ASTHMA Q & A

Q: What is the appropriate treatment for infrequent asthma attacks?

A: Treatment, of course, depends upon the severity and frequency of asthma attacks, with minor, infrequent attacks once or twice weekly effectively treated with inhaled PRN beta-2 agonists. The patient may benefit dramatically by the addition of routine nedocromil or cromolyn to his regimen. Though the exact mechanisms of action of these agents remain elusive, and they exert no immediate symptomatic relief whatsoever, they are thought to stabilize the membranes of mast cells and block the release of chemical mediators responsible for both the initial bronchospastic phase of asthma and the inflammatory hyperreactive phase. Regular use of one of these agents may eliminate the necessity for further measures in many patients, particularly in those suffering from exercise-induced asthma.


Q: When are steroids indicated for the treatment of asthma?

A: In patients whose attacks are more frequent or are severe enough to seek emergency treatment or hospitalization, more aggressive measures than beta-agonsits and mast-cell stabilizers are obviously appropriate. Once the acute emergency of a severe attack is over, prevention of future attacks and mitigation of their severity are crucial. In order to effect these changes, it is imperative that the consequences of the secondary inflammatory phase of the attack be adequately addressed.
     Systemic glucocorticoids are unquestionably effective for this purpose, but their side effects make them viable only as a last resort. Any of the various inhaled glucocorticoids can be added to regimens of beta-2 agonists and/or nedocromyl/cromolyn without complication; and properly used, their systemic effects are minimal.


Q: Any special counseling needed for the patient on multiple inhalers?

A: With all inhaled medications, proper administration remains a primary concern, for if administered improperly, such medications like Serevent can do more harm than good. The patient should be able to demonstrate proper use of his inhaler(s), with proper inhalation technique as well as proper administration order and timing for multiple inhalers. Five minutes should separate a beta-2 agonist (administered first to dilate the breathing passages) from a steroid or mast-cell stabilizer to maximize the penetration and benefit from the second agent.

Q: I’m confused about ozone’s role in asthma. Isn’t ozone necessary to protect us from ultraviolet radiation?

A: Yes, in the upper atmosphere, ozone is both necessary and perilously depleted. Ozone, though, is a major component of air pollution from combustion engines and is concentrated at ground level, particularly in cities prone to inversion layers. Cities like Albuquerque, Denver, San Antonio, and Los Angeles endure frequent ozone warnings during hot weather. Along with sulfur dioxide, ozone is a primary cause of asthma exacerbations, especially among adult sufferers.
(Just call me Cliff Clavin.)