
 
 
Archive-name: medicine/asthma/general-info
URL: http://www.cco.caltech.edu/~wrean/asthma-gen.html
 
 
       alt.support.asthma FAQ:  Asthma -- General Information
       ======================================================
 
 
Introduction:
------------
 
Welcome to alt.support.asthma!  This newsgroup provides a forum for
the discussion of asthma, its symptoms, causes, and forms of treatment.
Please note that postings to alt.support.asthma are intended to be
for discussion purposes only and are in no way to be construed as
medical advice.  Asthma is a serious medical condition requiring
direct supervision by a physician.
 
This FAQ attempts to answer the most frequently asked questions on
the newsgroup alt.support.asthma.  It is maintained by Patricia Wrean
<wrean@caltech.edu>.
 
Please be aware that the information in this FAQ is intended for
educational purposes only and should not be used as a substitute
for consulting with a doctor.  Most of the contributors are not
health care professionals; this FAQ is a collection of personal
experiences, suggestions, and practical information.  Please remember
when reading this that every asthmatic responds differently; what is
true for some asthmatics may or may not be true for you.  Although
every effort is made to keep this information accurate, this FAQ
should not be used as an authoritative reference.
 
Comments, additions, and corrections are requested; if you do not
wish your name to be included in the contributors list, please state
that explicitly when contributing.  I will accept additions upon my
own judgement -- I'll warn you right now that I'm a confirmed skeptic
and am not a great believer in alternative medicine.  All
unattributed portions are my own contributions.  For more
information about asthma medications, there is also an Asthma
Medications FAQ that is posted as a companion to this one.
 
* = not added yet
+ = added since last version
& = updated/corrected since last version
 
======================================================================
 
Table of Contents:
-----------------
 
General Information:
&    1.0  What is asthma?
+         1.0.1  What is chronic asthmatic bronchitis?
          1.0.2  What is status asthmaticus?
          1.0.3  What is anaphylactic shock?
+         1.0.4  What is COPD?
          1.0.5  What is emphysema?
+         1.0.6  What is bronchitis?
+         1.0.7  What is pneumonia?
+         1.0.8  What is cystic fibrosis?
+    1.1  What is an asthma attack?
+         1.1.1  What is wheezing?
+         1.1.2  Do all asthmatics wheeze?
+         1.1.3  What is "coughing asthma"?
+         1.1.4  Is asthma hereditary?
+    1.2  How is asthma diagnosed?
+         1.2.1  What is a spirometer?
+         1.2.2  What is a peak flow meter?
&    1.3  How is asthma normally treated?
&         1.3.1  How is an acute asthma attack treated?
+    1.4  What are the most common triggers of asthma?
+         1.4.1  What is intrinsic/extrinsic asthma?
+         1.4.2  Can gastric reflux trigger asthma?
 
Medications:
&    2.0  What are the major classes of asthma medications?
     2.1  What are the names of the various asthma medications?
          2.1.1  Are salbutamol and albuterol the same drug?
     2.2  Are some asthma drugs banned in athletic competitions?
     2.3  What kinds of inhalers are there?
          2.3.1  Do inhaler propellants bother some asthmatics?
          2.3.2  What is a spacer?
          2.3.3  What is "thrush mouth" and how can I avoid it?
          2.3.4  Is Fisons still making the Intal Spinhaler?
          2.3.5  What's the difference between Spinhalers and 
Rotahalers?
          2.3.6  Why are so many asthma drugs taken via inhaler?
+         2.3.7  How can I tell when my MDI is empty?
     2.4  What kinds of tablets are there?
          2.4.1  Why do I need a blood test when taking theophylline?
          2.4.2  Why are combination pills not commonly prescribed?
     2.5  What is a nebulizer?
&    2.6  What medications should asthmatics be careful about taking?
 
Miscellaneous:
     3.0  What resources are there for asthmatics?
+    3.1  Where can I get the latest copy of the FAQs?
 
======================================================================
 
1.0  What is asthma?
--------------------
 
     Asthma is best described by its technical name:  Reversible
     Obstructive Airway Disease (ROAD).  In other words, asthma
     is a condition in which the airways of the lungs become
     either narrowed or completely blocked, impeding normal
     breathing.  However, in asthma, this obstruction of the lungs
     is reversible, either spontaneously or with medication.
 
     Quickly reviewing the structure of the lung:  air reaches the
     lung by passing through the windpipe (trachea), which divides
     into two large tubes (bronchi), one for each lung.  Each
     bronchi further divides into many little tubes (bronchioles),
     which eventually lead to tiny air sacs (alveoli), in which
     oxygen from the air is transferred to the bloodstream, and
     carbon dioxide from the bloodstream is transferred to the air.
     Asthma involves only the airways (bronchi and bronchioles),
     and not the air sacs.  The airways are cleaned by trapping
     stray particles in a thin layer of mucus which covers the surface
     of the airways.  This mucus is produced by glands inside the
     lung, and is constantly being renewed.  The mucus is then
     either coughed up or swept up to the windpipe (trachea) by
     cilia, tiny hairs on the lining of the airways.  Once the
     mucus reaches the throat, it can again be coughed up or,
     alternatively, swallowed.
 
     Although everyone's airways have the potential for constricting
     in response to allergens or irritants, the asthmatic's airways
     are oversensitive, or hyperreactive.  In response to stimuli,
     the airways may become obstructed by one of the following:
         - constriction of the muscles surrounding the airway;
         - inflammation and swelling of the airway; or
         - increased mucus production which clogs the airway.
     Once the airways have become obstructed, it takes more effort
     to force air through them, so that breathing becomes laboured.
     This forcing of air through constricted airways can make a
     whistling or rattling sound, called wheezing.  Irritation of
     the airways by excessive mucus may also provoke coughing.
 
     Because exhaling through the obstructed airways is difficult,
     too much stale air remains in the lungs after each breath.
     This decreases the amount of fresh air which can be taken in
     with each new breath, and this lack of fresh air means that
     less oxygen is available for the whole body.  This decreased
     supply of oxygen is what makes an uncontrolled asthma attack
     so serious.
 
 
1.0.1  What is chronic asthmatic bronchitis?
--------------------------------------------
 
     Chronic asthmatic bronchitis is the condition in which the
     airways in the lungs are obstructed due to both persistent
     asthma and chronic bronchitis (see sections 1.0 and 1.0.6).
     People with this disease generally also have a persistent
     cough which brings up mucus.  This condition differs from
     COPD in that it doesn't involve emphysema.
 
 
1.0.2  What is status asthmaticus?
----------------------------------
 
     Status asthmaticus is defined as a severe asthma attack that
     fails to respond to routine treatment, such as inhaled
     bronchodilators, injected epinephrine (adrenalin), or
     intravenous theophylline.
 
 
1.0.3  What is anaphylactic shock?
----------------------------------
 
     Anaphylactic shock is defined as a severe and potentially
     life-threatening allergic reaction throughout the entire
     body.  It occurs when an allergen, instead of provoking a
     localized reaction, enters the bloodstream and circulates
     through the entire body, causing a systemic reaction.
     (There may also be an intrinsic trigger, as some cases of
     exercise-induced anaphylaxis have been reported.)
 
     The symptoms of anaphylactic shock begin with a rapid
     heartrate, flushing, swelling of the throat, nausea, coughing,
     and chest tightness.  Severe wheezing, cramping, and a rapid
     drop in blood pressure follow, which may lead to cardiac
     arrest.  The treatment for anaphylaxis is intravenous
     epinephrine (adrenalin).
 
 
1.0.4  What is COPD?
--------------------
 
     COPD is chronic obstructive pulmonary disease, also known as
     either COAD, for chronic obstructive airway disease, or COLD,
     for chronic obstructive lung disease.  COPD is a disease in
     which the airways are obstructed due to a combination of
     asthma, emphysema, and chronic bronchitis.  The 1987 Merck
     Manual notes that "the term COPD was introduced because these
     conditions often coexist, and it may be difficult in an
     individual case to decide which is the major one producing
     the obstruction."
 
 
1.0.5  What is emphysema?
-------------------------
 
     Emphysema is the disease in which the air sacs themselves, rather
     than the airways, are either damaged or destroyed.  This is an
     irreversible condition, leading to poor exchange of oxygen and
     carbon dioxide between the air in the lungs and the bloodstream.
 
