It’s frustrating for us RTs (and RNs and DRs too of course) when an asthmatic comes to see us in the ER and then we find out he stopped taking his meds meant to “prevent” such an attack.
It’s equally frustrating when an asthmatic comes in only because his inhaler ran out. We know that most of the time if he would have come in right away instead of taking those extra puffs his asthma would not have gotten so bad.
That in mind, I have come up with a list of five types of asthma meds commonly prescribed for asthma, and why it is essential they be used as instructed:
1. Rescue inhaler: (Albuterol, Xopenex) Ideally, Albuterol is to be used every 4-6 hours and Xopenex every 4-8 hours as needed for shortness of breath caused by narrowing of the airways (bronchospasm). It is meant to STOP an asthma attack. If it doesn’t work, you should avoid abusing it.
Sure you may have realized – as many asthmatics have – that side effects to this drug are minimal, so abusing it is easy. Still, the fact you are still short of breath after two extra puffs of your rescue inhaler should be an indicator you need to see your doctor, and not that you need more puffs.
Of course it is acceptable that you take an extra puff or two occasionally for mild asthma symptoms, and some of you may need it to prevent excercise-induced asthma, but if you need more than the occasional extra puff, this means that – for a majority of you asthmatics – your asthma is not controlled.
The fact you need this medicine more than recommended means that you are trying to manage your asthma on your own instead of calling your doctor and letting him do what he is trained to do.
(If you want some more tips on when to come into the ER for your asthma, check out this post, "Having asthma symptoms? Here’s five tips to help you decide what to do.")
2. Inhaled Corticosteroids: (Flovent, Pulmicort, Aerobid, Azmacort, Vanceril) These meds reduce inflammation in your lungs and ultimately make your lungs stronger so your lungs are better able to handle your asthma triggers, and your rescue inhaler works better when you need it.
It’s takes 2-3 weeks for this medicine to get into your system and take full effect.** And, therefore, if you wait until you are having an attack to start using it, the med will do you no good**.
**3. Long acting bronchodilators: ** (Serevent, formoterol) These are bronchodilators that last up to 12 hours and prevent asthma attacks. Normally, for asthma, they are given in conjunction with corticosteroids (Advair, Symbicort).
This med group usually takes up to 20 minutes to start working, and therefore will have little effect if used to stop an astha attack. Likewise, abuse of this medicine is believed to be a leading cause of death for asthmatics. The FDA, however, has noted that the benefits of using this medicine far outweigh the risks, but** this med is meant to be taken once in the morning and once before bed and NEVER more**. It is also meant to be taken in conjuction with a corticosteroid. The FDA ruled that asthmatics, in general, are probably better off taking a combo drug, i.e. Advair or Symbicort.
3. Leukotriene inhibitors: (Singulair) This is an excellent medicine used to prevent allergies. It is more commonly prescribed for asthmatics because it blocks the leukotrienes from being released when your body is exposed to allergens, and thus prevents bronchoconstriction during an asthma attack.
This medicine should be taken once daily by mouth even when you are feeling good, and it also takes up to 2-3 weeks to start working. This is a preventative medicine that is most effective when it is well established in your system. It should not be taken to stop an attack.
There are, however, some exceptions you may want to discuss with your doctor, as this med can also be used 2 hours prior to excercise to prevent excercise induced asthma.
4. Anti-inflammatory agents: (Cromolyn and Tilade) This is a classic asthma preventative medicine used to reduce swelling in your airways. It’s also a mast cell stabilizer that prevents the release of hystamine, a chemical that can cause allergic reactions, and leukotrieins, a chemical that causes bronchospasm.
This type of medicine does not work to stop an asthma attack, and sually takes 1-2 weeks of continued use before it starts working. Therefore, if you stop using this medicine it will not prevent an asthma attack.
There is one other thing I can say about #2-4 above that may sometimes be overlooked, but I know from personal experience it is true:
If you take your preventative medicines exactly as prescribed, when you do have asthma symptoms these symptoms are likely to be less severe and more easily treated with your rescue inhaler (#1 above).
So don’t be the goofus asthmatic who abuses his rescue inhaler until it runs out before rushing to the ER, and don’t be the asthmatic who makes a trip to the ER just because she decided to stop taking her preventative meds.
Instead, be the gallant asthmatic who is thankful science has provided you the opportunity to control your asthma, and take care of yourself.
A Registered Respiratory Therapist and asthmatic