribe corticosteroids for asthma except as a
final resort, when all else was not working to achieve the
desired result. Now that has completely reversed. Steroid
inhalers are now among the first line of drugs that a
doctor will try in asthma management after an acute attack has
resolved. They work by reducing inflammation of the bronchi, and
making future acute attacks less likely. There are also two
nonsteroidal anti-inflammatories available, cromolyn sodium and
nedocromil, which are a popular alternative to inhaled
corticosteroids.
*IT IS IMPORTANT TO NOTE THAT OBTAINING RELIEF FROM AN ACUTE
EPISODE OF ASTHMA (an asthma "attack") IS NOT THE SAME THING AS
TREATING THE ASTHMA.* Years ago it was thought that "asthma"
consisted only of the acute "attacks" which were suffered
intermittently; when you weren't wheezing, you didn't have
asthma any more. This is no longer thought to be the case. New
asthma research emphasizes the role of the inflammation component
of asthma, pointing out that bronchodilation alone does not
reverse or treat the inflammation, although it does offer
dramatic relief from an acute "attack". New thinking on the
subject is that if the underlying inflammation is successfully
treated, then the person with asthma will be much less
susceptible to the airway constriction, wheezing, and increased
mucus secretion which accompany an acute "attack". People with
asthma have been found often to have ongoing inflammation which
does not subside between acute "attacks", even when they are not
wheezing. However, treatment of the inflammation cannot be done
on an emergency basis. Treatment of the inflammation component
is done after control is regained from an acute episode. Without
treating the underlying inflammation, the asthma itself is not
being addressed and the acute attacks will continue to recur.
For this reason, it is particularly important for parents of
asthmatic children NOT to use the emergency room as the *only*
place or occasion for treating their children's asthma (during
acute attacks). That is not actually treating the asthma; it is
just alleviating the most acute symptoms. The child needs to be
seen when it is NOT an emergency, for evaluation of the asthma
and
development of a treatment plan.
Contributed in part by:
Ruth Ginzberg rginzberg@eagle.wesleyan.edu
1.1.1 How is an acute asthma attack treated?
---------------------------------------------
Treatment of acute asthma (an asthma "attack") usually is
directed mainly toward alleviating the constriction of the
airway. Drugs used for this effect are called bronchodilators,
because they dilate (open up) the constricted bronchi. Adrenalin
is often used in emergency rooms for this purpose, for an acute
asthma "attack" that is seriously out of control. Theophylline
also relaxes the muscles surrounding the airways, and may be
given intravenously in the emergency room.
Contributed in part by:
Ruth Ginzberg rginzberg@eagle.wesleyan.edu
1.1.2 What is a peak flow meter?
---------------------------------
- to be added in a future version
1.2 How is asthma diagnosed?
-----------------------------
- to be added in a future version
1.3 What are the common triggers of asthma?
--------------------------------------------
- to be added in a future version
1.4 What are some of the most common misconceptions about asthma?
------------------------------------------------------------------
People with asthma must not exercise because exercise might make
them ill. They must live sedentary lives.
(FALSE)
Asthma is primarily a psychogenic illness caused by
repressed emotions.
(FALSE)
All children outgrow their asthma eventually.
(FALSE, but many do.)
Childhood asthma turns into adult emphysema.
(FALSE)
All asthma is caused by allergies.
(FALSE)
Moving to another state or region will cure asthma.
(FALSE)
Food allergies are a frequent cause of children's asthma.
(FALSE, though rarely they are)
Asthma in children is made worse by paying attention to it,
because it is just a way of trying to get attention in the first
place.
(FALSE)
Asthma in children is caused by so-called "smother-mothers".
(FALSE)
Asthma is a drag, but it's not fatal.
(FALSE. Especially among African-American children and
young adults it is a growing cause of death for
reasons not fully understood.)
Smoking marijuana improves asthma.
(FALSE)
Asthma inhalers are addictive.
(FALSE)
Contributed by: Ruth Ginzberg rginzberg@eagle.wesleyan.edu
======================================================================
2.0 What are the major classes of asthma medications?
------------------------------------------------------
There are five major classes of asthma medications:
- steroidal anti-inflammatories,
- non-steroidal anti-inflammatories,
- anti-cholinergics,
- beta-agonists, and
- xanthines.
The first two categories of drug treat the underlying
inflammation of the lung, while the latter two categories are
bronchodilators. Once I understand what anti-cholinergics
do, I'll be sure to include a description for them, also.
2.1 What are the names of the various asthma medications?
----------------------------------------------------------
For a complete listing of asthma medications, please see the
alt.support.asthma FAQ: Asthma Medications. It is posted
monthly as the companion to this general information FAQ.
2.1.1 Are salbutamol and albuterol the same drug?
--------------------------------------------------
Ventolin is the brand name of salbutamol, which is the WHO
(World Health Organization) recommended name for the medication.
Unfortunately, in the US this same drug is called albuterol,
leading to endless confusion. In fact, it's one of the few
drugs in which the brand name stays the same from country
to country, while the chemical name changes! Ventolin is made
in the U.S. by Allen & Hanburys, and Proventil is the same drug
manufactured by Schering. You can also get this drug in
a sustained-action tablet, called either Repetabs (by Schering,
again) or Volmax (Muro).
