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alt.support.asthma FAQ: Asthma -- General Information |
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use" exemption to the worldwide ban, which grants the manufacturers an
extra few years to develop alternatives.
Since the inactive ingredients (i.e., everything but the drug itself)
must be changed, it's not as simple as using a different chemical for the
propellant - the new device must go through much the same approval
process as the original inhaler did, to ensure that the same dosage is
delivered to the patient, that there are no side effects, that patients
tolerate the new formulation well, etc.
The FDA has already approved one new non-CFC inhaler, Proventil HFA
(albuterol), which uses hydrofluoralkane instead of CFC propellants.
Other non-CFC devices are currently in the works. It is expected that
future non-CFC inhalers may be reviewed and approved more quickly than
the earlier ones.
CFC-based MDIs will continue to be available for some time. Proposed
guidelines for final phaseout include that there be at least 3 multi-use
(see below) non-CFC devices available in a drug class (i.e.,
bronchodilators, corticosteroids), providing at least 2 different drugs,
before all CFC inhalers in that class are banned. As an example,
CFC-based bronchodilators would be permitted as long as Proventil HFA is
the only alternative; if Ventolin (also albuterol) and Alupent
(metaproterenol) had non-CFC versions, then all CFC formulations might be
banned.
The term "multi-use" refers both to aerosol inhalers and multi-use
dry-powder inhalers such as the diskhaler. It does not include
single-use dry-powder inhalers such as the rotahaler, which requires
insertion of a new capsule of medication with each use.
2.4 What kinds of tablets are there?
-------------------------------------
CR - controlled release. This means that the drug has a
constant rate of release.
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, such
as implants which release the drug over a period of
months or years.
SA - sustained action. Used interchangeably with CR
(above), except that SA usually refers to the
pharmacologic action while CR refers to the drug
release process.
TD - time delayed. This is slightly different from DR in
that the drug release is designed to occur after a
certain period of time, such as pellets coated to a
certain thickness, multi-layered tablets, tablets
within a capsule, or double-compressed tablets.
Contributed by: Susan Graham sgraham@hpb.hwc.ca
2.4.1 Why do I need a blood test when taking theophylline?
-----------------------------------------------------------
Theophylline is commonly used as a third-line agent in the
management of asthma, after beta-agonists and anti-inflammatories.
Unfortunately, its therapeutic level is quite close to its toxic
level. This means that the dose that the asthmatic 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 asthmatic
is receiving the optimal amount of theophylline is to take
a blood level concentration.
2.4.2 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 in the U.S.
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.
2.5 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
2.6 What medications should asthmatics be careful about taking?
----------------------------------------------------------------
Aspirin can trigger an asthma attack in approximately one in
five asthmatics. This is especially common in those asthmatics
who also have nasal polyps. As acetominophen (Tylenol), also
known as paracetamol overseas, doesn't have this effect, it may
be used as an alternative for anyone who suspects that they might
have aspirin sensitivity.
Cough medicines should also be treated with caution. In general,
suppressing a productive cough (one which is bringing up mucus)
is not a good idea, since the mucus can obstruct the airways
and also irritate them further. Also, in _Asthma: Stop
Suffering, Start Living_, the authors caution that "prescription
cough suppressants (including those with codeine) are potentially
dangerous for asthmatics. They may make you sleepy and reduce
your breathing effort. They may also dry out your secretions,
making mucus harder to raise."
Antihistamines, however, should not pose a problem for most
asthmatics, in spite of many warning labels. In _Children with
Asthma_, Dr. Plaut states, "Most asthma experts see no problems
with using antihistamines between or during asthmatics . . .
Theoretically these drugs might dry up the mucus in the
windpipes, thus making it harder to cough it up, but this has
never been proved."
Asthmatics taking theophylline should be careful when taking any
of the following medications: the ulcer medications cimetidine
(Tagamet) and troleandomycin (TAO), beta-blocker drugs such as
propranolol, and the antibiotics erythromycin and ciprofloxacin.
These medications may increase the concentration of theophylline
in the bloodstream, possibly even to the toxic level (see
section 2.4.1). People taking theophylline should be alert for
signs of possible toxicity such as rapid or irregular heartrate,
nervousness, or nausea, when taking these medications. In fact,
asthmatics taking theophylline should check with their physician
before taking any OTC medication, as the list of drugs, including
antihistamines, which affect theophylline levels is almost
endless.