 
1.0.6  What is bronchitis?
-------------------------
 
     Bronchitis is an inflammation of the bronchi, the large airways
     inside the lungs.  (Bronchiolitis is the inflammation of the
     bronchioles, the small airways.)  This inflammation often leads
     to increased mucus production in the airways.
 
     Bronchitis is generally caused either by a virus or by exposure
     to irritants such as dust, fumes, or cigarette smoke.  If caused
     by a virus, the bronchitis will likely be only temporary.  In
     the case of prolonged exposure to irritants, particularly
     cigarette smoking, if there is permanent damage to the bronchi,
     bronchitis may become chronic.
 
 
1.0.7  What is pneumonia?
-------------------------
 
     Pneumonia is an infection of the tissue inside the lung.
     In adults, it is generally caused by bacterial infections.
     Fortunately, there is a pneumococcal pneumonia vaccination
     available as a preventive measure for the most common of
     these bacterial infections, streptococcus pneumoniae.  In
     children, pneumonia is most commonly caused by viruses.
 
 
1.0.8  What is cystic fibrosis?
-------------------------------
 
     Cystic fibrosis is a disease in which excessive amounts of
     unusually thick mucus are produced throughout the body.
     Because this mucus production also occurs in the lungs,
     people with cystic fibrosis are extraordinarily prone to
     bacterial infections which result in progressive lung damage.
     Cystic fibrosis can be diagnosed by a "sweat test" as people
     with cystic fibrosis have elevated chloride levels in their
     perspiration.  This condition often resembles asthma in
     children.
 
 
1.1  What is an asthma attack?
------------------------------
 
     An asthma attack, also known as an asthma episode or flare,
     is any shortness of breath which interrupts the asthmatic's
     routine and requires either medication or some other form of
     intervention for the asthmatic to breathe normally again.
 
 
1.1.1  What is wheezing?
------------------------
 
     Wheezing is the whistling or rattling sound that occurs when
     air flows through obstructed airways.  At the start of an
     asthma attack, wheezing usually only occurs while exhaling, or
     breathing out, but as the attack progresses, wheezing may
     then be heard both while inhaling and exhaling.  If after
     the attack progresses further, the asthmatic then stops wheezing,
     this may indicate that many bronchioles (small airways) have
     become completely blocked, which is a very serious condition.
 
 
1.1.2  Do all asthmatics wheeze?
--------------------------------
 
     No, not all asthmatics wheeze.  Although wheezing is extremely
     common in asthmatics, in _All About Asthma_, Dr. Paul says,
     "It is important to note that not all asthmatic symptoms need be
     present for one to experience an asthma attack.  For instance,
     not all asthmatics wheeze.  And sometimes wheezing is so slight,
     it can only be heard with a stethoscope.  With some asthmatics,
     coughing is the only symptom present."  Similarly, in _Children
     with Asthma_, Dr. Plaut states that children with chronic coughs
     "may have asthma even though no wheezing is present."  He
     diagnoses such children with asthma if their peak flow improves
     when given an inhaled bronchodilator.
 
 
1.1.3  What is "coughing asthma"?
---------------------------------
 
     In _Children with Asthma_, Dr. Plaut defines "coughing asthma"
     as "a form of asthma in which coughing is the only symptom and
     there is no abnormality in any lung function test."  This
     condition is also known as "cough variant asthma."  Coughing
     asthma often improves when standard asthma medications are
     taken.
 
 
1.1.4  Is asthma hereditary?
----------------------------
 
     Yes, there seems to be a hereditary component to the tendency
     to develop asthma.  In _All About Asthma_, Dr. Paul states that
     if neither parent has asthma, the chances of each of their
     children having asthma are less than 10%.  When one parent has
     asthma, the chances rise to 25%, and when both parents have
     asthma, the chances climb to 50%.  (Actually, there is
     considerable disagreement among my sources as to the exact
     numbers, but all agree that the chances climb dramatically if
     one or both parents have asthma.)
 
     Similarly, if one or both parents have allergies, the chances
     of each of their children having allergies are 35% and 65%,
     respectively, compared to a less than 10% chance if neither
     parent has allergies.
 
     However, Dr. Paul cautions that "children don't inherit asthma
     itself, but the tendency to develop it."  Whether or not an
     individual develops asthma is also influenced by their exposure
     to various other factors such as infections, irritants, and
     allergens.
 
 
1.2  How is asthma diagnosed?
-----------------------------
 
     Asthma is diagnosed based on a physical examination, personal
     history, and possibly lung function tests.  The physical
     examination looks for typical asthma symptoms such as wheezing
     or coughing, and the personal history provides additional clues
     such as allergies or a familial tendency towards asthma.  Lung
     function tests may be as simple as measuring peak flow with a
     peak flow meter, or using a simple spirometer, or may involve
     a battery of spirometry tests in a pulmonary function lab.
     In general, though, if the peak flow or lung volume increases
     significantly after use of a short-acting, inhaled bronchodilator,
     the diagnosis is probably that of asthma.
 
 
1.2.1  What is a spirometer?
----------------------------
 
     A spirometer is a machine for testing lung function that you
     breathe in and out of through a hose attached to a mouthpiece.
     You are usually given nose clips so that all the air you breathe
     goes through the machine.  One I've been tested on had a little
     expanding tank surrounded by water into which the air goes, and
     I could see the top rising and falling as I breathed out and in.
     It can measure a fair number of characteristics of your lungs,
     including FVC, FEV1, and PEPR.  FVC, or forced vital capacity,
     is the amount of air that you can exhale forcefully after taking
     a deep breath.  FEV1, or forced expiratory volume in one second,
     is the amount of air that you can be exhale in one second.
     Peak flow, or PEPR, is described in section 1.2.2.
     The sophisticated spirometers I've seen have a PC attached, and
     have neat little curves generated with each breath, which
     apparently have characteristic shapes for different respiratory
     diseases.
 
     There is a slightly less sophisticated machine that I've blown
     into, and I'm not sure if this is also classed as a spirometer or
     not, but you take a deep breath and blow into it, much like a
     peak flow meter, except that it draws a little graph of how much
     volume you've blown out, and I'd imagine that you can get the
     FVC and FEV1 off this graph.
 
     For more information, I recommend the book by Drs. Haas,
     _The Essential Asthma Book_, which goes into more detail about
     the various things you can find out from spirometry.
 



 
 
1.2.2  What is a peak flow meter?
---------------------------------
 
     A peak flow meter is a little plastic device which you blow hard
     into, after having taken a deep breath.  It records the rate at
     which you've blown into it in litres exhaled per minute (L/min)
     -- this is called the peak expiratory flow rate (PEF or PEFR).
     The meter is essentially a cylinder with a mouthpiece at one end,
     a place for the air to escape at the other end, and a calibrated
     meter along the side.  When you blow into it, a marker is pushed
     along the scale and comes to rest at a point which indicates your
     PEF.  Since you want to measure your maximum peak flow, it is
     important to take a deep breath and blow as hard and as fast as
     you can.  Many asthmatics find that their maximum peak flow 
provides
     a good objective measure of how their asthma is doing, so peak flow
     meters now are used extensively for self-monitoring of asthma, and
     also for monitoring the effectiveness of asthma medications.
 
 
1.3  How is asthma normally treated?
------------------------------------
 
     Treatment of mild asthma usually tries to relieve occasional
     symptoms as they occur by use of short-acting, inhaled
     bronchodilators.  Treatment of moderate or severe asthma,
     however, attempts to alleviate both the constriction and
     inflammation of the airways, through the use of both
     bronchodilators and anti-inflammatories.  Bronchodilators are
     drugs which open up or dilate the constricted airways, while
     drugs aimed at reducing inflammation of the airways are called
     anti-inflammatories.  Avoidance of irritants and allergens are
     also good treatment measures, and if the asthma is strongly
     triggered by allergies, then taking anti-allergic medication
     or taking shots for allergy desensitization are other
     alternatives.
 
     Taking anti-inflammatory drugs (usually inhaled corticosteroids)
     daily for moderate to severe asthma is a relatively new approach
     to treating asthma.  The idea behind it is that if the underlying
     inflammation of the airways is reduced, the bronchi may become
     less hyperreactive, making future attacks less likely.  Such
     anti-inflammatory therapy, however, must be taken regularly in
     order to be effective.
 