2.1.2 Are some asthma drugs banned in athletic competitions?
-------------------------------------------------------------
Many asthma drugs are BANNED and may result in disqualification
of an athlete from international and Olympic competition or
other qualifying events, for a 2 year period for the first
offense if urine drug analysis tests are positive. The USOC
follows protocol in the US for the International Olympic
Committee, so the banned substances are banned in both US and
international competition.
Banned substances unfortunately are not defined by whether they
are medically necessary but by whether they enhance performance
(and thus give an unfair advantage). A partial list of such
substances includes: ephedrine, bitolterol, metaproterenol,
orciprenaline, rimiterol, and pirbuterol. Albuterol,
terbutaline, beclomethasone, dexamethasone, and triamcinolone,
previously banned, are now allowed for use in Olympic competition
·
in inhaler/or nasal form only with written notification from the
physician in question on file with the United States Olympic
Committee prior to competition. Oral use of certain beta-2
agonists is banned. Cromolyn sodium is allowed.
** However, athletes should be aware that recommendations
regarding the use of asthma medications (i.e. allowed vs.
banned) in athletic competition may be revised.
Ultimately, it is the athlete's responsibility to check
with the USOC Drug Hotline, (800) 233-0393, and the
athlete's coaches and/or National Sport Governing Body
to get the most current recommendations.
Asthma medications do not cause false positives on drug tests,
at least for substances tested for in drug control with sports
testing. Most importantly, any athlete who is competing at the
level where drug testing is being performed can check with the
United States Olympic Committee Drug Hotline, (800) 233-0393,
24 hours, to confirm whether a particular drug is allowed or
banned. Such an athlete should also discuss with both their
coach and physician whether the drug is allowed or banned, and
if banned, when should the drug be stopped prior to competition
to get the medical benefits but avoid testing positive and
suspension from competition. The USOC Drug Control Program also
has a wide range of literature for athletes on what asthma
medications are banned, allowed, and allowed with prior
notification.
Contributed by: Lyn Frumkin, M.D., Ph.D. lrfrum@u.washington.edu
2.2 What kinds of inhalers are there?
--------------------------------------
aerosol inhalers:
----------------
MDI - metered-dose inhaler, consisting of an aerosol unit
and plastic mouthpiece
autohaler - MDI made by 3M which is activated by one's breath,
and doesn't need the breath-hand coordination that
a regular MDI does
respihaler - aerosol inhaler for Decadron. I have no idea how
this differs from the usual MDI
dry powder inhalers:
-------------------
rotahaler - dry powder inhaler used with Ventolin Rotacaps (see
table above), i.e. albuterol sulfate in capsules.
Each capsule contains one dose; the inhaler opens
the capsule such that the powder may be inhaled
through the mouthpiece. Available in the U.S.,
Canada, and UK.
spinhaler - dry powder inhaler used with Intal capsules for
spinhaler. Each capsule contains one dose; the
inhaler opens the capsule such that the powder
may be inhaled through the mouthpiece. Available
in Canada, UK, and the U.S.
diskhaler - dry powder inhaler. The drug is kept in a series of
little pouches on a disk; the diskhaler punctures
the pouch and drug is inhaled through the
mouthpiece.
Currently available in Canada and UK, not in U.S.
turbohaler - dry powder inhaler. The drug is in form of a
pellet;
when body of inhaler is rotated, prescribed amount
of
drug is ground off this pellet. The powder is then
inhaled through a fluted aperture on top. Available
in Australia.
2.2.1 Which kind of inhaler should I use?
------------------------------------------
Some asthmatics find the dry powder inhalers more effective than
their MDI (aerosol) counterparts. It is suspected that the
aerosol or propellent in the MDI may act as an irritant to some
asthmatics, as in the following article:
J.R.W. Wilkinson et al., Paradoxical bronchoconstriction in
asthmatic patients after salmeterol by metered dose inhaler,
British Medical Journal 305 (1992) 931. The first sentence
in the conclusion is: "Bronchoconstriction after both
salmeterol and placebo by metered dose inhaler but not after
salmeterol by diskhaler suggests that the irritant is not
the salmeterol itself." . . . "The similarity in characteristics
of bronchoconstriction after beclomethasone by metered dose
inhalers implicates one or both chlorofluorocarbons . . . as
the irritant. That salbutamol caused no bronchoconstriction was
attributed to its faster onset of action opposing any
bronchoconstrictor effects of the propellants."
** However, according to the 1994 Physicians' Desk Reference,
Intal Spinhaler capsules are "contraindicated in those
patients who have shown hypersensitivity to . . . lactose."
So asthmatics who are lactose-intolerant may not have this
form of cromolyn sodium as an option.
2.2.2 What is a spacer?
------------------------
A spacer is a device that simplifies the inhalation of aerosol
metered-dose-inhalers (MDIs).
Most people find it difficult (at least initially) to time the
spraying of an MDI and the inhalation of the medicine, and, thus,
most of the medicine is deposited in their mouths or the backs
of their throats instead of their lungs. Besides being less
effective, this can lead to other side effects (e.g., for inhaled
steroids, an increased potential for thrush, an oral fungal
infection).
The spacer is basically a temporary holding chamber for the
medication. You spray the medicine into the chamber where it
temporarily remains suspended, and then you inhale deeply and
SLOWLY. The column of medication rapidly passes through the
mouth
and goes into the lungs.
There are a few different types of spacers. The one I'm most
familiar with is the Aerochamber. It's a plastic tube with a
mouthpiece on one end and a place to insert the MDI on the other.
