Asthma

Currently, several drugs are used to treat asthma. Not all of the asthma drugs, however, should be used by every asthma patient. Some patients with mild asthma only need to use medication intermittently to control wheezing, while patients with more serious asthma need to take medication at regular intervals to avoid life-threatening attacks. It is important for asthma patients to see their doctors if the frequency or severity of their symptoms change. It has been suggested that many of the life-threatening asthma attacks are in people who once had mild asthma—with symptoms that could be treated as they occurred—which then progressed to a more severe case of the disease.

Bronchodilators dilate constricted lung airways by relaxing the muscles that line the bronchial tubes. Oral bronchodilators include theophylline; theophylline's counterpart, aminophylline, is used through a needle in the vein (intravenous or IV) for severe episodes of asthma. During severe, acute attacks of asthma, injections of epinephrine are given just under the patient's skin. Epinephrine has a quick, but short-lasting effect of bronchodilatation.

Most asthma patients are given bronchodilators such as albuterol that are used in a mist form that is inhaled A comparison of normal bronchioles and those of an asthma sufferer. Illustration by Hans & Cassidy. Courtesy of Gale Group. from either a special inhaler device or an aerosol machine. Some patients are instructed to use their bronchodilator at regular intervals, while others may just be told to use the inhaler if they notice the beginning of an asthma attack. The inhaled medications are quick-acting because they are directly applied to the constricted airways.

In the 1990s, some controversy about inhaled bronchodilators arose in the medical field. In a study published in 1993, doctors found an increased risk of death or near-death from asthma when patients used a type of inhaled bronchodilator commonly prescribed to control asthma. Although more information is still needed regarding the reasons behind the increase in deaths and near-deaths and their association with inhaled bronchodilators, some experts think that the association can be explained by several factors:

1. More people who use inhaled bronchodilators die because their asthma suddenly becomes more severe and they do not see their doctors. These patients are treating severe asthma with a drug usually prescribed for milder forms.
2. Bronchodilators may have long-term effects on organ systems.
3. Bronchodilators may, over time, increase airway hyper-responsiveness.
4. Physicians are not adequately monitoring their patients for progression from mild to severe asthma.

These factors are currently being investigated. Asthma experts stress, however, that people with asthma who use inhaled bronchodilators should continue to do so, but under medical supervision. They should also immediately contact their physicians if they notice a change in the severity and frequency of their symptoms.

A newer inhaled bronchodilator, called salmeterol, combines the direct effects of inhaled bronchodilators with the long-lasting protection afforded by oral bonchodilators. Salmeterol offers a new, effective drug choice for mild and severe asthma.