Managing Asthma and Living a “Normal” Life
- Wednesday, September 23, 2009, 9:04
- Asthma
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- I’ve noticed that there are many people with asthma who seek information, but some people are rather complacent about it. As an asthma specialist, are you concerned that some asthmatics may not be doing all they can to manage their illness?
- Dr. Shapiro:
- Oh, yes, it’s a major problem! As I was saying, people should be able to lead a fairly normal lifestyle. And many people go under-treated because they put up with dysfunction and they don’t really need to. There are very well-tolerated medications these days. Even if you don’t want to get rid of your cat, you shouldn’t just give up and say, “I’m going to have to deal with this.” There are options today, and many people can do better than they’re doing.
- Andrew:
- Would you please describe the latest drugs and treatment available to people for both management and episodic treatment of asthma?
- Dr. Shapiro:
- Understanding that asthma is an inflammatory disease, in the last ten years or so, has led to the development of therapies that really hit the inflammation. There are also very good rescue medications today to get you out of a bind when your anti-inflammatory isn’t quite doing everything. We were talking earlier about some of the types of anti-inflammatory medications. There are non-steroidal agents like Cromolyn and Adocramil, and the new leukotrine agents. And then there are inhaled corticosteroids, which are very good for mild disease and also for moderate and severe disease. There are a number of brands available so that people have choices now, between more classic metered dose inhalers, the “puffers” that people see on TV shows and movies, and all over the place. And also dry powder devices, which may be easier for some people to use. There are all sorts of spacers and holding chambers to help people get the medication into their lungs. So there is a wide range of anti-inflammatory therapy. There is also a wide range of bronchodilator therapy. And each patient who has asthma, at least chronic asthma that’s a daily or almost daily problem, should have a daily management plan, and an action plan. So that there are things that they can do right away when things aren’t going well, to keep them from losing sleep and ending up in emergency rooms.
- Andrew:
- One of the classes of drugs you talked about was an inhaled corticosteroid that could help people with moderate to severe asthma to keep it under control. Is this something that you do routinely–take a couple of puffs when you brush your teeth in the morning and then again at night?
- Dr. Shapiro:
- That would be a typical sort of program, where it’s very easy to do and would not interfere with your day or your night. And amazingly, something like an inhaled corticosteroid used that way–two puffs morning and night–can make a huge difference. If you could look down with a little telescope into the bronchial tubes you would see that over a week or two or use, swelling would calm down, mucous production would calm down, and you can make an angry airway look very normal with drugs like inhaled steroids.
- Andrew:
- I understand that there are national guidelines suggesting that patients with ongoing asthma have a plan to manage their illness. How is a plan formed–for example, is it written?
- Dr. Shapiro:
- It would be a good idea for you to tell your doctor–or, your doctor may come up with it spontaneously–that you would like to have something that you can hold on to, something that you can refer to in the future, that refreshes you on what you should be doing every day to maintain good health, and then what you should do when you start to see things going downhill. So that you can catch things early and not have an emergency.
- Andrew:
- Is there sort of an overriding take-home message you’d like to leave with our audience?
- Dr. Shapiro:
- I think the message all along is that people can be managed well so that they can have a normal lifestyle, and that preventive therapy on a regular, ongoing basis with these anti-inflammatory medications is very important to maintaining that sort of good lifestyle we want for everyone.
- Andrew:
- Well, that’s a good message and I think one that’s very comforting to people to know that they can go on and not suffer with asthma.
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