The mouthpiece has a delicate one-way valve built in so that you
can exhale without displacing the medication in the chamber and
then inhale.
Some spacers are clear, some have a little whistle built in that
tells you if you're inhaling too fast. I've read (and believe)
that the medication is more efficiently delivered using a spacer
than if it were merely inhaled directly from the MDI. Some
packages (AeroBID, I believe, and others) come with a spacer
built into its MDI housing.
There are special spacers for younger children. There's an
Aerochamber that has a mask built in; the child breathes normally
for a few seconds with the mask held over his/her mouth and nose.
This is typically used when a nebulizer is not available or not
required, and for medications that cannot be nebulized, such as
Beclovent or Vanceril.
There is also a device for children called InspirEase, which is
kind of like a plastic bellows or balloon with a plastic
mouthpiece. The child inflates it, the medicine is sprayed into
it, and the child inhales, holds his/her breath for the count of
5 (or whatever the doctor recommends), exhales into the device,
and then repeats. It's really helpful for younger children who
don't really know about breathing in and breathing out or how to
hold their breath or breathe evenly and slowly. It gives them
immediate physical feedback, and also has a whistle built in to
tell them when they're breathing too fast (although they seem to
like making it whistle, so it's positive reinforcement for
something that they shouldn't be doing). As the child grows, the
Inspirease becomes less effective, since it has a limited
capacity.
Although spacers are sometimes provided by some HMOs and covered
by some insurers, I don't believe that a prescription is
required.
Contributed by: Mark Feblowitz mfeblowitz@GTE.com
2.2.3 What is "thrush mouth" and how can I avoid it?
-----------------------------------------------------
Thrush mouth is the popular term for a yeast infection
(candida albicans) in the back of throat. The major symptom
of thrush is a white film located at the back of the throat
and tonsil area. It is usually cured by the use of an
antifungal mouthwash.
Thrush is a very common side effect of taking inhaled
corticosteroids. The way to avoid this complication is to
ensure that the back of the throat doesn't remain coated with
corticosteroid after use of the inhaler, either by using
a spacer or by rinsing the mouth very thoroughly afterwards.
Unfortunately, some people still get it even when they are very
thorough about rinsing.
2.2.4 Is Fisons still making the Intal Spinhaler?
--------------------------------------------------
Yes, Fisons is still manufacturing both the Intal Spinhaler
(a dry powder inhaler for cromolyn sodium) and the capsules
for it. Many pharmacists in the U.S. are under the impression
that it is unobtainable, probably due to the fact that the
Spinhaler was unavailable for a short time in the U.S. some
while back due to a change in formulation. During this time,
some wholesalers stopped buying the inhaler, and didn't
restock it once the Spinhaler was back in production. So
your pharmacist's regular wholesaler still may not be
carrying this product. For further information,
Fisons Corporation's number for Rx Customer Service is
(800) 334-6433.
Contributed in part by: Paula Ford pxf3@psuvm.psu.edu
2.2.5 What's the difference between Spinhalers and Rotahalers?
---------------------------------------------------------------
[Maintainer's note: the Rotahaler is a dry powder inhaler
for Ventolin (albuterol), manufactured by Allen & Hanburys,
while the Spinhaler is a dry powder inhaler for Intal
(cromolyn sodium), manufactured by Fisons Corporation. Both
inhalers are available in the U.S.]
The Rotahaler and the Spinhaler are very different animals.
The Rotahaler is a pussycat, the Spinhaler a ferocious lion.
The Rotahaler is a two-part mouthpiece that you snap apart,
put a capsule in, twist, and inhale. When you twist the device,
the capsule breaks open. When you inhale, the medicine lands
in your lungs.
The Spinhaler is a three-piece device: a mouthpiece, a tiny
fan, and a cap to cover the fan. You open it, put the capsule
in a space on the fan, close it, push down then up on the cap
(this breaks the capsule) and then tilt your head back, put
the mouthpiece in your mouth, and inhale. The fan throws the
medicine into the back of your throat. Then you gag.
I don't like the propellants in MDIs, so I was highly motivated
to get a Spinhaler. It took me a month to get my drugstore to
find it, and now I must admit I'm disappointed. I tried using
a capsule in the Rotahaler, since that device works so well, but
the medicine seems to be of the wrong consistency, and the
capsule
is too small for the space it should go into.
Another difference: The Spinhaler comes in a little container
like a medicine bottle, but the lid doesn't stay on very well in
a purse. The Rotahaler comes in a little plastic case sort of
like a compact and stays shut (i.e. clean) in a purse, backpack,
or jeans pocket.
Contributed by: Paula Ford pxf3@psuvm.psu.edu
2.2.6 Should I use an inhaler or take pills? What's the difference?
---------------------------------------------------------------------
Medications taken orally almost always have a much higher
systemic concentration (concentration in your entire body)
than inhaled medications. So if the side effects are due
to systemic concentrations, then an inhaled drug is less
likely to have these side effects, or may have them much
less severely.
The idea behind an inhaler is that the full dose is delivered to
the lungs, where it is immediately absorbed by the lung tissue,
and starts to take effect locally. Excess drug may be absorbed
by the bloodstream and delivered to the rest of your body, but
this amount tends to be minimal. So your lungs receive an
immediate, high concentration of the drug, and the rest of your
body receives very little.