 
1.3.1  How is an acute asthma attack treated?
---------------------------------------------
 
     An acute asthma attack is usually treated by us of bronchodilators
     to reduce the constriction of the airways.  Intravenous adrenalin
     and theophylline are often given in emergency rooms for this
     purpose, if short-acting bronchodilators given by nebuliser
     haven't sufficiently controlled the attack.
 
     Once the acute attack is over, anti-inflammatories may be used to
     reduce the inflammation of the airways.  Inhaled steroids are
     usually the first choice, but for a sufficiently severe attack,
     oral steroids such as prednisone may also be given.
 
 
1.4  What are the most common triggers of asthma?
--------------------------------------------
 
     The most common triggers of asthma are:
         - viral respiratory infections, such as influenza (the flu)
           or bronchitis;
         - bacterial infections, including sinus infections;
         - irritants, such as pollution, cigarette smoke, perfumes,
           dust, or chemicals;
         - sudden changes in either temperature or humidity;
         - allergens, for people with allergies;
         - emotional upsets, such as stress; and
         - exercise.
 
 
1.4.1  What is intrinsic/extrinsic asthma?
------------------------------------------
 
     Intrinsic asthma is asthma which seems to be triggered by
     non-allergic factors.  Similarly, extrinsic asthma seems to
     be triggered by the presence of allergens in allergic
     individuals.  According to the 1987 Merck Manual, about
     30-50% of adult asthmatics have intrinsic asthma alone,
     10-20% have extrinsic asthma alone, and the remainder have
     a combination of the two.
 
     In _All About Asthma_, Dr. Paul states that "asthma triggers
     tend to be extrinsic in younger people and intrinsic in
     older people.  However, for both kinds of asthma, the symptoms
     are generally the same."
 
 
1.4.2  Can gastric reflux trigger asthma?
----------------------------------------
 
     Yes, gastric reflux can act as an irritant which triggers
     asthma.  Reflux, properly known as gastroesophageal reflux,
     occurs when the liquids in the stomach pass up the esophagus,
     or feeding tube.  Because these liquids are usually highly
     acidic, they can irritate and inflame the esophagus, and
     also the airways of the lung, should any of this liquid be
     aspirated.  This irritation can trigger an asthma attack.
 
     Asthma flares caused by reflux are more common at night,
     for it is easier for material to pass up the esophagus when
     one is lying down.  Some simple treatments to prevent reflux
     include raising the head of the bed, not eating close to
     bedtime, or using either antacids or medications such as
     ranitidine (Zantac) which reduce the amount of acid produced
     by the stomach.
 
 
======================================================================
 
2.0  What are the major classes of asthma medications?
------------------------------------------------------
 
     There are six major classes of asthma medications:
         - steroidal anti-inflammatories,
         - non-steroidal anti-inflammatories,
         - beta-agonists,
         - xanthines,
         - anti-cholinergics, and
         - anti-allergics.
 
     The first two categories of drug treat the underlying
     inflammation of the lung.  All steroidal anti-inflammatories
     are glucocorticosteroids, which are entirely different from the
     anabolic steroids that have become notorious for their abuse
     by athletes.  There are many different corticosteroids available
     for the treatment of asthma, almost all available via inhaler
     to reduce the amount of side effects (see section 2.2.6).  The
     only non-steroidal anti-inflammatory currently available is
     nedocromil sodium.
 
     The second two classes of asthma medications, beta-agonists and
     xanthines, are both bronchodilators.  Beta-agonists are
     chemically related to adrenalin.  They are usually taken in
     inhaled form, and all but one (salmeterol) are short-acting.
     The major xanthine, theophylline, is present in coffee and tea,
     and is taken orally.  Theophylline is chemically related to
     caffeine, since caffeine is also a xanthine derivative.
 
     Anti-cholinergics are also bronchodilators, and like the
     beta-agonists they block the contraction of the underlying
     smooth muscle of the bronchi.  Although used to treat asthma
     in Canada, the anti-cholinergic ipratropium bromide (Atrovent)
     has not approved by the US Food and Drug Administration for the
     treatment of asthma, but is used for the treatment of COPD.
     (It is interesting to note, however, that in the April 1982
     issue of The FDA Drug Bulletin, the FDA states that "the
     FD&C Act does not, however, limit the manner in which a
     physician may use an approved drug.  Once a product has been
     approved for marketing, a physician may prescribe it for uses
     or in treatment regimens or patient populations that are not
     included in a approved labeling."  The FD&C Act is the Food,
     Drug, and Cosmetic Act.)
 
     The last class, the anti-allergics, has been included because
     the two anti-allergic drugs, cromolyn sodium and zaditen, are
     commonly taken for the prevention of extrinsic asthma, asthma
     that has a strong allergy component.  Although cromolyn sodium
     is commonly thought of as a non-steroidal anti-inflammatory, it
     is actually anti-allergic, and both the Physicians' Desk Reference
     and the Compendium of Pharmaceuticals and Specialties state firmly
     that cromolyn sodium has no intrinsic anti-inflammatory properties.
     Zaditen, used mostly for pediatric allergic asthma, is not
     currently available in the United States.
 
 
2.1  What are the names of the various asthma medications?
----------------------------------------------------------
 
     For a complete listing of asthma medications, please see the
     alt.support.asthma FAQ:  Asthma Medications.  It is posted
     monthly as the companion to this general information FAQ.
 
 
2.1.1  Are salbutamol and albuterol the same drug?
--------------------------------------------------
 
     Ventolin is the brand name of salbutamol, which is the WHO
     (World Health Organization) recommended name for the medication.
     Unfortunately, in the US this same drug is called albuterol,
     leading to endless confusion.  In fact, it's one of the few
     drugs in which the brand name stays the same from country
     to country, while the chemical name changes!  Ventolin is made
     in the U.S. by Allen & Hanburys, and Proventil is the same drug
     manufactured by Schering.  You can also get this drug in
     a sustained-action tablet, called either Repetabs (by Schering,
     again) or Volmax (Muro).
 
 
2.2  Are some asthma drugs banned in athletic competitions?
-----------------------------------------------------------
 
     Banned substances in athletic competitions are not defined by
     whether they are medically necessary.  Instead, the determination
     of whether a substance is banned or allowed is based on whether
     it can enhance athletic performance and thus potentially give an
     unfair competitive advantage.  Many asthma drugs are BANNED in
     athletic competitions, and positive drug tests may result in
     disqualification of an athlete from competition for a 2 year
     period for the first offense.  The United States Olympic Committee
     and International Olympic Committee follow similar protocols for
     American amateur athletes competing in events held in the United
     States and internationally.
 
     A partial list of banned substances includes:  ephedrine,
     bitolterol, metaproterenol, orciprenaline, rimiterol, pirbuterol,
     and salmeterol.  Oral use of many selective beta-2 agonists such
     as albuterol is banned. However, inhaler or nasal vehicles
     containing many beta-2 agonists [e.g. albuterol and terbutaline]
     as well as steroid preparations [e.g. beclomethasone,
     dexamethasone, and triamcinolone] are allowed for use in
     competition with written notification from the treating physician.
     Such notification must be on file with the United States Olympic
     Committee [USOC] Doping Control prior to competition.  All forms
     of cromolyn sodium and theophylline are allowed.  Asthma
     medications do not cause false positives for substances assayed
     for in athletic competition.
 
     Athletes should be aware that recommendations regarding the use
     of asthma medications (i.e. allowed vs. banned) in athletic
     competition may be revised.  Ultimately, it is the athlete's
     responsibility to check with his or her National Governing Body
     [NGB] and coaches to identify whether any substance is allowed
     in athletic competition where drug testing may occur.  The
     USOC Drug Hotline, (800) 233-0393, can provide assistance for
     the most current recommendations.  In addition, the USOC Drug
     control program has a wide range of literature for athletes on
     what asthma medications are banned, allowed, and allowed with
     prior notification.
 
