Asthma - a treatable disease
with Steven M. Brown, M.D., pulmonary specialist, Columbia St. Mary's
Dr. Steven M. Brown, a pulmonary specialist with Columbia St. Mary's, published his first research paper on asthma 25 years ago. Since then, he has seen this potentially dangerous illness become a treatable one. This is due to increased awareness of how to control asthma, and the drugs that have been developed to treat it.
Unfortunately, many people are so used to the symptoms that they do not seek treatment but, Dr. Brown stressed, even moderate asthma has the potential to be dangerous. Left untreated, asthma can cause permanent changes in the structure of the lungs, a condition called airway remodeling. This may make the lungs unresponsive to asthma medications should the condition worsen.
Also, a sudden acute asthma attack can cause respiratory failure, alteration in heart rhythm or a lack of oxygen in the tissues. All of these have the potential to be lethal and nearly all of them can be controlled with the modern-day arsenal of asthma drugs.
"The goal of asthma treatment is to make the patient as symptom-free as possible, using as few drugs as possible, so as not to break the bank, and with a regimen of medication that is as convenient as possible," Dr. Brown said.
The type of asthma a patient has and its severity will determine the drugs used and the frequency of treatment.
Types of drugs
Asthma drugs fall into two basic categories. The first treat the underlying causes of asthma. These are called "maintenance medications." A second, usually fast-acting type that is often called "rescue medication," is used when a person has an asthma attack. Today, many of the medications of both types are given via inhalers rather than pills. The advantage of inhalers is "that systemic side effects can be significantly reduced," Dr. Brown said.
Maintenance medications
Often called "controller medications," these work to reduce constriction and inflammation in the airways. These include long-term bronchodilators, which relax the airways and allow more air to pass through. With daily use, they can help prevent constriction from occurring in the first place, alleviating a major asthma symptom. They may also be given orally and some are available in liquid form which is of special benefit for small children.
One of the newest types of maintenance drugs are leukotriene modifiers. Leukotrienes, formed from essential fatty acids, are released in the body in response to allergic reactions. Since they are powerful bronchoconstrictors, reducing their presence in the body may alleviate asthma symptoms. These drugs are taken orally.
A third group of drugs for long-term asthma treatment are corticosteroids, which reduce inflammation in the airways. The National Institute of Health has noted that inhaled corticosteroids are the most beneficial control medications for those suffering from chronic asthma. This class of drugs can also be taken orally. Though some people confuse them with steroids taken by athletes, they are not the same drugs. "We have a twenty-year track record with inhaled steroids and they seem to be very safe," Dr. Brown said.
Physicians also may prescribe a number of milder anti-inflammatory drugs. Cromolyn or antihistimines are two drugs frequently prescribed for children. Patients may be instructed to use these daily, or prior to exposure to something known to cause an asthma attack. For example, a child suffering from exercise-triggered asthma may be instructed to use an inhaler prior to a soccer game to control symptoms. Once in the body, these drugs keep working to prevent symptoms over a number of hours.
Rescue medications
Rescue medications are taken when asthma symptoms suddenly occur or worsen. They can be life saving in certain circumstances, but will not prevent future attacks or alleviate the underlying cause of asthma.
Rescue medications include fast-acting bronchodilators which relax the airways. The most common of these is albuterol. It starts working within five minutes and can alleviate symptoms for up to six hours. Albuterol and other rescue medications also may be prescribed before an attack to prevent symptoms, in much the same way cromolyn is used.
Drug breakthroughs for asthma
Many of the new groups of asthma inhalers are designed to get the medication deep into the areas where it can do the most good. "Foremost of these newer delivery systems are the Diskus device (used in Advair and Serevent) and the Turbuhaler (used in Pulmicort). In addition, the combination of an inhaled steroid and a long-acting bronchodilator in one inhaler (Advair) has been a boon to many with moderate or severe asthma," Dr. Brown said.
In addition, Dr. Brown noted other advantages to the multi-drug inhaler. "There is a substantial cost savings in combination therapy, ease of use - one inhalation twice daily instead of four to six inhalations two to four times daily - and each device has a built-in counter to let you know when you are running out of medication," he said.
These drugs have been valuable for many asthma sufferers but there is even more help on the way. "Newer drugs, using genetic engineering technology, may prove even more effective and may be used as infrequently as once a week or once a month," he said.
