Medications Fall Into 4 Groups, Cover Spectrum
Asthma treatment has changed in recent years as researchers have discarded notions that asthma is simply a constriction of bronchial tubes in the lungs.
Researchers now believe that inflammation--in which cells accumulate in the lungs causing secretions to plug the airways--plays a bigger role than was previously thought.
Although past therapy focused on keeping the airways open, many specialists now give their patients drugs that prevent inflammation as well.
Some asthma patients may live in fear of their next attack, but doctors say that with proper medication, the disease can be well managed. There are four major types of drugs being used, all of which require prescriptions:
* Cromolyn sodium. An inhaled drug, it is used to prevent asthma attacks by suppressing inflammation. Researchers believe that it helps stop the mast cells from releasing histamines.
* Beta-agonists. These adrenaline-like sprays, called bronchodilators, are inhaled when the tightness occurs in breathing. They help relax the muscles that can choke the airways. Some of these drugs can cause such side effects as a racing heart, and they have recently been under scrutiny in studies that link increased risks of death to long-term reliance on the drugs. Some researchers suspect that the beta-agonists make the air passages more irritable over time.
* Steroids. These are generally inhaled, and they also help suppress the inflammation, reduce muscle spasms and reduce mucus production. Steroids that are taken by mouth have long been considered to have serious side effects, such as weight gain, thinning of the skin and breakdown of bone. But the inhaled sprays are much less dangerous, doctors said.
* Theophylline. These long-acting pills were once the primary medication for asthma. The drug opens airways by relaxing the muscles surrounding the bronchial tubes. The drug is related to caffeine and can sometimes cause intestinal problems, headaches and anxiety. Blood levels must be carefully monitored to prevent side effects.
Because of the growing evidence that the bronchial inflammation is a more important aspect in controlling asthma than the constriction of the airway muscles, theophylline is no longer the mainstay drug, some doctors say.
Several researchers speculate that the widespread use of beta-agonists may be increasing the asthma complication rate.
A recent study suggested that patients who rely heavily on beta-agonist inhalers are more likely to have severe attacks than asthmatics who use such medicines sparingly. But Sonia Buist, an asthma specialist at Oregon Health Sciences University in Portland, Ore., who worked on the study, said the beta-agonist users might have been more at risk because they were sicker to begin with.
Others, however, worry that many of their less affluent patients may be relying heavily on such medicines because they are less expensive. Several specialists said they are frustrated because many of the new treatments are more expensive than traditional medications.
Several asthma specialists said they prefer treating most patients with a combination of medicines. But with medicines so expensive, patients aren’t always able to stick with treatment plans, doctors said.
“Availability of medications and access to care play key roles,” said Floyd Malveaux, an associate professor at Howard University School of Medicine who specializes in asthma. “I have had patients who have had lots of hospital-room visits simply because they could not afford the medications.”
During the last two years, the National Institutes of Health has issued new asthma-treatment guidelines for doctors and has begun a four-year study of asthma in the inner city.
“I think the whole area of awareness is going to have a positive impact,” Malveaux said. “We have given the same priority to asthma that has been given to hypertension and high cholesterol. . . . Perhaps we’ve started to listen.”