Beta-blockers, usually taken for hypertension, can pose problems
even for those asthmatics not taking theophylline. Beta-blockers
work by blocking the hormone adrenalin, but as adrenalin and
other adrenergic drugs help keep airways dilated, the use of
beta-blockers may aggravate asthma symptoms.
2.6.1 What about corticosteroids and chicken pox?
--------------------------------------------------
According to the pamphlet "Advice from your Allergist", published
by the American College of Allergy & Immunology, children taking
oral or injected corticosteroids may be at increased risk of
complications from chicken pox. Such children should avoid
exposure to chicken pox -- if the child has been exposed, their
physician should be notified. However, the child's medications
shouldn't be changed without advice from their physician, since
corticosteroid therapy should not be stopped abruptly.
Children taking inhaled corticosteroids are not at this increased
risk, according to the pamphlet, since the system concentrations
of the medication are so small.
======================================================================
3.0 What resources are there for asthmatics?
---------------------------------------------
Please see the alt.support.asthma Reading/Resource List. It
is maintained by Lynn Short , and is
posted periodically to alt.support.asthma, alt.med.allergy,
sci.med, and misc.kids. I highly recommend it!
I also strongly recommend the following guidelines: the
"Global Initiative for Asthma", the "NHLBI Executive Summary:
Guidelines for the Diagnosis and Management of Asthma", and
the "Executive Summary: Management of Asthma during Pregnancy"
(full citations in References section). They may be ordered
in the U.S. by calling (301) 251-1222 and asking for publication
numbers 95-3659, 94-3042A, and 93-3279A, respectively. When I
ordered them, and asked that they be sent to a US address, there
was no charge.
Another set of guidelines which has been recommended to me but
which I haven't seen myself yet is "NAEPP. Nurses: Partners
in Asthma Care", publication number 95-3308, which I assume is
also available at the number given above.
The newsgroup misc.kids also has an allergy and asthma FAQ,
which is available either by following the instructions
posted on misc.kids.info, or by accessing the World Wide Web,
.
In addition, I maintain an Asthma and Allergy WWW Resources Page,
, and
two FAQs on allergies. For information on how to access these
allergy FAQs, please see section 3.1.
3.1 Where can I get the latest copy of the FAQs?
-------------------------------------------------
The two asthma FAQs I maintain,
alt.support.asthma FAQ: Asthma -- General Information
alt.support.asthma FAQ: Asthma Medications
are posted once a month, on or about the 17th, to the following
newsgroups: alt.support.asthma, alt.med.allergy, sci.med,
alt.answers, sci.answers, and news.answers.
If these FAQs have already expired at your site, you can get
them by sending mail to mail-server@rtfm.mit.edu, with a blank
subject line, and with one or more of the following commands
in the message:
send usenet/news.answers/medicine/asthma/general-info
send usenet/news.answers/medicine/asthma/medications
Alternatively, if you're really in a hurry, you can get them via
anonymous ftp from rtfm.mit.edu, with the path names:
/pub/usenet/news.answers/medicine/asthma/general-info
/pub/usenet/news.answers/medicine/asthma/medications
The general information FAQ is also available in html format on
the World Wide Web, at
; a plaintext
version of the FAQ is at http://www.radix.net/~mwg/asthma-gen.txt.
Of the two allergy FAQs I maintain,
alt.support.asthma FAQ: Allergies -- General Information
alt.support.asthma FAQ: Allergy Medications
the first is still under construction. The second is posted
monthly to the following newsgroups: alt.support.asthma,
alt.med.allergy, sci.med, alt.answers, sci.answers, and news.answers.
If the allergy medication FAQ has already expired at your site, you
can get it by sending mail to mail-server@rtfm.mit.edu, with a blank
subject line, and with the following command in the message:
send usenet/news.answers/medicine/allergy/medications
Alternatively, if you're really in a hurry, you can get it via
anonymous ftp from rtfm.mit.edu, with the path name:
/pub/usenet/news.answers/medicine/allergy/medications
3.2 What is an FAQ, anyway? What is a Usenet newsgroup?
---------------------------------------------------------
The term FAQ is an acronym which stands for Frequently Asked
Questions. Often the term is also used for any document, such
as this one, which attempts to answer questions which are
frequently posted to a specific Usenet newsgroup. For example,
this is one of the three alt.support.asthma FAQs which attempt
to answer questions frequently posted to the newsgroup
alt.support.asthma.