If you take the drug orally in tablet or capsule form, then you
need a much higher dose. The reason is that for the same amount
of drug to reach the lungs through the bloodstream, you need the
same concentration of drug in the rest of your body. For
example,
most people take one or two puffs of albuterol (Ventolin or
Proventil) every four to six hours, and each puff is 90
micrograms
of albuterol. The usual dosage of Ventolin in tablets is 2-4
milligrams three or four times a day, which is something like 200
times the amount inhaled.
However, one advantage that tablets have is that the medication
may be available in a time-release format. So for a short-acting
medication like albuterol, the inhaled version might need to be
taken every four to six hours, while a extended-release tablet
such as Volmax would need to be taken only every twelve hours.
2.2.7 How can I tell when my MDI is empty?
-------------------------------------------
- to be added in a future version
2.3 What kinds of tablets are there?
-------------------------------------
SA - sustained action. SA and CR (below) have been used
interchangeably and almost mean the same thing,
except SA refers to the pharmacologic action while
CR refers to the drug release process. Any drug
release which is controlled in a zero-order fashion
(constant rate of release) is generally referred to
as Sustained or Controlled Release.
CR - controlled release. See SA.
DR - delayed release. This generally refers to enteric-
coated tablets which are designed to release the drug
in the intestine where the pH is in the alkaline range.
ER - extended release. Dosage forms which are designed to
release the drug over an extended period of time,
e.g. implants which release drug over a period of
one or two months or years.
TD - time delayed. This is slightly different from DR in
that the drug release is designed to occur after a
certain period of time, e.g. pellets coated to a
certain thickness or multi-layered tablets or tablets
within a capsule or double-compressed tablets.
Contributed by: Susan Graham sgraham@hpb.hwc.ca
2.3.1 Why do I need a blood test when taking theophylline?
-----------------------------------------------------------
Theophylline is a very effective drug but unfortunately its
therapeutic level is quite close to its toxic level. This
means that the dose that the patient needs to get the full
benefit of the drug is not very much lower than the dose
which causes side effects which range from unpleasant to
dangerous. This would not be such a problem if there weren't
such large variations in the rate at which people metabolize
theophylline. Apparently, if a group of people are given
the same dose of theophylline, the concentration of the
drug in their bloodstreams may vary by up to a factor of
seven. Therefore, the best way to monitor that the patient
is receiving the optimal amount of theophylline is to take
a blood level concentration.
2.3.2 Why are combination pills not commonly prescribed?
---------------------------------------------------------
The combination drugs such as Tedral and Marax commonly
contain theophylline, ephedrine, and some form of sedative
such as phenobarbital. These combination pills are no longer
commonly prescribed because the amount of theophylline in
the pill cannot be varied with respect to the other drugs.
Since there is great variation in the rate at which an
individual metabolizes theophylline, it is now considered
better to take theophylline separately, for better adjustment
of theophylline levels. In fact, Tedral is no longer
manufactured by Parke-Davis.
Also, ephedrine is no longer considered the bronchodilator
of choice. From Drs. Haas, _The Essential Asthma Book_,
"ephedrine initiates the release of catecholamines -- including
adrenaline -- that are already stored in the body. This is
its biggest drawback. Its effects depend on the availability
of catecholamine in the body at the time it is given, and
these concentrations vary." Since much better bronchodilators
are now available, ephedrine is no longer commonly prescribed.
2.4 What is a nebulizer?
-------------------------
A nebulizer is a device that uses pressurized air to turn a
liquid medication into a fine mist for inhalation. If you've
ever received emergency treatment for asthma, they've probably
used a nebulizer on you.
The term nebulizer is often used to describe both the pump
that pressurizes the air, and the part that holds and
"nebulizes" the medication. There are hand-held nebulizer
units and ones with masks that you strap onto your face.
The pressurized air typically comes from a portable pump unit
that internally consists of a motor-driven air pump that
resembles the fancier types of aquarium pumps. It forces air
through a plastic tube into the plastic nebulizer unit. Inside,
the nebulizer unit acts much like a perfume atomizer, creating
a fine mist that is directed either through a tube that you
inhale through or a mask that directs the mist into your nose
and mouth.
Since the nebulizer takes a few minutes to deliver the
medication,
you inhale it over a longer period of time than if you were using
an inhaler. This can really help, especially if your passages
are
not fully open and you're taking a bronchodilator. As you
breathe
the medication, your lungs can gradually accept more and more of
the medication. In addition to the medication, many people find
the accompanying mist (typically a sterile saline solution) to be
soothing.
For very young children, the nebulizer is the only practical
means of administering inhaled medications. Older children and
adults have the options of using inhalers and a variety of
spacers to make the timing a bit easier. The doctor overseeing
the treatment decides which is the most effective/appropriate
delivery mechanism.
At least in Massachusetts, the nebulizer pump unit, the
hand-held nebulizers, the medications, and the sterile saline
inhalation solution are all prescription items. Replacement
parts for the pumps are not available to the general public
(if there are sources, I'd like to hear about them).
The portable nebulizer pump units cost little ($100-$300)
relative to the cost of an emergency room visit, so some health
plans / insurers provide them to patients for times when an
asthma episode is "manageable but not dangerous." This seems to
be a trend in the management of pediatric asthma.