     Contributed by:  Lyn Frumkin, M.D., Ph.D. lrfrum@u.washington.edu
 
 
2.3  What kinds of inhalers are there?
--------------------------------------
 
     aerosol inhalers:
     ----------------
 
     MDI         - metered-dose inhaler, consisting of an aerosol unit
                   and plastic mouthpiece.  This is currently the most
                   common type of inhaler, and is widely available.
 
     autohaler   - MDI made by 3M which is activated by one's breath,
                   and doesn't need the breath-hand coordination that
                   a regular MDI does.  Available in U.S. for Maxair.
 
     respihaler  - aerosol inhaler for Decadron.  I have no idea how
                   this differs from the usual MDI.  Available in the
                   U.S.
 
     syncroner   - MDI with elongated mouthpiece, used as training 
device
                   to see if medication is being inhaled properly.
                   Available in Canada for Intal.
 
 
 
     dry powder inhalers:
     -------------------
 
     insufflator - dry powder nasal inhaler used with Rynacrom
                   cartridges.  Each cartridge contains one dose;
                   the inhaler opens the cartridge, allowing the
                   powder to be blown into the nose by squeezing
                   the bulb.  Available in Canada.
 
     rotahaler   - dry powder inhaler used with Rotacaps capsules.
                   Each capsule contains one dose; the inhaler opens
                   the capsule such that the powder may be inhaled
                   through the mouthpiece.  Available in the U.S.,
                   Canada, and UK for Ventolin.  In Canada, Beclovent
                   Rotacaps are also available.
 
     spinhaler   - dry powder inhaler used with Intal capsules for
                   spinhaler.  Each capsule contains one dose; the
                   inhaler opens the capsule such that the powder
                   may be inhaled through the mouthpiece.  Available
                   in Canada, UK, and the U.S.
 
     diskhaler   - dry powder inhaler.  The drug is kept in a series of
                   little pouches on a disk; the diskhaler punctures
                   the pouch and drug is inhaled through the mouthpiece.
                   Currently available in Canada and UK, not in U.S.
 
     turbuhaler  - dry powder inhaler.  The drug is in form of a pellet;
                   when body of inhaler is rotated, prescribed amount of
                   drug is ground off this pellet.  The powder is then
                   inhaled through a fluted aperture on top.  Available
                   in Australia and Canada.
 
 
2.3.1  Do inhaler propellants bother some asthmatics?
-----------------------------------------------------
 
     Some asthmatics find the dry powder inhalers more effective than
     their MDI (aerosol) counterparts.  It is suspected that the
     aerosol or propellant in the MDI may act as an irritant to some
     asthmatics, as in the following article:
 
     J.R.W. Wilkinson et al., Paradoxical bronchoconstriction in
     asthmatic patients after salmeterol by metered dose inhaler,
     British Medical Journal 305 (1992) 931.  The first sentence
     in the conclusion is:  "Bronchoconstriction after both
     salmeterol and placebo by metered dose inhaler but not after
     salmeterol by diskhaler suggests that the irritant is not
     the salmeterol itself."  . . . "The similarity in characteristics
     of bronchoconstriction after beclomethasone by metered dose
     inhalers implicates one or both chlorofluorocarbons . . . as
     the irritant.  That salbutamol caused no bronchoconstriction was
     attributed to its faster onset of action opposing any
     bronchoconstrictor effects of the propellants."
 
       However, according to the 1994 Physicians' Desk Reference,
        Intal Spinhaler capsules are "contraindicated in those
        patients who have shown hypersensitivity to . . . lactose."
        So asthmatics who are lactose-intolerant may not have this
        form of cromolyn sodium as an option.
 
 
2.3.2  What is a spacer?
------------------------
 
     A spacer is a device that simplifies the inhalation of aerosol
     metered-dose-inhalers (MDIs).
 
     Most people find it difficult (at least initially) to time the
     spraying of an MDI and the inhalation of the medicine, and, thus,
     most of the medicine is deposited in their mouths or the backs
     of their throats instead of their lungs.  Besides being less
     effective, this can lead to other side effects (e.g., for inhaled
     steroids, an increased potential for thrush, an oral fungal
     infection).
 
     The spacer is basically a temporary holding chamber for the
     medication.  You spray the medicine into the chamber where it
     temporarily remains suspended, and then you inhale deeply and
     SLOWLY.  The column of medication rapidly passes through the mouth
     and goes into the lungs.
 
     There are a few different types of spacers.  The one I'm most
     familiar with is the Aerochamber.  It's a plastic tube with a
     mouthpiece on one end and a place to insert the MDI on the other.
     The mouthpiece has a delicate one-way valve built in so that you
     can exhale without displacing the medication in the chamber and
     then inhale.
 
     Some spacers are clear, some have a little whistle built in that
     tells you if you're inhaling too fast.  I've read (and believe)
     that the medication is more efficiently delivered using a spacer
     than if it were merely inhaled directly from the MDI.  Some
     packages (AeroBID, I believe, and others) come with a spacer
     built into its MDI housing.
 
     There are special spacers for younger children.  There's an
     Aerochamber that has a mask built in; the child breathes normally
     for a few seconds with the mask held over his/her mouth and nose.
     This is typically used when a nebulizer is not available or not
     required, and for medications that cannot be nebulized, such as
     Beclovent or Vanceril.
 
     There is also a device for children called InspirEase, which is
     kind of like a plastic bellows or balloon with a plastic
     mouthpiece.  The child inflates it, the medicine is sprayed into
     it, and the child inhales, holds his/her breath for the count of
     5 (or whatever the doctor recommends), exhales into the device,
     and then repeats.  It's really helpful for younger children who
     don't really know about breathing in and breathing out or how to
     hold their breath or breathe evenly and slowly.  It gives them
     immediate physical feedback, and also  has a whistle built in to
     tell them when they're breathing too fast (although they seem to
     like making it whistle, so it's positive reinforcement for
     something that they shouldn't be doing).  As the child grows, the
     Inspirease becomes less effective, since it has a limited
     capacity.
 
     Although spacers are sometimes provided by some HMOs and covered
     by some insurers, I don't believe that a prescription is required.
 
     Contributed by:  Mark Feblowitz                mfeblowitz@GTE.com
 
 
2.3.3  What is "thrush mouth" and how can I avoid it?
-----------------------------------------------------
 
     Thrush, or thrush mouth, is the popular term for a yeast
     infection (candida albicans) in the back of throat.  The major
     symptom of thrush is a white film located at the back of the
     throat and tonsil area.  It is usually cured by the use of an
     antifungal mouthwash.
 
     Thrush is a very common side effect of taking inhaled
     corticosteroids.  The way to avoid this complication is to
     ensure that the back of the throat doesn't remain coated with
     corticosteroid after use of the inhaler, either by using
     a spacer or by rinsing the mouth very thoroughly afterwards.
 



     Unfortunately, some people still get it even when they are very
     thorough about rinsing.
 
 
2.3.4  Is Fisons still making the Intal Spinhaler?
--------------------------------------------------
 
     Yes, Fisons is still manufacturing both the Intal Spinhaler
     (a dry powder inhaler for cromolyn sodium) and the capsules
     for it.  Many pharmacists in the U.S. are under the impression
     that it is unobtainable, probably due to the fact that the
     Spinhaler was unavailable for a short time in the U.S. some
     while back due to a change in formulation.  During this time,
     some wholesalers stopped buying the inhaler, and didn't
     restock it once the Spinhaler was back in production.  So
     your pharmacist's regular wholesaler still may not be
     carrying this product.  For further information,
     Fisons Corporation's number for Rx Customer Service is
     (800) 334-6433.
 
 
2.3.5  What's the difference between Spinhalers and Rotahalers?
---------------------------------------------------------------
 
     [Maintainer's note:  the Rotahaler is a dry powder inhaler
     for Ventolin (albuterol), manufactured by Allen & Hanburys,
     while the Spinhaler is a dry powder inhaler for Intal
     (cromolyn sodium), manufactured by Fisons Corporation.  Both
     inhalers are available in the U.S.]
 
     The Rotahaler and the Spinhaler are very different animals.
     The Rotahaler is a pussycat, the Spinhaler a ferocious lion.
 
     The Rotahaler is a two-part mouthpiece that you snap apart,
     put a capsule in, twist, and inhale.  When you twist the device,
     the capsule breaks open.  When you inhale, the medicine lands
     in your lungs.
 
