Asthma Control Made Easy
- Monday, September 7, 2009, 23:01
- Asthma
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- Andrew:
- Most people don’t hesitate to use their inhalers to prevent asthma attacks, but it seems many people are not aware that asthma is a chronic condition. What do you tell your patients about long-term management of asthma?
- Dr. Nathan:
- Clearly, asthma is a chronic disease. To keep it under good control, you need to take medication on an ongoing basis.
- Andrew:
- To some people, “ongoing basis” means, “If I feel tight, I’ll reach for that rescue inhaler.” But you mean something much more active than that, don’t you?
Common controller and rescue medications
- Dr. Nathan:
- People take their controller medication regularly to prevent, or try to prevent, having to use that rescue inhaler. We use controller drugs to prevent symptoms. We have rescue medication to treat symptoms. For patients with persistent disease, the preferred approach is to use medication proactively to try to prevent symptoms, versus having to rely on their rescue medication to treat the disease on a reactive basis.
- Andrew:
- If someone is using a rescue medication frequently – and maybe you could tell us what frequently means – that means that it’s getting too far, right?
“If patients are having to use their rescue inhaler more than two to three times a week, that tells us their asthma is not under good control.”
- Dr. Nathan:
- If they’re having to use their rescue inhaler more than two to three times a week, that tells us their asthma is not under good control.
- Andrew:
- Let’s differentiate between controller medications and rescue medications- what are some brand names?
- Dr. Nathan:
- We have three or four different types of controller medications. The most important are the inhaled corticosteroids-these are the most potent anti-inflammatory drugs that we have available. Examples would be fluticasone [Flovent], budesonide [Pulmicort] and triamcinolone [Azmacort]. We have two long-acting bronchodilators- salmeterol [Serevent] and formoterol [Foradil]. We have the anti-leukotriene agents, which work on inflammation and bronchial constriction, but probably not to the same degree as inhaled steroids work on inflammation and as the long-acting bronchodilators work on bronchial constriction. Of those drugs, we have montelukast, which is Singular, and zafirlukast, which is Accolate. And then, we have one of the old standbys, theophylline [generic name], which is used less frequently.
Examples of the rescue medications are albuterol, which is Proventil or Ventolin. Maxair, which is pirbuterol, is another example of a rescue inhaler. But just to clarify, if people are going to be on a controller drug, first they’re going to be on an anti-inflammatory medication — one of the inhaled steroids.
- Andrew:
- And they’d use these medications daily?
- Dr. Nathan:
- Yes.
- Andrew:
- When do people typically use them? I’ve heard that it’s a good idea to take them when you brush your teeth, morning and night.
“For compliance reasons, it’s best to tie in taking a medication to rituals, whether it’s brushing your teeth, eating meals, or combing your hair.”
- Dr. Nathan:
- It’s really best for compliance reasons to tie in taking a medication to rituals, so whether it’s brushing your teeth, eating meals or combing your hair, whatever. You have to pick a ritual that works best for you.
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