·
Our family has been able to successfully avoid a few trips to
the ER, and have even been able to head off some more severe
allergic asthma episodes with early intervention. After a few
rather gruesome visits to the Mass. General Hospital's waiting
room on a Saturday night, we welcome opportunity to treat our
children at home, when it's safe. We tend to go in to the doctor
or ER for the more severe episodes or those that don't respond
well enough to early intervention.
Contributed by: Mark Feblowitz mfeblowitz@GTE.com
2.5 What medications should I avoid if I have asthma?
-----------------------------------------------------
Aspirin can trigger an asthma attack in approximately one in
five asthmatics. This is especially common in those patients
who also have nasal polyps. As acetominophen (Tylenol) doesn't
have this effect, it may be used as an alternative for anyone
who suspects that they might have aspirin sensitivity.
======================================================================
3.0 What does HEPA stand for?
------------------------------
Maintainer's contribution:
-------------------------
HEPA is an acronym that has been around for so long that people
no longer remember what it stands for. I personally have seen:
High Efficiency Particulate Arrestor, High Efficiency PArticle,
High Efficiency Particle Air, High Efficiency Particulate Air,
and High Efficiency Particulate Abatement. Either the first
or last seem to me to be the most likely. (At least there is
some consensus on what the `HE' stands for.) At any rate, it
is a standard for the filtration of particles in air.
From National Allergy Supply's product literature:
"Filtering efficiency on a HEPA air cleaner, by law, has to
be at least 99.97% on all particles down to 1/3 micron in
size (a hair is about 60 microns, or 180 times larger than
that!) The term "HEPA" may not be used by any manufacturer
unless these two requirements are met. In addition, HEPA
filters lose no efficiency and stay at 99.97% for years."
Andrew M. Gough's contribution:
------------------------------
HEPA filters are basically folded (to increase surface area)
high-density fiberglass sheets.
HEPA filters for home use usually have a capture efficiency
rating of 99.97% at 0.3 micron size. This means that 99.97%
of particles of 0.3 micron diameter, or larger, are captured
when passing through the filter. Below 0.3 micron, the capture
efficiency will drop quickly.
Other filter types (disposable foam/fiberglass, electronic,
electrostatic) typically have high capture efficiencies for
particles above 10 microns in diameter. They are absolutely
useless for particles below 1 micron in diameter, where they
have capture efficiencies of about 1%.
Why is this important you ask? Many common allergens are below
10 microns in size, with many below 1 micron. A "micron" is a
micrometer, or one millionth (10E-6) of a meter. For comparison,
a strand of human hair is typically 75 to 100 microns in
diameter.
The sizes (diameter in microns) of allergens and other items of
interest are:
Pollens 8 - 80
Molds 4 - 12
Mold spores 5 - 15, with some down to 0.4*
Dust mites 0.8 - 1 micron
Dust mite feces 0.2 - 0.02
Animal dander 0.4 - 10
Tobacco smoke 0.02 - 1
Ragweed pollen 21
Red blood cell 8
Polio virus 0.025
Bacteria 0.2 - 40
Smallest visible 40 - 10 depending on individual
& conditions
* I recall reading once that the spore diameter for aspergillus
is 0.4 micron. The 5-15 range comes off a chart I have, but
I need to look out for further information, as I believe a lot
of mold spores are below 1 micron.
HEPA filters are the only type that are really effective in
eliminating allergens from the air, especially if you are
allergic
to molds.
I am aware of two choices for HEPA filters for the home market:
freestanding and whole-house:
Freestanding units are short circular tubes which suck in air
from the sides and exhaust filter air at the base. An example
is the Honeywell Enviracare. You put it in a closed room and
run it all day, and at night if you can stand the noise (they
can be quite noisy). Freestanding units will go for $250-$350
and are available in retail stores or mail order. I used one
for my apartment, where I tried to cheat fate by trying to
filter all the apartment air by placing it near the air return.
It helped. HEPA filters need to be replaced every 2-3 years,
depending on conditions, and will cost $70-$90. You need to
change prefilters every 3 months, but they are cheap.
I am aware of one company that makes a whole-house unit, Pure
Air Systems, Inc. in Plainfield Indiana, phone (800) 869-8025.
They make a system that attaches to the air return of a furnace
in a bypass configuration. The unit has its own blower, as a
normal furnace blower wouldn't be able to pull air through a
HEPA filter (very dense, remember) and transport it through the
house. The unit operates whenever the furnace/AC does, but of
course you can leave your thermostat in the "fan on" position
and run it as long as you want. This will run you $1000-1200
installed.
From the personal experience with HEPA air, I recommend it. I
used to work in a semiconductor fabrication clean room, of class
10, which means that there were only 10 particles per cubic foot
that were 0.5 microns in diameter or larger. Whenever I would
walk into the cleanroom, my nose would instantly clear up and I
would feel much better.
Contributed by: Andrew M. Gough andrew_m_gough@ccm.ch.intel.com
3.1 What are some cheap ways to reduce my exposure to dust?
------------------------------------------------------------
The approach that I've found to be most beneficial when trying
to avoid allergens is to concentrate on the bedroom, since that's
where I spend eight hours a night. I find that if my bedroom is
reasonably allergen-free, then I can tolerated much higher levels
of allergens elsewhere. Also, I then have a place to retreat to
when I have a cold or are otherwise more prone to an allergic
reaction.
Being a student, I've tried to keep expenses down, so here are
the
steps I've taken in every place I've lived so far:
- I keep the room as bare as possible. It can still be
cheerful, with a brightly-coloured bedspread and posters,
but I do my best to keep it uncluttered.