     The Spinhaler is a three-piece device: a mouthpiece, a tiny
     fan, and a cap to cover the fan.  You open it, put the capsule
     in a space on the fan, close it, push down then up on the cap
     (this breaks the capsule) and then tilt your head back, put
     the mouthpiece in your mouth, and inhale.  The fan throws the
     medicine into the back of your throat.  Then you gag.
 
     I don't like the propellants in MDIs, so I was highly motivated
     to get a Spinhaler.  It took me a month to get my drugstore to
     find it, and now I must admit I'm disappointed.  I tried using
     an Intal capsule in the Ventolin Rotahaler, since that device
     works so well, but the medicine seems to be of the wrong
     consistency, and the capsule is too large for the space it
     should go into.
 
     Another difference: The Spinhaler comes in a little container
     like a medicine bottle, but the lid doesn't stay on very well in
     a purse.  The Rotahaler comes in a little plastic case sort of
     like a compact and stays shut (i.e. clean) in a purse, backpack,
     or jeans pocket.
 
     Contributed by:  Paula Ford                    pxf3@psuvm.psu.edu
 
 
2.3.6  Why are so many asthma drugs taken via inhaler?
------------------------------------------------------
 
     Medications taken orally almost always have a much higher
     systemic concentration (concentration in your entire body)
     than inhaled medications.  So if the side effects are due
     to systemic concentrations, then an inhaled drug is less
     likely to have these side effects, or may have them much
     less severely.
 
     The idea behind an inhaler is that the full dose is delivered to
     the lungs, where it is immediately absorbed by the lung tissue,
     and starts to take effect locally.  Excess drug may be absorbed
     by the bloodstream and delivered to the rest of your body, but
     this amount tends to be minimal.  So your lungs receive an
     immediate, high concentration of the drug, and the rest of your
     body receives very little.
 
     If you take the drug orally in tablet or capsule form, then you
     need a much higher dose.  The reason is that for the same amount
     of drug to reach the lungs through the bloodstream, you need the
     same concentration of drug in the rest of your body.  For example,
     most people take one or two puffs of albuterol (Ventolin or
     Proventil) every four to six hours, and each puff is 90 micrograms
     of albuterol.  The usual dosage of Ventolin in tablets is 2-4
     milligrams three or four times a day, which is something like 200
     times the amount inhaled.
 
     However, one advantage that tablets have is that the medication
     may be available in a time-release format.  So for a short-acting
     medication like albuterol, the inhaled version might need to be
     taken every four to six hours, while a extended-release tablet
     such as Volmax would need to be taken only every twelve hours.
 
 
2.3.7  How can I tell when my MDI is empty?
-------------------------------------------
 
     You can tell whether an MDI (metered dose inhaler) canister is
     empty by taking the canister out of the mouthpiece and placing
     it in a container of water.  If the canister sinks, and lies
     horizontally on the bottom, then it is full.  If it floats
     horizontally at the top, it is empty.  The intermediate stages,
     floating vertically at the bottom of the container, floating
     vertically at the top of the container, and floating at the top
     at an angle of 30 to 40 degrees, indicate that it is roughly
     3/4 full, 1/2 full, and 1/4 full, respectively.
 
     However, Dr. Thomas Plaut warns in the September 1994 issue of
      Prevention magazine that this technique doesn't work for the
     cromolyn sodium inhaler:  "That's a perfect example of how fast
     asthma information changes. The float test doesn't work with the
     cromolyn inhaler because the powder in the MDI valve stem swells
     up when in comes in contact with water.  This blocks the medicine
     from leaving."
 
     The last-ditch alternative, of course, is to count the doses as
     you take them, and discard the canister for a new one once the
     number of doses on the label has been reached.  One variation
     of this, for medications that are taken regularly, is to calculate
     the date on which the medication will be used up, and discard the
     old canister for a new one on this date.
 
 
2.4  What kinds of tablets are there?
-------------------------------------
 
     CR  - controlled release.  This means that the drug has a
           constant rate of release.
     DR  - delayed release.  This generally refers to enteric-
           coated tablets which are designed to release the drug
           in the intestine where the pH is in the alkaline range.
     ER  - extended release.  Dosage forms which are designed to
           release the drug over an extended period of time, such
           as implants which release the drug over a period of
           months or years.
     SA  - sustained action.  Used interchangeably with CR
           (above), except that SA usually refers to the
           pharmacologic action while CR refers to the drug
           release process.
     TD  - time delayed.  This is slightly different from DR in
           that the drug release is designed to occur after a
           certain period of time, such as pellets coated to a
           certain thickness, multi-layered tablets, tablets
           within a capsule, or double-compressed tablets.
 
     Contributed by:  Susan Graham                  sgraham@hpb.hwc.ca
 
 
2.4.1  Why do I need a blood test when taking theophylline?
-----------------------------------------------------------
 
     Theophylline is a very effective drug but unfortunately its
     therapeutic level is quite close to its toxic level.  This
     means that the dose that the asthmatic needs to get the full
     benefit of the drug is not very much lower than the dose
     which causes side effects which range from unpleasant to
     dangerous.  This would not be such a problem if there weren't
     such large variations in the rate at which people metabolize
     theophylline.  Apparently, if a group of people are given
     the same dose of theophylline, the concentration of the
     drug in their bloodstreams may vary by up to a factor of
     seven.  Therefore, the best way to monitor that the asthmatic
     is receiving the optimal amount of theophylline is to take
     a blood level concentration.
 
 
2.4.2  Why are combination pills not commonly prescribed?
---------------------------------------------------------
 
     The combination drugs such as Tedral and Marax commonly
     contain theophylline, ephedrine, and some form of sedative
     such as phenobarbital.  These combination pills are no longer
     commonly prescribed because the amount of theophylline in
     the pill cannot be varied with respect to the other drugs.
     Since there is great variation in the rate at which an
     individual metabolizes theophylline, it is now considered
     better to take theophylline separately, for better adjustment
     of theophylline levels.  In fact, Tedral is no longer
     manufactured by Parke-Davis in the US.
 
     Also, ephedrine is no longer considered the bronchodilator
     of choice.  From Drs. Haas, _The Essential Asthma Book_,
     "ephedrine initiates the release of catecholamines -- including
     adrenaline -- that are already stored in the body.  This is
     its biggest drawback.  Its effects depend on the availability
     of catecholamine in the body at the time it is given, and
     these concentrations vary."  Since much better bronchodilators
     are now available, ephedrine is no longer commonly prescribed.
 
 
2.5  What is a nebulizer?
-------------------------
 
     A nebulizer is a device that uses pressurized air to turn a
     liquid medication into a fine mist for inhalation.  If you've
     ever received emergency treatment for asthma, they've probably
     used a nebulizer on you.
 
     The term nebulizer is often used to describe both the pump
     that pressurizes the air, and the part that holds and
     "nebulizes" the medication.  There are hand-held nebulizer
     units and ones with masks that you strap onto your face.
 
     The pressurized air typically comes from a portable pump unit
     that internally consists of a motor-driven air pump that
     resembles the fancier types of aquarium pumps.  It forces air
     through a plastic tube into the plastic nebulizer unit.  Inside,
     the nebulizer unit acts much like a perfume atomizer, creating
     a fine mist that is directed either through a tube that you
     inhale through or a mask that directs the mist into your nose
     and mouth.
 
     Since the nebulizer takes a few minutes to deliver the medication,
     you inhale it over a longer period of time than if you were using
     an inhaler.  This can really help, especially if your passages are
     not fully open and you're taking a bronchodilator.  As you breathe
     the medication, your lungs can gradually accept more and more of
     the medication.  In addition to the medication, many people find
     the accompanying mist (typically a sterile saline solution) to be
     soothing.
 
     For very young children, the nebulizer is the only practical
     means of administering inhaled medications.  Older children and
     adults have the options of using inhalers and a variety of
     spacers to make the timing a bit easier.  The doctor overseeing
     the treatment decides which is the most effective/appropriate
     delivery mechanism.
 
     At least in Massachusetts, the nebulizer pump unit, the
     hand-held nebulizers, the medications, and the sterile saline
     inhalation solution are all prescription items.  Replacement
     parts for the pumps are not available to the general public
     (if there are sources, I'd like to hear about them).
 
     The portable nebulizer pump units cost little ($100-$300)
     relative to the cost of an emergency room visit, so some health
     plans / insurers provide them to patients for times when an
     asthma episode is "manageable but not dangerous." This seems to
     be a trend in the management of pediatric asthma.
 
