Monday, March 8, 2010

Medications to treat asthma

Medications for asthma tend to fall into 2 different categories: controllers and rescue medications. Controllers are meant for daily use and rescue medications should only be used as needed. If you are needing the rescue medication more than 2 times per week, your asthma is not under control.

Asthma is usually treated in a stepwise approach.

The first step is mild (intermittent) asthma. These are patients who have mild symptoms less than 2 times per week or have symptoms that are predictible, such as with exercise. These patients need a rescue medication (usually albuterol) which can be used before the onset of predictable triggers. It can also be used for mild symptoms that happen less than 2 times per week.

If you find that you or your child is needing your rescue inhaler more than twice per week then your asthma falls into step 2, mild presistent asthma. Your child probably needs a daily controller medication such as Flovent or Pulmicort. These are used daily and are not a rescue inhaler. The purpose of these medications is to control symptoms. If your child starts on Flovent then you should still use albuterol if she has breakthrough symptoms. The albuterol is a rescue inhaler which will stop worsening symptoms. The flovent is not going to stop an impending asthma attack.

If symptoms are still not controlled and you need the albuterol more than 2 times per week then you fall into step 3, moderate persistent asthma. The preferred treatment is the addition of a different controller medication such as Servent. This medication is similar to albuterol except it is long acting and does not help stop immediate attacks. A common medication used for patients in step 3 is Advair. Advair is a combination of flovent and servent in one medication. It is dosed twice a day and very easy for patients to use. Advair is also not a rescue inhaler. If your child is on Advair and still having symptoms then they need to use their albuterol.

If patients still have symptoms then the doses of controller medications can be increased. Severe symptoms can be treated with daily use of steroids such as prednisone.

This may be confusing but here is the bottom line-
Albuterol is a RESCUE inhaler.
Any other medication is not going to stop an attack.
Any medication other than Albuterol needs to be used AS PRESCRIBED (usually daily) and not AS NEEDED.
If you need the albuterol more than 2 times per week then your asthma is not controlled and you need to discuss this with your health care provider.

Besides medication, the most important thing is to avoid environmental triggers. Medication is not going to be completely effective if you do not eliminate the triggers of your asthma.

Next- inhaler vs nebulizer and how to use them.

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