- if possible, I sleep in an uncarpeted room, or one with
a very short pile (hard to arrange when sleeping in
student housing, I know)
- I don't hang dust traps such as wall hangings on walls.
I prefer posters, which are easy to wipe down.
- if I must have small fiddley things such as ornaments or
knickknacks around, I keep them behind glass
- I turn off any forced air heating in the room, and just
use extra blankets if necessary (yes, even in Edmonton).
Another alternative would be to install a filter in the
room outlet.
- I buy one really good air filter (currently an Enviracaire
EV-25) and leave it running 24 hours a day
- I bought some allergy control covers for my pillows, since
they're closest to my face when I sleep. If I had more
money, I'd buy the mattress and comforter covers also.
(For those interested, I bought the Perfect Allergy
Control Membrane covers from Allergy Control Products,
and I highly recommend them. They're both effective and
very comfortable.)
- I trade chores with my roommates so that someone else
vacuums my room when I'm not there
I'd recommend trying some of these low-expense, low-tech
approaches to the bedroom before going all out and buying lots
of expensive stuff. If these approaches don't work, then it's
time to think about the more expensive options.
======================================================================
4.0 What resources are there for asthmatics?
---------------------------------------------
Please see the alt.support.asthma Reading/Resource List. It
is maintained by Lynn Short <lfshort@europa.com>, and is
posted monthly to alt.support.asthma, alt.med.allergy,
sci.med, and misc.kids. I highly recommend it!
======================================================================
Contributors:
------------
Mark Delany markd@bushwire.apana.org.au
Mark Feblowitz mfeblowitz@GTE.com
Paula Ford pxf3@psuvm.psu.edu
Lyn Frumkin, M.D., Ph.D. lrfrum@u.washington.edu
Ruth Ginzberg rginzberg@eagle.wesleyan.edu
Andrew M. Gough andrew_m_gough@ccm.ch.intel.com
Susan Graham sgraham@hpb.hwc.ca
======================================================================
References:
----------
The Physicians' Desk Reference is published annually by:
Medical Economics Data Production Company
Montvale, NJ 07645-1742
ISBN 1-56363-061-3
It is a compendium of official, FDA-approved prescription
drug labeling. The FDA is the U.S. Food and Drug Administration.
Drs. Francois Haas and Sheila Sperber Haas, _The
Essential Asthma Book_, (Ballentine Books, USA) 1987.
ISBN 0-8041-0287-2
Dr. Francois Haas is the director of the Pulmonary Function
Laboratory at the Medical Center of the New York University
School of Medicine, and is on the faculty of the Dept. of
Physiology there.
Paul J. Hannaway, M.D. _The Asthma Self Help Book_,
2nd ed., (Prima Publishing, USA) 1992.
ISBN 1-55958-166-2
1-55958-434-3 paperback
The author is Assistant Clinical Professor of Tufts
University School of Medicine. The first edition of
this book won an American Medical Writers Association
Award.
Allan M. Weinstein, M.D., _Asthma - The Complete Guide
to Self-Management of Asthma and Allergies for Patients
and their Families_, (Fawcett Crest, NY, USA) 1987.
ISBN 0-449-21562-8
The author is Assistant Clinical Professor of Medicine at
Georgetown University, and is a board-certified allergist
who practices in Washington, D.C.
======================================================================
Disclaimer: I am not a physician; I am only a reasonably
well-informed asthmatic. This information is for
educational purposes only, and should be used only as
a supplement to, not a substitute for, professional
medical advice.
Copyright 1994 by Patricia Wrean. Permission is given to freely
copy or distribute this FAQ provided that it is distributed in full
without modification, and that such distribution is not intended for
profit.
--
Patricia Wrean wrean@caltech.edu
@FROM :wrean@cco.caltech.edu
@SUBJECT:alt.support.asthma FAQ: Asthma Medications
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From: wrean@cco.caltech.edu (Patricia Rose Wrean)
Newsgroups:
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news.answers
Subject: alt.support.asthma FAQ: Asthma Medications
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Summary: This posting is a list of medications used for the
prevention and treatment of asthma. It is a companion
posting to the alt.support.asthma FAQ: Asthma --
General Information.
Keywords: asthma faq medications drugs
Xref: ns.channel1.com alt.support.asthma:1991 sci.med:107641
alt.answers:5880
sci.answers:1865 news.answers:33262
Archive-name: medicine/asthma/medications
Posting-Frequency: monthly
Last-modified: 13 Dec 1994
Version: 3.4
alt.support.asthma FAQ: Asthma Medications
===========================================
This FAQ attempts to list the most commonly prescribed medications
for the prevention and treatment of asthma, both in the U.S. and
overseas. It is maintained by Patricia Wrean <wrean@caltech.edu>.
The following information came from two sources: most of the
drugs available in the U.S. are listed in the 1994 Physician's
Desk Reference (full citation at end of post); the remainder
of the information, including those medications available
overseas, came from the many helpful contributors listed at the
end of the post. If you do not wish your name to be included
in the contributors list, please state that explicitly when
contributing. Also, if I have left anyone's name out, please let
me know so that I may include it.
** Although the maintainer and contributors do their best to keep
this FAQ updated, it is by no means an authoritative work.
Asthma is a serious illness requiring supervision by a
physician. Please do not attempt to change your medication
regime without consulting your doctor.