     Our family has been able to successfully avoid a few trips to
     the ER, and have even been able to head off some more severe
     allergic asthma episodes with early intervention.  After a few
     rather gruesome visits to the Mass. General Hospital's waiting
     room on a Saturday night, we welcome opportunity to treat our
     children at home, when it's safe.  We tend to go in to the doctor
     or ER for the more severe episodes or those that don't respond
     well enough to early intervention.
 
     Contributed by:  Mark Feblowitz                mfeblowitz@GTE.com
 
 
2.6  What medications should asthmatics be careful about taking?
----------------------------------------------------------------
 
     Aspirin can trigger an asthma attack in approximately one in
     five asthmatics.  This is especially common in those asthmatics
     who also have nasal polyps.  As acetominophen (Tylenol) doesn't
     have this effect, it may be used as an alternative for anyone
     who suspects that they might have aspirin sensitivity.
 
     Cough medicines should also be treated with caution.  In general,
     suppressing a productive cough (one which is bringing up mucus)
     is not a good idea, since the mucus can obstruct the airways
     and also irritate them further.  Also, in _Asthma:  Stop
     Suffering, Start Living_, the authors caution that "prescription
     cough suppressants (including those with codeine) are potentially
     dangerous for asthmatics.  They may make you sleepy and reduce
     your breathing effort.  They may also dry out your secretions,
     making mucus harder to raise."
 
     Antihistamines, however, should not pose a problem for most
     asthmatics, in spite of many warning labels.  In _Children with
     Asthma_, Dr. Plaut states, "Most asthma experts see no problems
     with using antihistamines between or during asthmatics . . .
     Theoretically these drugs might dry up the mucus in the
     windpipes, thus making it harder to cough it up, but this has
     never been proved."
 
     Asthmatics taking theophylline should be careful when taking any
     of the following medications:  the ulcer medications cimetidine
     (Tagamet) and troleandomycin (TAO), beta-blocker drugs such as
     propranolol, and the antibiotics erythromycin and ciprofloxacin.
     These medications may increase the concentration of theophylline
     in the bloodstream, possibly even to the toxic level (see
     section 2.4.1).  People taking theophylline should be alert for
     signs of possible toxicity such as rapid or irregular heartrate,
     nervousness, or nausea, when taking these or other additional
     medications with theophylline.
 
     Beta-blockers, usually taken for hypertension, can pose problems
     even for those asthmatics not taking theophylline.  Beta-blockers
     work by blocking the hormone adrenalin, but as adrenalin and
     other adrenergic drugs help keep airways dilated, the use of
     beta-blockers may aggravate asthma symptoms.
 
 
======================================================================
 
3.0  What resources are there for asthmatics?
---------------------------------------------
 
     Please see the alt.support.asthma Reading/Resource List.  It
     is maintained by Lynn Short <lfshort@europa.com>, and is
     posted monthly to alt.support.asthma, alt.med.allergy,
     sci.med, and misc.kids.  I highly recommend it!
 
 
3.1  Where can I get the latest copy of the FAQs?
-------------------------------------------------
 
     The two FAQs I maintain,
          alt.support.asthma FAQ:  Asthma -- General Information
          alt.support.asthma FAQ:  Asthma Medications
     are posted once a month, on or about the 17th, to the following
     newsgroups:
          alt.support.asthma, alt.med.allergy, sci.med,
 
     If these FAQs have already expired at your site, you can get
     them by sending mail to mail-server@rtfm.mit.edu, with a blank
     subject line, and with one or both of the following commands
     in the message:
 
 
     Alternatively, if you're really in a hurry, you can get them via
     anonymous ftp from rtfm.mit.edu, with the path names:
 
 
     The general information FAQ is also available in html format on
     the World Wide Web, with URL:
 
          http://www.cco.caltech.edu/~wrean/asthma-gen.html
 
 
======================================================================
 
Contributors:
------------
 
+ Kevin Ball                                        kb036@seqeb.gov.au
  Mark Delany                              markd@bushwire.apana.org.au
  Mark Feblowitz                                    mfeblowitz@GTE.com
  Paula Ford                                        pxf3@psuvm.psu.edu
  Lyn Frumkin, M.D., Ph.D.                     lrfrum@u.washington.edu
+ Joe Gems                                              jgems@cais.com
  Ruth Ginzberg                           rginzberg@eagle.wesleyan.edu
  Susan Graham                                      sgraham@hpb.hwc.ca
+ Gwenith Jones                                     gaj5m@virginia.edu
 
======================================================================
 
References:
----------
 
The Physicians' Desk Reference is published annually by:
     Medical Economics Data Production Company
     Montvale, NJ 07645-1742
     ISBN 1-56363-061-3
     It is a compendium of official, FDA-approved prescription
     drug labeling.  The FDA is the U.S. Food and Drug Administration.
 
 
The Compendium of Pharmaceuticals and Specialties is published
     annually by:
     Canadian Pharmaceutical Association
     Ottawa, Ontario, Canada  K1G 3Y6
     ISBN 0-919115-94-2
 
 
Robert Berkow, M.D., editor in chief, _The Merck Manual of Diagnosis
     and Therapy_, 15th ed., (Merck & Co., Inc., USA) 1987.
     ISBN 0911910-06-09
     The Merck Manual provides an overview of the diagnosis and
     therapy of the whole range of medical disorders that can occur
     in infants, children, and adults.
 
 
M. Eric Gershwin, M.D., and E.L. Klingelhofer, Ph.D., _Asthma:
     Stop Suffering, Start Living_,  (Addison-Wesley, USA) 1986.
     ISBN 0-201-11581-6
     The first author is Chief of Allergy and Immunology, University
     of California, Davis, Medical School.  He is board-certified
     in internal medicine, allergy, and clinical immunology.
 
 
Drs. Francois Haas and Sheila Sperber Haas, _The Essential Asthma
     Book_, (Ballentine Books, USA) 1987.
     ISBN 0-8041-0287-2
     Dr. Francois Haas is the director of the Pulmonary Function
     Laboratory at the Medical Center of the New York University
     School of Medicine, and is on the faculty of the Department
     of Physiology there.
 
 



 
Paul J. Hannaway, M.D.  _The Asthma Self Help Book:  how to live a
     normal life in spite of your condition_, 2nd ed., (Prima
     Publishing, USA) 1992.
     ISBN 1-55958-166-2, 1-55958-434-3 paperback
     The author is Assistant Clinical Professor of Tufts University
     School of Medicine.  The first edition of this book won an
     American Medical Writers Association Award.
 
 
Glennon H. Paul, M.D. and Barbara A. Fafoglia, _All About Asthma
     & How to Live with It:  the complete guide to understanding and
     controlling asthma_, (Sterling Publishing Co., NY, USA) 1988.
     ISBN 0-8069-6808-7, 0-8069-6809-5 paperback
     Dr. Paul is the medical director of respiratory therapy at
     St. John's Hospital in Springfield, Illinois, and specializes
     in allergy and respiratory diseases.
 
 
Thomas F. Plaut, _Children with Asthma -- A Manual for Parents_,
     (Pedipress, Inc., Amherst, Massachusetts, USA) 1988.
     ISBN 0-914625-03-9
 
 
Richard N. Podell, M.D. and William Proctor, _When Your Doctor Doesn't
     Know Best:  medical mistakes that even the best doctors make --
     and how to protect yourself_, (Simon & Schuster, USA) 1995.
     ISBN 0-671-87112-9
 
 
Nancy Sander, _A Parent's Guide to Asthma_, (Doubleday, USA) 1989.
     ISBN 0-385-24478-9
     The author is the founder of Mothers of Asthmatics.
 
 
Genell Subak-Sharpe, _Breathing Easy -- A Handbook for Asthmatics_,
     (Doubleday, NY, USA) 1988.
     ISBN 0-385-23440-6
     This book was written in consultation with the National Jewish
     Center for Immunology and Respiratory Medicine.
 
 
Allan M. Weinstein, M.D., _Asthma - The Complete Guide to Self-
     Management of Asthma and Allergies for Patients and their
     Families_, (Fawcett Crest, NY, USA) 1987.
     ISBN 0-449-21562-8
     The author is Assistant Clinical Professor of Medicine at
     Georgetown University, and is a board-certified allergist who
     practices in Washington, D.C.
 
