Cystic Fibrosis and Asthma

Dick:
Is what is happening with asthma at all similar to what happens with cystic fibrosis?

Dr. Berger:

Well, cystic fibrosis is a different type of disease, and again, it is genetic. It’s one of the more common genetic diseases, but the difference is that in cystic fibrosis, it has to do with an abnormality in the mucus formation. It’s very thick. And those patients unfortunately have their lives shortened despite very, very aggressive treatment. They’re much sicklier. And it also involves other organs, such as the gastrointestinal tract. Asthma is specifically a disease of the airways, and the mucus, although there’s mucus formation, it is not abnormal mucus formation. It’s just that there are large amounts of it. The major part is actually the inflammation. Cystic fibrosis by itself does not have a response to allergies. Certainly, a patient with cystic fibrosis can have allergies, but cystic fibrosis as opposed to asthma is not an allergic disease.

Dick:

Are we having more success, then, and are patients getting better relief or control of their asthma with the anti-inflammatories?

Dr. Berger:

Well, we have certainly seen a much greater success rate in controlling asthma with the use of anti-inflammatories, and the majority of anti-inflammatories being used are what we refer to as inhaled corticosteroids. Inhaled corticosteroids are steroids from the adrenal cortex, and the reason I like to mention that is there’s a lot of concern about the word “steroid.” Steroid is actually a word for a chemical structure of some of the hormones that are produced in our body. Estrogen is a steroid. And the one that people get particularly concerned about are the anabolic steroids, the testosterone developed drugs. That’s why people sometimes get a little nervous about using steroids, but the adrenocorticosteroids from the adrenal cortex that have an anti-inflammatory action have absolutely no relationship with the anabolic steroids. I want to stress that it’s very clear to those of us who take care of asthma that anti-inflammatory therapy with inhaled corticosteroids is, right now, the gold standard for treatment.

Dick:

And these are the medications that we see in the inhalers that asthmatic persons may have.

Dr. Berger:

Correct, and they come in different forms. We have metered dose inhalers. We have dry powder inhalers, and there’s a lot of push right now towards dry powder inhalers because of the fact that the freon propellant that was used in the past to help get the metered dose inhalers to release the medication has been affecting our ozone later. And so we’re seeing these Freon propellants being taken out of refrigeration units. We’re seeing them being taken out of deodorant sprays, and they’re also being taken care of in removing them out of metered dose inhalers. And so, as a result, we’re using non-Freon-propellant dry powder inhalers. They say that necessity very often is the mother of invention. We’ve re-looked at the whole topic of inhalation medications, and we’re finding that in many cases the dry powder inhalers have advantages in terms of better deposition to the lungs and easier in terms of their ability to use.

Dick:

I see. Is there any downside to these medications?

Dr. Berger:

I think the only downside, really, is not using them. Certainly, if you take them in very, very high doses, just like any other medication, there can be some side effects. But we find in most cases that by not using these medications, the side effect is that you have chronic inflammatory airway disease. And especially in children where we’re seeing literally an epidemic of severe asthma in terms of increased emergency rooms and increased hospitalizations, not using these medications certainly has a much greater effect than the use of these medications.