Wednesday, August 1, 2012

Asthma needs to be treated seriously and treated well.

Asthma can be a terrible scourge. An asthmatic attack is like having to breath through a thin straw 24 hours a day  because of the changes that happen to the network of tubes that make up the lungs.

Asthma is a combination of inflammation and muscular contraction affecting the tubes - or bronchioles - within the lungs. The inflammation is to the lining of the tubes, and when the lining gets thicker then the lumen - or open part of the tube where the air travels through - has to get narrower. The inflammation also affects the quality of the mucous produced by the lining: instead of having a watery consistency it becomes thicker and more sticky not only making it difficult to clear from the lungs, but also leads to plug formation which can block some of the smaller airways.

In asthma, the circular muscle that controls the diameter of the Bronchioles become thicker and more sensitive to varying stimuli such as cigarette smoke, viruses, chemicals, exercise etc. And it's this combination of narrow inflamed tubes and increased sensitivity to stimuli that can move an asthmatic with reasonably comfortable breathing to someone seriously struggling to breath in an Emergency Department. Thankfully, we now have very effective medications that can help prevent most of these serious consequences of Asthma, but the concern is that patients are not getting the best treatment through lack of "compliance" - not taking their medications properly - or as in the case of some children, they are being given inappropriate treatment.

The medications we have for preventing asthma are based on Steroids, and these are nearly always given by inhaler, though they can be supplemented by oral medication if control is poor and the symptoms bad. Another type of anti-inflammation medication which is not a Steroid, is know as a Leukotrene Receptor Antagonist - LTRA's - and these usually come in tablet form. LTRAs are not "first choice" meds, but can be added to inhaled steroids if the steroids are not giving maximum control.

To relieve the spasm of the thickened circular muscle, Doctors have been using Salbutamol for over 50 years. The problem with salbutamol is that it only lasts about 4 hours, but his has been overcome by a more recent medication known as Salmeterol that is known as a Long Acting Beta Agonist, and its the combination of long acting Beta Agonists and inhaled steroids that has been used in adult Asthma regimes for many years. But this is NOT the ideal for 90% of childhood asthmatics.

Asthmatics should be controlled where possible by Inhaled Steroids: and the least effective dose is the preferred dose. If the inhaled steroid is not sufficient then there are three step-up options for poorly controlled asthmatics on inhaled corticosteroids:

adding a long-acting beta2 agonist
adding a leukotriene receptor antagonist
increasing the dose of inhaled corticosteroids.

The addition of a leukotriene receptor antagonist is the preferred option for children with ongoing activity-related asthma. Long-acting beta2 agonists are not recommended for children
five years or younger.


If you are an asthmatic, or your child is an asthmatic, you should have a written Asthma Management Plan which needs to be reviewed and updated by your treating Doctor on a regular basis. If you don't have an Asthma Plan, get one: it could save your life.


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