A newsgroup is a world-wide electronic forum of discussion which
generally takes place over the Internet, each newsgroup having
its own topic of discussion. For more information about FAQs and
newsgroups in general, I recommend any of the periodical postings
in the newsgroup news.announce.newusers, particularly
"FAQs about FAQs" and "What is Usenet?" These last two may also
be accessed by sending mail to mail-server@rtfm.mit.edu, with a
blank subject line, and with one or both of the following commands
in the message:
send usenet/news.answers/faqs/about-faqs
send usenet/news.answers/usenet/what-is/part1
Alternatively, if you're really in a hurry, you can get them via
anonymous ftp from rtfm.mit.edu, with the path names:
/pub/usenet/news.answers/faqs/about-faqs
/pub/usenet/news.answers/usenet/what-is/part1
+3.3 How about some other WWW links?
---------------------------------------------------------
The original Asthma Resources page that Pat maintained is temporarily
unavailable. In the meantime, I'm compiling a list of a few
sites whose URLs I have handy. As with any website, these are
not intended to substitute for competent medical advice, nor
do I vouch for the currency or accuracy of information on these
sites.
http://asthma.about.com
http://www.virtualdrugstore.com
http://www.cs.unc.edu/~kupstas/FAQ.html
http://nationaljewish.org
http://www.vh.org/Providers/ClinGuide/AsthmaIM/staging/chronic/classif.html
http://www.pslgroup.com
http://www.srs.org.uk
http://www.gpiag-asthma.org/asthma/GPIAG/welcome.htm
http://www.nhlbi.nih.gov/index.htm
http://www.nhlbisupport.com/asthma/index.html
======================================================================
List of Contributors:
---------------------
Kevin Ball kb036@seqeb.gov.au
Betty Bridges bcb56@ix.netcom.com
Mark Delany markd@bushwire.apana.org.au
Mark Feblowitz mfeblowitz@GTE.com
Bill Ellis Fleenor efleenor@pacbell.net
Paula Ford pxf3@psuvm.psu.edu
Lyn Frumkin, M.D., Ph.D. lrfrum@u.washington.edu
Joe Gems jgems@cais.com
Susan Graham sgraham@hpb.hwc.ca
Gwenith Jones gaj5m@virginia.edu
Philip D. Mayo, M.D., FCCP cn1435@coastalnet.com
Judith B. Paquet, R.N. judyp@snip.net
======================================================================
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.
The Compendium of Pharmaceuticals and Specialties is published
annually by:
Canadian Pharmaceutical Association
Ottawa, Ontario, Canada K1G 3Y6
ISBN 0-919115-94-2
Robert Berkow, M.D., editor in chief, _The Merck Manual of Diagnosis
and Therapy_, 15th ed., (Merck & Co., Inc., USA) 1987.
ISBN 0911910-06-09
The Merck Manual provides an overview of the diagnosis and
therapy of the whole range of medical disorders that can occur
in infants, children, and adults. I am told that the 16th
edition is now available, with ISBN 0911910-16-6, and that
the 17th edition should be available sometime in 1997.
"Global Initiative for Asthma: Global strategy for Asthma Management
and Prevention. NHLBI/WHO Workshop Report. March 1993",
National Institutes of Health/NHLBI, Publication No. 95-3659,
January 1995.
These are often called the "GINA Guidelines".
National Asthma Education Program Expert Panel Report, "Executive
Summary: Guidelines for the Diagnosis and Management of Asthma",
U.S. Department of Health and Human Services, Public Health
Service, National Institutes of Health, Publication No. 94-3042A,
Reprinted July 1994.
Often called the "NHLBI Guidelines", this is a summary of the
current wisdom on asthma treatment and prevention for physicians.
I found it very readable.
The above report, written in 1991, has now been superseded by:
National Asthma Education and Prevention Program Expert Panel Report 2:
Guidelines for the Diagnosis and Management of Asthma (revised
6/18/97)
This report provides clinicians with recommendations for the
diagnosis and management of asthma. These recommendations are
organized into four components of therapy: measures of assessment
and monitoring, control of factors contributing to asthma severity,
pharmacologic therapy, and education for a partnership in asthma care.
The recommendations are an update of the 1991 Expert Panel Report.