 
Stuart H. Young, M.D. with Susan A. Shulman and Martin D. Shulman,
     _The Asthma Handbook -- A Complete Guide for Patients and Their
     Families_, (Bantam Books, USA) 1985.
     ISBN 0-553-24797-2
     Dr. Young is the Chief of Allergy Clinics in both the Department
     of Medicine and Department of Pediatrics at the Mount Sinai
     Medical Center.  He is also a clinical assistant professor of
     Medicine and a clinical associate professor of Pediatrics at the
     Mount Sinai Medical School.
 
 
======================================================================
 
Disclaimer:  I am not a physician; I am only a reasonably
             well-informed asthmatic.  This information is for
             educational purposes only, and should be used only as
             a supplement to, not a substitute for, professional
             medical advice.
 
Copyright 1995 by Patricia Wrean.  Permission is given to freely
copy or distribute this FAQ provided that it is distributed in full
without modification, and that such distribution is not intended for
profit.
 
--
Patricia Wrean                             wrean@caltech.edu
 


 
 
Archive-name: medicine/asthma/medications
 
 
          alt.support.asthma FAQ:  Asthma Medications
          ===========================================
 
This FAQ attempts to list the most commonly prescribed medications
for the prevention and treatment of asthma, both in the U.S. and
overseas.  It is maintained by Patricia Wrean <wrean@caltech.edu>.
 
The following information came from three sources:  most of the
drugs available in the U.S. are listed in the 1994 Physicians'
Desk Reference (full citation at end of post); many of the drugs
available in Canada are listed in the 1995 Compendium of
Pharmaceuticals and Specialities (full citation at end of post);
the remainder of the information, including those medications
available overseas, came from the many helpful contributors listed
at the end of the post.  If you do not wish your name to be
included in the contributors list, please state that explicitly when
contributing.  Also, if I have left anyone's name out, please let
me know so that I may include it.
 
 Although the maintainer and contributors do their best to keep
   this FAQ updated, it is by no means an authoritative work.
   Asthma is a serious illness requiring supervision by a
   physician.  Please do not attempt to change your medication
   regime without consulting your doctor.
 
Corrections, additions, and comments are requested; please include
the name of the country in which the medication is available, as
it isn't always obvious from the user-id.  If the drug is available
as an inhaler, please specify it as a MDI or one of the other types
mentioned in the glossary, or add a description of the inhaler if
it is not present already.
 
Abbreviations are explained in the glossary at the end of the table.
If the medication is followed by a country name in brackets, then
to the best of my knowledge it is only available in that country,
and not in the U.S.
 
If the drug is available in a nasal form for allergies, I've
included it for completeness.  I haven't covered oral steroids,
only inhaled, or antihistamines at the present time.
 
+ = added since last version
& = updated/corrected since last version
 
----------------------------------------------------------------------
 
Type of drug
         Chemical name         Brand name       Comments
----------------------         ----------       --------
 
Anti-allergic
 
&        cromolyn sodium       Intal            available as MDI,
           (sodium cromoglycate                   neb soln, capsules
            is WHO recommended                    for Spinhaler
            name generally in                     (US, elsewhere),
+           use outside the                       Syncroner (Can)
            U.S.)              Nasalcrom        nasal spray
+                              Novo-Cromolyn    neb soln (Can)
+                              Rynacrom         nasal spray, cartridges
                                                  for nasal insufflator
                                                  (Can)
 
+        ketotifen fumarate    Zaditen          tablets, syrup (Can)
 
         sodium cromoglycate -- see cromolyn sodium
 
 
Anti-inflammatory,
  non-steroidal
 
         nedocromil            Tilade           MDI
&          sodium              Tilade Mint      MDI (UK)
 
 
Anti-inflammatory,
  steroidal (inhaled)
 
         beclomethasone        Beclovent        MDI (US, elsewhere),
+          dipropionate                           Rotacaps for
+                                                 Rotahaler (Can)
                               Beclodisk        diskhaler (Can)
&                              Becloforte       MDI (Can, Sw, UK),
&                                                 5 times larger dose
&                                                 than Beclovent
                               Becotide         MDI (UK)
                               Beconase         nasal MDI
                               Beconase AQ      nasal spray
                               Respocort        MDI, autohaler (NZ)
                               Vanceril         MDI
                               Vancenase        Pockethaler (nasal MDI)
                               Vancenase AQ     nasal spray
 
         budesonide            Pulmicort        turbuhaler (Aus, Can),
                                                  neb soln (UK, Can)
                               Rhinocort        nasal MDI
&                                                 (US, elsewhere),
                                                  nasal turbuhaler,
+                                                 nasal spray (Can)
                               Nebuamp          neb soln (Can)
 
         dexamethasone         Decadron         Respihaler
           sodium phosphate      Phosphate
 
         flunisolide           Aerobid          MDI
                               Aerobid-M        MDI, with menthol as
                                                  flavouring agent
&                              Bronalide        MDI (Can)
                               Nasalide         nasal spray
                               Rhinalar         nasal spray (Can)
 
         fluticasone           Flixotide        MDI, diskhaler (UK)
+          propionate          Flonase          nasal spray
 
         triamcinolone         Azmacort         MDI
           acetonide           Nasacort         nasal MDI
 
 
Anticholinergics (bronchodilators)
 
         ipratropium           Atrovent         MDI, inh soln
           bromide                                (US, elsewhere),
+                                                 nasal MDI (Can)
 
 
Beta-agonists (bronchodilators)
 
         albuterol*            Airet            inh soln
+          (salbutamol is      Asmavent         inh soln (Can)
           WHO recommended     Proventil        MDI, inh soln, syrup,
           name generally                         tablets,
           in use outside                         Repetabs (SA tablets)
           the U.S.)           Respolin         MDI, autohaler (NZ)
                               Ventolin         MDI, inh soln, tablets,
                                                  neb soln, Rotacaps,
                                                  for Rotahaler, syrup
                                                  (US, elsewhere)
+                                                 injection (Can)
                               Ventodisk        diskhaler (Can, UK)
                               Volmax           ER tablets
 
              * MDI uses albuterol, all other forms (tablets, etc.)
                use albuterol sulfate
 
         bitolterol mesylate   Tornalate        MDI
 
         ephedrine             Ephedrine        inh soln (Can)
 
         epinephrine           Bronkaid Mist    MDI, OTC, epinephrine
                                                  in form of nitrate
                                                  and hydrochloride
                               Bronkaid Mist    MDI, OTC**
                                 Suspension
                               Medihaler-Epi    MDI, OTC**
                               Primatene Mist   MDI, OTC
                               Primatene Mist   MDI, OTC**
                                 Suspension
                               Sus-Phrine       injection
                as epinephrine bitartrate
 
         fenoterol             Berotec          MDI, inh soln, tablets
           hydrobromide                           (Can, Aus, NZ)
+                              Berotec Forte    MDI (Can), 2 times
+                                                 larger dose than
+                                                 Berotec
 
         isoetharine           Bronkosol        inh soln
           hydrochloride       Bronkometer      MDI
                               Isoetharine      inh soln
                                 Arm-a-Med
 
 
&        isoproterenol         Medihaler-Iso    MDI, as sulfate
                               Isuprel          MDI, neb soln (Can),
                                                  as hydrochloride
 
         metaproterenol        Alupent          MDI, inh soln, tablets,
           sulfate                                neb soln, syrup
           (orciprenaline      Metaprel         MDI, inh soln, syrup,
            sulfate is WHO                        tablets
            recommended name   Metaproterenol   inh soln
            generally in use     Sulfate
            outside the U.S.)    Arm-a-Med
 
+        orciprenaline sulfate -- see metaproterenol sulfate
 
         pirbuterol acetate    Maxair           MDI, autohaler
 
         procaterol HCl        Pro-Air          MDI (Can)
 
         salbutamol -- see albuterol
 
         salmeterol            Serevent         MDI (US, elsewhere),
           xinafoate                              diskhaler (UK)
 
         terbutaline           Brethaire        MDI
           sulfate             Brethine         tablets, neb soln,
                                                  injection
                               Bricanyl         tablets, injection
                                                  (US, elsewhere),
&                                                 turbuhaler (Aus, Can)
 
