Asthma Treatment: An Overview Of Quick Relief Asthma Medicines

An asthmatics attack is like an emergency, since it causes severe anxiety and a panic like situation. While the treatment of such an attack or any other case of exacerbated asthma should be only in accordance with expert medical advice, being aware can help in alleviating anxiety and taking a more informed approach for its overall management.
Asthma Treatment: An Overview of Quick Relief Asthma Medicines
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The immediate relief of an asthmatic attack requires medicines that are different from those being used for the long term asthma control. Hence, the first thing to remember is that when you get an attack of asthma, increasing the daily dose of your regular medicine is unlikely to be of great help. Instead, you need medicines that can provide quick relief from symptoms. You must take these medicines strictly according to the prescription, as self-prescription can lead to complications.

There are three types of medicines used for the quick relief of asthma.

1. Albuterol like Medicines

These belong to the category of 'short

acting beta-2 agonists', which provide relief by dilating the airways. The asthma attack is precipitated by two factors, secretion of excessive mucus and constriction of airways. Albuterol (Proventil, Ventolin), which is known as Salbutamol outside the Unitede States helps in providing quick relief by directly dilating the airways and thereby releasing the obstruction to some extent. However, it does not take care of the underlying process of inflammation and mucus nor does it heal the injury to airways, which means that its effect is temporary and once the effect of a dose tapers, the asthma will again worsen. This is why it is often combined with other medicines.

Other medicines in this category are Isoproterenol (Isuprel, Norisodrine), Metaproterenol (Alupent, Metaprel), Terbutaline (Bricanyl), Pirbuterol (Maxair), Bitolterol (Tornalate) and Levalbuterol (Xopenex). Levalbuterol, a new medicine, is considered as effective as Albuterol, and seems to have fewer side effects.

While using these medicines, there are many precautions, and hence they should not be used without proper consultation and prescription of a physician, nor should their dose be altered without consultation. Their overdose can be dangerous at times, especially in case of people with heart diseases, diabetes, high blood pressure and hyperthryroidism. They also interact with many other medicines, so if you are taking any other medicines do not forget to bring it to the notice of your physician. They can cause anxiety, tremors, headache and restlessness as side effects.

Another important aspect of their use is that in some people they are far more effective than others. A recent study called 'Beta Adrenergic response by genotype trial' or 'BARGE' found that some people have arginine type of beta receptors on which Albuterol is not very effective; while others who have glycine type of beta receptors respond well to Albuterol. So if you are not responding to Albuteol, this may be an explanation, meaning that you may respond better to other medicines, even if you are not responding to Albuterol or similar


2. Sytemic Corticosteroids

In moderate to severe attacks, one may need to resort to oral or injectable steroids. In such cases, inhaled steroids do not help. An additional dose of your regular long term steroid inhaler like Flovent or Pulmicort may provide little relief. During acute asthma, the airways are also constricted preventing the inhaled medicines to reach the target. Hence, oral and injectable steroids are the mainstay of treatment.

Most commonly used steroids are Prednisolone, Methylprednisolone and Hydrocortisone. They should be taken only on prescription of a physician, and more importantly, they should never be stopped nor their dose be modified without consultation with your physician as such a step can precipitate other medical complications including Adrenal suppression. When used for long term, steroids can lead to osteoporosis, which can be prevented by calcium supplements and hormonal replacement therapy. Other side effects include cataract, glaucoma, fluid retention, weight gain, hypertension, infections, menstrual irregularities and wasting of muscles. Because of these side effects, usually they are tapered off after the attack subsides. Such tapering must be done strictly as per prescription.

3. Anti-Cholinergic Medicines

These include inhaled Ipatropium Bromide (Atrovent), which also acts as a bronchodilator. Its action is through a mechanism different to Albuterol. It is usually not given alone, and is used along with Albuterol to enhance its effect. It is also beneficial for those who are having emphysema and chronic bronchitis, as it also helps in the penetration of medicines inhaled and allow other medicines to have a greater effect. Its side effects include dry mouth.

Thus, the way an acute attack of asthma is treated is very different compared to its long term regular treatment for preventing attacks. While in long term control, the patient herself needs to take a more proactive role and manage and modify her life-style in a manner that best serves her, in case of an acute attack, it is always preferable to strictly follow a physician's advice. Early treatment can avoid a lot of agony.

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