Corrections, additions, and comments are requested; please include
the name of the country in which the medication is available, as
it isn't always obvious from the user-id. If the drug is available
as an inhaler, please specify it as a MDI or one of the other types
mentioned in the glossary, or add a description of the inhaler if
it is not present already.
Abbreviations are explained in the glossary at the end of the table.
If the medication is followed by a country name in brackets, then
to the best of my knowledge it is only available in that country,
and not in the U.S.
If the drug is available in a nasal form for allergies, I've
included it for completeness. I haven't covered oral steroids,
only inhaled, or antihistamines at the present time.
+ = added since last version
& = updated/corrected since last version
----------------------------------------------------------------------
Type of drug
Chemical name Brand name Comments
---------------------- ---------- --------
Anti-inflammatory,
non-steroidal
cromolyn sodium Intal available as MDI,
(called sodium capsules for
Spinhaler,
cromoglycate neb soln
in UK) Nasalcrom nasal spray
nedocromil Tilade MDI
Tilade Mint MDI (UK)
sodium cromoglycate -- see cromolyn sodium
Anti-inflammatory,
steroidal (inhaled)
beclomethasone Beclovent MDI
dipropionate Beclodisk diskhaler (Can)
Becloforte MDI (Can, Sw), larger
dose than Beclovent
Becotide MDI (UK)
Beconase nasal MDI
Beconase AQ nasal spray
+ Respocort MDI, autohaler (NZ)
Vanceril MDI
Vancenase Pockethaler (nasal
MDI)
Vancenase AQ nasal spray
budesonide Pulmicort turbohaler (Aus, Can)
neb soln (UK)
& Rhinocort nasal inhaler (US),
nasal turbohaler
(Can)
Nebuamp neb soln (Can)
dexamethasone Decadron Respihaler
sodium phosphate Phosphate
flunisolide Aerobid MDI
Aerobid-M MDI, with menthol as
flavouring agent
Bronalide nasal turbohaler (Can)
Nasalide nasal spray
Rhinalar nasal spray (Can)
fluticasone Flixotide MDI (UK)
proprionate diskhaler (UK)
triamcinolone Azmacort MDI
acetonide Nasacort nasal MDI
Anticholinergics (bronchodilators)
ipratropium Atrovent MDI, inh soln
bromide
Beta-agonists (bronchodilators)
albuterol* Airet inh soln
(salbutamol is Proventil MDI, inh soln, syrup,
WHO recommended tablets,
name generally Repetabs (SA
tablets)
+ in use outside Respolin MDI, autohaler (NZ)
the U.S.) Ventolin MDI, inh soln, syrup,
neb soln, tablets,
Rotacaps for
Rotahaler
Ventodisk diskhaler (Can, UK)
Volmax ER tablets
* MDI uses albuterol, all other forms (tablets, etc.)
use albuterol sulfate
bitolterol mesylate Tornalate MDI
ephedrine Ephedrine inh soln (Can)
epinephrine Bronkaid Mist MDI, OTC - epinephrine
in form of nitrate
and hydrochloride
Bronkaid Mist MDI, OTC - epinephrine
Suspension in form of
bitartrate
Medihaler-Epi MDI, OTC - epinephrine
in form of
bitartrate
Primatene Mist MDI, OTC
Primatene Mist MDI, OTC - epinephrine
Suspension in form of
bitartrate
Sus-Phrine injection
fenoterol Berotec MDI, inh soln, tablets
hydrobromide (Can, Aus, NZ)
isoetharine Isoetharine inh soln
hydrochloride Arm-a-Med
isoproterenol Medihaler-Iso MDI
sulfate Isuprel MDI, neb soln (Can) --
as hydrochloride
metaproterenol Alupent MDI, inh soln,
tablets,
sulfate neb soln, syrup
Metaprel MDI, inh soln, syrup,
tablets
Metaproterenol inh soln
Sulfate
Arm-a-Med
pirbuterol acetate Maxair MDI, autohaler
procaterol HCl Pro-Air MDI (Can)
salbutamol -- see albuterol
salmeterol Serevent MDI
xinafoate diskhaler (UK)
terbutaline Brethaire MDI
sulfate Brethine tablets, neb soln,
injection
Bricanyl tablets, injection
turbohaler (Aus)
Xanthines (bronchodilators)
theophylline Aerolate TD capsules, liquid
Quibron-T tablets, SA tablets
(see also
combinations)
Respbid SR tablets
Slo-bid ER capsules
Slo-phylline ER capsules
T-Phyl CR tablets
Theo-24 ER capsules
Theo-Dur ER tablets
Theo-Dur SA capsules
Sprinkle
Theo-X tablets
Theolair tablets, SR tablets,
liquid
Uniphyl CR tablets
dyphylline** Lufyllin tablets, injection,
syrup
** similar to theophylline
oxtriphylline*** Choledyl DR tablets, SA tablets
*** oxtriphylline is the choline salt of theophylline,
and 400 mg of it is equivalent to 254 mg of
anhydrous theophylline
----------------------------------------------------------------------
Combination Medications:
Brand name Chemical names of ingredients Comments
---------- ----------------------------- --------
Asbron G theophylline sodium glycinate, elixir, tablets
guaifenesin (expectorant)
Bronkaid Caplets ephedrine sulfate, guaifenesin tablets, OTC
Congess guaifenesin, pseudoephedrine tablets
Duo-Medihaler isoproterenol hydrochloride, MDI
phenylephrine bitartrate
Duovent fenoterol hydrobromide, MDI (UK)
ipratropium bromide
Marax ephedrine sulfate, tablets
theophylline,
Atarax (hydroxyzine HCl)
Primatene Tablets theophylline, ephedrine HCl tablets, OTC
Quadrinal theophylline calcium salicylate, tablets
ephedrine HCl, phenobarbital,
potassium iodide
Rynatuss carbetapentane tannate, tablets, syrup
chlorpheniramine tannate,
ephedrine tannate,
phenylephrine tannate
Tedral theophylline, ephedrine HCl, tablets -- no
longer
phenobarbital manufactured
Ventolin-Plus albuterol, beclomethasone MDI (Sw)
dipropionate
----------------------------------------------------------------------
Glossary
--------
aerosol inhalers:
MDI - metered-dose inhaler, consisting of an aerosol unit and
plastic mouthpiece
autohaler - MDI made by 3M which is activated by one's breath, and
doesn't need the breath-hand coordination that a
regular
MDI does
respihaler - aerosol inhaler for Decadron (see table above). I have
no idea how this differs from the usual MDI
dry powder inhalers:
rotahaler - dry powder inhaler used with Ventolin Rotacaps (see
table above), i.e. albuterol sulfate in capsules.
