How to Treat Asthma

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Last time we talked about signs that your asthma is not in good control like if you need your blue puffer more than 3 times per week. This time we will talk about what the different asthma medications do.

There does seem to be some confusion about what asthma medications do what. I have a story. There was this health care professional whose son ended up in the emergency room with asthma twice in one night. So the next day, the boy was seen by a doctor and prescribed an antibiotic, Prednisone pills for 5 days, an inhaled steroid puffer to use twice a day, and told the boy to continue using his salbutamol (blue) puffer as needed. The health care professional was very upset. This person didn’t know why the boy needed so much medication. This person felt the inhaled steroid did the same thing as the blue puffer, the prednisone was ridiculous, and that the boy was well controlled on his blue puffer anyway.

We will come back to the case in a minute, but two important points are that even us health care professionals can often use some education, and that you know already from last week that if a patient ends up in the emergency room because of asthma problems, that by definition they have poor asthma control.

We think that the majority of problems in asthma are from inflammation of the lining of the tubes in your lungs. Since most of us have never seen the inside of our lungs, let’s talk about the back of your hand. Normally, if you rub a feather or sprinkle some sand on the back of your hand, it doesn’t hurt, right? Now let’s pretend the back of your hand has poison ivy. It is red, and inflamed. Now if we rub a feather or sprinkle some sand on your hand, the muscles in your arm will twitch, pull your hand away, and spill your coffee. So to prevent you from spilling your coffee, we could treat your hand and arm in two ways. We could inject some muscle relaxants into the muscles in your arm. This would mean that although rubbing the feather on your hand hurts, the muscles in your arm are too relaxed to spill your coffee. We could also rub some steroid cream onto the red, inflamed rash. This would slowly, over time (like weeks) reduce the rash so that rubbing the feather on your hand wouldn’t hurt and so you wouldn’t spill your coffee.

This is how we treat asthma in the lungs. When you are having an asthma attack (like coughing, wheezing, having trouble breathing, etc.), we should give you something that will immediately relax the bands of muscles around the tubes in your lungs. Often (but not always) this is an inhaled medication like salbutamol (the brand name is Ventolin) and the inhaler is blue. Just like with your inflamed hand, if a little bit of dust, cold air, or some other irritant gets into your inflamed lungs, the muscles over-react and you cough, and wheeze. So the salbutamol (or short acting beta-agonist) relaxes the twitchy muscles in your lungs and stops the coughing and wheezing. The short acting beta-agonist does NOT fix the underlying problem of inflammation in your lungs. As an extra problem, short acting beta-agonists like salbutamol or Ventolin, speed up the heart. So if you use too much salbutamol or Ventolin it can be hard on the heart.

So how do we fix the inflammation in the lungs and not speed up the heart too much? Just like with your inflamed hand, we use a steroid. In the lungs we use a steroid puffer, not a cream, but if we use it every day, over weeks and months the inflammation in the lungs will go down. So after the inflammation goes down, if you inhale a little dust or cold air you won’t cough and wheeze. This is just like after the inflammation on your hand goes down, if you rub a feather on it you won’t jerk your hand away and spill your coffee.

This is why we say that ideally we want an asthma patient to use an inhaled steroid regularly everyday to keep the inflammation down and only need there short acting beta-agonist (like salbutamol or Ventolin) three or fewer times a week.

So back to our case study. The medications the doctor prescribed were appropriate. The antibiotic will kill the bugs in the lungs that caused the problem in the first place. Prednisone pills are the strongest antiinflammatories for the lungs that we have. The prednisone will quickly reduce the swelling in the lungs caused by the infection. The problem is that prednisone is too strong to be used for more than about a week in asthma. So we use the inhaled steroid to keep helping the inflammation in the lungs heal. Remember, just like the poison ivy on your hand, it may take weeks or longer for the inflammation in the lungs to go away. After the inflammation in the lungs has healed, we think the patient should remain on the inhaled steroid so the next irritation (infection, etc) doesn’t make the lungs swell up again. Finally we hope that if the boy continues to use his inhaled steroid regularly he will end up needing his blue puffer 3 or less times a week and stay out of the emergency room.

As always if you have any questions or concerns about these or other products, ask your pharmacist.