Asthma
How is it treated?
There are four stages of asthma severity. Treatment is provided in a stepwise manner, dependent on the severity or stage of the disease. Many treatment strategies are based on the level of control of the condition. For example, in patients who are very poorly controlled, therapy will be increased, or ?stepped up?, in order to achieve better control. In patients who are very well controlled, therapy will be decreased, or ?stepped down?, in order to use the least amount of therapy for the most control. Below is a summary of the stages of asthma, as well as current treatment recommendations. In each case, it is important to use your short-acting beta2-agonist (fast-acting inhaler) to manage immediate symptoms of your disease.
The stages of asthma and recommended treatments are:
- Intermittent: Considered the mildest form of asthma, with patients experiencing symptoms less than 2 days a week and 2 nights a month. Patient use of a rescue inhaler is limited to less than two days per week. These patients have no limitations in daily activities due to their condition. Treatment at this stage is limited to use of a short-acting beta2-agonist (fast acting or rescue inhaler) as needed for symptom management.
- Mild Persistent: Patients experience asthma symptoms more than twice a week, but less than once a day, with nighttime symptoms 3-4 times per month. Use of a rescue inhaler is required no more than two days per week and not more than once per day. These patients have minor limitations in daily activities.
At this stage, treatment with a low dose inhaled corticosteroid is recommended. Alternative treatments would include Cromolyn, leukotriene inhibitors, or theophylline.
- Moderate Persistent: Patients experience symptoms more than once a day and more than one night a week, but not nightly. Use of a rescue inhaler is required almost daily. These patients have some limitation in daily activities due to their condition.
At this stage, a low- to medium-dose inhaled corticosteroid and a long-acting beta2-agonist are recommended. Alternative treatments include high dose inhaled corticosteroids alone, a leukortriene inhibitor, or theophylline.
- Severe Persistent: Considered the most severe form of asthma, with patients experiencing continuous symptoms throughout the day on most days and frequently at night, often seven nights per week. Use of a rescue inhaler is required several times per day. These patients have extremely limited activity levels due to their condition. Patients with severe persistent asthma require treatment with a high dose inhaled corticosteroid and a long-acting beta2- agonist. Alternative treatment includes an oral corticosteroid tablet or syrup that may be used to prevent or treat severe asthma symptoms. Patients with allergies and severe persistent asthma may benefit from the use of Xolair (omalizumab).
CFC's in Inhalers and Depletion of the Ozone
The production of substances that damage the earth's ozone layer is being phased out world wide under the terms of an international agreement called the Montreal Protocol on Substances that Deplete the Ozone Layer. Since most of the metered-dose inhalers (MDIs) available in the United States for the treatment of asthma contained ozone-damaging chlorofluorocarbons (CFCs), many of these MDIs are being reformulated to no longer use CFCs. Many products will be reformulated with the propellant hydrofluoroalkane (HFA), which carries medicine into the lungs with no known ozone-depleting chemicals. The reformulation effort is underway and several non-CFC products are currently approved and/or marketed for a range of different drugs (including non-CFC MDI versions for albuterol, beclomethasone, fluticasone, and ipratropium, as well as dry powder inhaler (DPI) versions of fluticasone, formoterol, and salmeterol.) Several more non-CFC products are currently being developed.
Do not be concerned that the medicines you need to treat your asthma will be removed from the market. CFC-containing MDIs will not be removed by the FDA until sufficient alternative medicines exist to serve the needs of patients. The reformulation effort should be complete by December 31, 2008, when all production and sale of MDIs that contain CFCs must stop.
If your MDI has been changed over to a non-CFC containing formulation, ask your doctor or pharmacist to educate you on the use of your new inhaler, as there may be some differences in administration technique. Additionally, as a result of the new propellant, you may experience a different taste or sensation when using your new inhaler.
Drug classes used to treat Asthma Combination Inhalers Inhaled Beta-2 Agonists Inhaled Corticosteroids Leukotriene Modifiers Mast Cell Stabilizers Monoclonal Antibodies Oral Beta-2 Agonists Theophyllines
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How is it treated?