Each capsule contains one dose; the inhaler opens
the capsule such that the powder may be inhaled
through the mouthpiece. Available in the U.S.,
Canada, and UK.
spinhaler - dry powder inhaler used with Intal capsules for
spinhaler. Each capsule contains one dose; the
inhaler opens the capsule such that the powder
may be inhaled through the mouthpiece. Available
in Canada, UK, and the U.S.
diskhaler - dry powder inhaler. The drug is kept in a series of
little pouches on a disk; the diskhaler punctures
the pouch and drug is inhaled through the mouthpiece.
Currently available in Canada and UK, not in U.S.
turbohaler - dry powder inhaler. The drug is in form of a pellet;
when body of inhaler is rotated, prescribed amount of
drug is ground off this pellet. The powder is then
inhaled through a fluted aperture on top. Available
in Australia and Canada.
forms of tablets:
SA - sustained action. SA and CR (below) have been used
interchangeably and almost mean the same thing,
except SA refers to the pharmacologic action while
CR refers to the drug release process. Any drug
release which is controlled in a zero-order fashion
(constant rate of release) is generally referred to
as Sustained or Controlled Release.
CR - controlled release. See SA.
DR - delayed release. This generally refers to enteric-
coated tablets which are designed to release the drug
in the intestine where the pH is in the alkaline range.
ER - extended release. Dosage forms which are designed to
release the drug over an extended period of time,
e.g. implants which release drug over a period of
one or two months or years.
TD - time delayed. This is slightly different from DR in
that the drug release is designed to occur after a
certain period of time, e.g. pellets coated to a
certain thickness or multi-layered tablets or tablets
within a capsule or double-compressed tablets.
forms of solutions:
neb soln - nebulizer solution. Drug comes in nebules for use with
nebulizer.
inh soln - inhalation solution. Some manufacturers use this as a
synonym for neb soln; others use it to mean that drug
comes in bottle with dropper, distinct from neb soln.
country abbreviations:
Aus - Australia
Can - Canada
UK - United Kingdom
Sw - Switzerland
NZ - New Zealand
misc:
OTC - over-the-counter, all other medications are
prescription-
only in the U.S.
----------------------------------------------------------------------
The Physicians' Desk Reference is published annually by:
Medical Economics Data Production Company
Montvale, NJ 07645-1742
ISBN 1-56363-061-3
It is a compendium of official, FDA-approved prescription
drug labeling. The FDA is the U.S. Food and Drug Administration.
----------------------------------------------------------------------
Contributors:
------------
Lawrence M. (Larry) Bezeau BEZEAU@UNB.CA
Daniel Canonica d_canonica@trzcl1.mrgate.mailer.umc.alcatel.ch
John Connett jrc@concurrent.co.uk
Mark Delany markd@bushwire.apana.org.au
+ Walter de Wit dewit@hamilton.niwa.cri.nz
Steve Dyer dyer@spdcc.com
Ian Ford ianford@dircon.co.uk
Susan Graham sgraham@hpb.hwc.ca
Rick Hughes richardh@Newbridge.COM
Simon Kelley srk@sanger.ac.uk
Rick Nopper nopperrw@esvax.dnet.dupont.com
Kevin A. Nunan pp000165@interramp.com
+ Janet Pierson JPierson@highlands.com
Matt Ray M.J.Ray@bradford.ac.uk
John Saunders John@gemini.demon.co.uk
Stephan Seillier seillier@on.bell.ca
John Underhay junderhay@upei.ca
David Williams exudnw@exu.ericsson.se
Travis Lee Winfrey travis.winfrey@fi.gs.com
----------------------------------------------------------------------
·
Disclaimer: I am not a physician; I am only a reasonably
well-informed asthmatic. This information is for
educational purposes only, and should be used only as
a supplement to, not a substitute for, professional
medical advice.
Copyright 1994 by Patricia Wrean. Permission is given to freely
copy or distribute this FAQ provided that it is distributed in full
without modification, and that such distribution is not intended for
profit.
--
Patricia Wrean wrean@caltech.edu