The report can be accessed directly from
http://www.ama-assn.org/special/asthma/treatmnt
/guide/guidelin/guidelin.htm
Report of the Working Group on Asthma and Pregnancy, "Executive
Summary: Managment of Asthma during Pregnancy", National
Institutes of Health/NHLBI, Publication No. 93-3279A, March 1993.
The American College of Allergy & Immunology, (ACAI), publishes a
pamphlet titled "Advice from your Allergist." It may be
ordered from:
ACAI
85 West Algonquin Road, Suite 550
Arlington Heights, IL 60005
(708) 427-1200
+ Michael R. Freedman, Samuel J. Rosenberg, Cynthia L. Divino
Living Well With Asthma (Guilford Press, USA) 1998.
ISBN 1572303182 hardback, 1572300515 paperback
The authors are former associates of National Jewish
Medical and Research Center.
M. Eric Gershwin, M.D., and E.L. Klingelhofer, Ph.D., _Asthma:
Stop Suffering, Start Living_, 2nd ed., (Addison-Wesley, USA) 1986.
ISBN 0-201-60847-2
The first author is Chief of Allergy and Immunology, University
of California, Davis, Medical School. He is board-certified
in internal medicine, allergy, and clinical immunology.
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 Department
of Physiology there.
Paul J. Hannaway, M.D. _The Asthma Self Help Book: how to live a
normal life in spite of your condition_, 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.
Glennon H. Paul, M.D. and Barbara A. Fafoglia, _All About Asthma
& How to Live with It: the complete guide to understanding and
controlling asthma_, (Sterling Publishing Co., NY, USA) 1988.
ISBN 0-8069-6808-7, 0-8069-6809-5 paperback
Dr. Paul is the medical director of respiratory therapy at
St. John's Hospital in Springfield, Illinois, and specializes
in allergy and respiratory diseases.
Thomas F. Plaut, _Children with Asthma -- A Manual for Parents_,
(Pedipress, Inc., Amherst, Massachusetts, USA) 2nd edition 1995.
ISBN 0-914625-03-9
Richard N. Podell, M.D. and William Proctor, _When Your Doctor Doesn't
Know Best: medical mistakes that even the best doctors make --
and how to protect yourself_, (Simon & Schuster, USA) 1995.
ISBN 0-671-87112-9
Nancy Sander, _A Parent's Guide to Asthma_, (Doubleday, USA) 1989.
ISBN 0-385-24478-9
The author is the founder of Mothers of Asthmatics.
Genell Subak-Sharpe, _Breathing Easy -- A Handbook for Asthmatics_,
(Doubleday, NY, USA) 1988.
ISBN 0-385-23440-6
This book was written in consultation with the National Jewish
Center for Immunology and Respiratory Medicine.
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.
Stuart H. Young, M.D. with Susan A. Shulman and Martin D. Shulman,
_The Asthma Handbook -- A Complete Guide for Patients and Their
Families_, (Bantam Books, USA) 1985.
ISBN 0-553-24797-2
Dr. Young is the Chief of Allergy Clinics in both the Department
of Medicine and Department of Pediatrics at the Mount Sinai
Medical Center. He is also a clinical assistant professor of
Medicine and a clinical associate professor of Pediatrics at the
Mount Sinai Medical School.
Francis V. Adams, MD, _The Asthma Sourcebook_ (Lowell House, Los Angeles
CA) 1996
ISBN 1-56565-471-471-4
Dr. Adams is an award-winning pulmonary specialist in the field of
asthma. He is currently Assistant Professor of Clinical Medicine at
New York University and Attending Physician at Bellevue Hospital in
New York.
The following citations were used in compiling the
Occupational Asthma section:
O'Neil, CE: Review: Mechanisms of Occupational Airways Diseases
Induced by Exposures to Organic and Inorganic Chemicals. Am j Med Sci
1990; 299(4) 265-275
Bernstein, DI: Respiratory Sensitization to Chemical Allergens.
Masters in Allergy Vol 1, (1) 17-21
Grammer, LC: Occupational Asthma. Immunology and Allergy Clinics
of North America Vol 13 (4) Nov 1993 769-783
Chan-Yeung, M: A Clinician's Approach to Determine the Diagnosis,
Prognosis, and Therapy of Occupational Asthma. Medical Clinics of
North America Vol 74 (3) May 1990 811-822
======================================================================
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 1996 by Patricia Wrean, 1997-2000 by Marie Goldenberg. 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.
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