 
Xanthines (bronchodilators)
 
         theophylline          Aerolate         TD capsules, liquid
                               Quibron-T        tablets, SA tablets
                                                  (see also
                                                  combinations)
                               Respbid          SR tablets
                               Slo-bid          ER capsules
                               Slo-phylline     ER capsules
                               T-Phyl           CR tablets
                               Theo-24          ER capsules
                               Theo-Dur         ER tablets
                               Theo-Dur         SA capsules
                                 Sprinkle
                               Theo-X           tablets
                               Theolair         tablets, SR tablets,
                                                  liquid
                               Uniphyl          CR tablets
 
         dyphylline***          Lufyllin        tablets, injection,
                                                  syrup
               * similar to theophylline
 
         oxtriphylline****      Choledyl        DR tablets, SA tablets
 
               ** oxtriphylline is the choline salt of theophylline,
                 and 400 mg of it is equivalent to 254 mg of
                 anhydrous theophylline
 
 
----------------------------------------------------------------------
 
Combination Medications:
 
Brand name         Chemical names of ingredients    Comments
----------         -----------------------------    --------
 
Asbron G           theophylline sodium glycinate,   elixir, tablets
                     guaifenesin (expectorant)
 
Bronkaid Caplets   ephedrine sulfate, guaifenesin   tablets, OTC
 
Congess            guaifenesin, pseudoephedrine     tablets
 
Duo-Medihaler      isoproterenol hydrochloride,     MDI
                     phenylephrine bitartrate
 
Duovent            fenoterol hydrobromide,          MDI (UK)
                     ipratropium bromide
 
Marax              ephedrine sulfate,               tablets
                     theophylline,
                     Atarax (hydroxyzine HCl)
 
Primatene Tablets  theophylline, ephedrine HCl      tablets, OTC
 
Quadrinal          theophylline calcium salicylate, tablets
                     ephedrine HCl, phenobarbital,
                     potassium iodide
 
Rynatuss           carbetapentane tannate,          tablets, syrup
                     chlorpheniramine tannate,
                     ephedrine tannate,
                     phenylephrine tannate
 
Tedral             theophylline, ephedrine HCl,     tablets (Can),
                     phenobarbital                    no longer
                                                      manufactured
                                                      in US
 
Ventolin-Plus      albuterol, beclomethasone        MDI (Sw)
                     dipropionate
 
 
----------------------------------------------------------------------
 
Glossary
--------
 
aerosol inhalers:
 
  MDI         - metered-dose inhaler, consisting of an aerosol unit and
&               plastic mouthpiece.  This is currently the most common
                type of inhaler, and is widely available.
 
  autohaler   - MDI made by 3M which is activated by one's breath, and
                doesn't need the breath-hand coordination that a
&               regular MDI does.  Available in U.S. for Maxair.
 
  respihaler  - aerosol inhaler for Decadron (see table above).  I have
                no idea how this differs from the usual MDI.
 
+ syncroner   - MDI with elongated mouthpiece, used as training device
+               to see if medication is being inhaled properly.
+               Available in Canada for Intal.
 
dry powder inhalers:
 
+ insufflator - dry powder nasal inhaler used with Rynacrom cartridges.
+               Each cartridge contains one dose; the inhaler opens the
+               cartridge, allowing the powder to be blown into the
+               nose by squeezing the bulb.  Available in Canada.
 
& rotahaler   - dry powder inhaler used with Rotacaps capsules.
                Each capsule contains one dose; the inhaler opens
                the capsule such that the powder may be inhaled
                through the mouthpiece.  Available in the U.S.,
+               Canada, and UK for Ventolin.  In Canada, Beclovent
+               Rotacaps are also available.
 
  spinhaler   - dry powder inhaler used with Intal capsules for
                spinhaler.  Each capsule contains one dose; the
                inhaler opens the capsule such that the powder
                may be inhaled through the mouthpiece.  Available
                in Canada, UK, and the U.S.
 
  diskhaler   - dry powder inhaler.  The drug is kept in a series of
                little pouches on a disk; the diskhaler punctures
                the pouch and drug is inhaled through the mouthpiece.
                Currently available in Canada and UK, not in U.S.
 
  turbuhaler  - dry powder inhaler.  The drug is in form of a pellet;
                when body of inhaler is rotated, prescribed amount of
                drug is ground off this pellet.  The powder is then
                inhaled through a fluted aperture on top.  Available
                in Australia and Canada.
 
forms of tablets:
 
     CR  - controlled release.  This means that the drug has a
           constant rate of release.
     DR  - delayed release.  This generally refers to enteric-
           coated tablets which are designed to release the drug
           in the intestine where the pH is in the alkaline range.
     ER  - extended release.  Dosage forms which are designed to
           release the drug over an extended period of time, such
           as implants which release drug over a period of
           one or two months or years.
     SA  - sustained action.  Used interchangeably with CR
           (above), except that SA usually refers to the
           pharmacologic action while CR refers to the drug
           release process.
     TD  - time delayed.  This is slightly different from DR in
           that the drug release is designed to occur after a
           certain period of time, such as pellets coated to a
           certain thickness, multi-layered tablets, tablets
           within a capsule, or double-compressed tablets.
 
forms of solutions:
 
  neb soln    - nebulizer solution.  Drug comes in nebules for use with
                nebulizer.
 
  inh soln    - inhalation solution.  Some manufacturers use this as a
                synonym for neb soln; others use it to mean that drug
                comes in bottle with dropper, distinct from neb soln.
 
country abbreviations:
 
  Aus         - Australia
  Can         - Canada
  NZ          - New Zealand
  Sw          - Switzerland
  UK          - United Kingdom
  US          - United States
 



 
misc:
 
  OTC         - over-the-counter, all other medications are
                prescription-only in the U.S.
 
----------------------------------------------------------------------
 
The Physicians' Desk Reference is published annually by:
      Medical Economics Data Production Company
      Montvale, NJ 07645-1742
      ISBN 1-56363-061-3
It is a compendium of official, FDA-approved prescription
drug labeling.  The FDA is the U.S. Food and Drug Administration.
 
The Compendium of Pharmaceuticals and Specialties is published annually
by:
      Canadian Pharmaceutical Association
      Ottawa, Ontario, Canada  K1G 3Y6
      ISBN 0-919115-94-2
 
----------------------------------------------------------------------
 
Contributors:
------------
 
+ Andrew Benham                                 A.D.S.Benham@bnr.co.uk
  Lawrence M. (Larry) Bezeau                             BEZEAU@UNB.CA
  Daniel Canonica       d_canonica@trzcl1.mrgate.mailer.umc.alcatel.ch
  John Connett                                    jrc@concurrent.co.uk
  Mark Delany                              markd@bushwire.apana.org.au
  Walter de Wit                             dewit@hamilton.niwa.cri.nz
  Steve Dyer                                            dyer@spdcc.com
  Ian Ford                                        ianford@dircon.co.uk
  Susan Graham                                      sgraham@hpb.hwc.ca
  Rick Hughes                                   richardh@Newbridge.COM
  Simon Kelley                                        srk@sanger.ac.uk
  Rick Nopper                           nopperrw@esvax.dnet.dupont.com
  Kevin A. Nunan                                pp000165@interramp.com
  Janet Pierson                                 JPierson@highlands.com
  Matt Ray                                      M.J.Ray@bradford.ac.uk
  John Saunders                                John@gemini.demon.co.uk
  Stephan Seillier                                 seillier@on.bell.ca
  John R. Strohm                              strohm@mksol.dseg.ti.com
+ Elaine Turner, M.D.                         elturn@richmond.infi.net
  John Underhay                                      junderhay@upei.ca
  David Williams                                exudnw@exu.ericsson.se
  Travis Lee Winfrey                          travis.winfrey@fi.gs.com
 
 
----------------------------------------------------------------------
 
Disclaimer:  I am not a physician; I am only a reasonably
             well-informed asthmatic.  This information is for
             educational purposes only, and should be used only as
             a supplement to, not a substitute for, professional
             medical advice.
 
Copyright 1995 by Patricia Wrean.  Permission is given to freely
copy or distribute this FAQ provided that it is distributed in full
without modification, and that such distribution is not intended for
profit.
 
--
Patricia Wrean                             wrean@caltech.edu
 

