Anabolic Steroids

Profile

"Anabolic Steroids" are any drug(s) (other then estrogens, progestins, and corticosteroids) or hormonal substance(s), chemically related to testosterone, a male hormone that promotes muscle growth. Today, there are more than 100 varieties of anabolic steroids that have been developed, but only a limited number have been approved for human or veterinary use, and each of them are Schedule III and require a prescription in order to be used medically in the United States. Many of the illegal steroids are smuggled in from other countries, illegally diverted from U.S. pharmacies, or synthesized in secret laboratories. Estimates show that there are more than $400 million worth of black-market (illegal) sales of steroids per year . For the most part, illicit steroid use is linked to athletic competitions and/or an athlete trying to gain a competitive edge ; but, sports and athletic competitions are not the only place steroids are used. Outside of sports, they are used because someone wants to alter his or her physical appearance, usually based on distorted perceptions that he or she is obese, underweight, too weak, or other personal views. Over the years, the popularity of steroids has varied, but in 2001, it was found that about 2% of high school students used steroids in the past year.


History

The history of anabolic steroids can be traced back to as early as 1930's, before the term steroid was even used. In the 1930's, a team of scientists was able to create a synthetic form of testosterone (a male hormone) to help treat men who were unable to produce enough of the hormone for normal growth, development, and sexual functioning. Later, during World War II it was found that this artificial form of testosterone could be used to help malnourished soldiers gain weight and improve performance. After the war, athletes began to use steroids to enhance their performance in competitions. In the 1956 Olympics, Soviet athletes, especially wrestlers, performed at exceptionally high levels. After learning that those athletes were using testosterone, an American physician (Dr. Zeigler) created a more selective form of what we know as anabolic steroids. From that point until the early 1970's, steroids became increasingly popular among not just Olympic athletes, but also professional sports players and high school athletes. In 1975, the International Olympic Committee finally banned the use of steroids in Olympic competition. Black market (or illegal) sales continued to increase in the following years, and in 1988, the first major federal regulation of steroids was introduced as part of the Anti-Drug Abuse Act - stiffening penalties for the sale and possession of steroids. Only a couple of years later, Congress passed the Anabolic Steroid Enforcement Act of 1990, which placed certain anabolic steroids on Schedule III of the Controlled Substances Act (CSA). Previously, steroids had been unscheduled and controlled only by state laws. Today, illicit sales of steroids are still prevalent and surveys show that adolescent use of steroids is on the rise and that a great number of adults are actively using .


Methods of Use

Steroids are often used through injection, by using a needle to inject the drug directly into the blood stream (intravenously) or into the muscle (intramuscularly). There are also pills or gel tabs that are taken orally, or creams that are rubbed directly onto the users skin. Though these drugs can be taken during a single occurrence, some users elect to use them in complex patterns known as pyramiding, cycling, or stacking. In each of these three methods, ingested doses can range from 10 to 100 times higher than those prescribed for medical conditions. And while they are thought to provide superior results, the perceived effects have yet to be proven successful.


Physical Effects

There are two major ways that steroids can affect a person's body. Steroids can have androgenic effects, which include masculinizing effects like deepening of the voice, increased facial hair, and initial enlargement of some male sex glands. Steroids can also have anabolic effects that include increases in muscle mass, the size of some internal organs, and calcium in the bones.

Overall, the process by which steroids work on the body can be very complex. Essentially, steroid hormones work by stimulating certain parts of a muscle cell. This stimulation then causes an increase in production of proteins, one of the many chemicals that are associated with increases in muscle mass.


Short-Term and Long-Term Physical Effects

Men - Even though anabolic steroids are derived from male sex hormones, men who choose to take them can experience some of the following effects:

Short-term
*Reduced sperm count
*Damage to the heart
*Impotence
*Difficulty or pain while urinating

Long-term
*Liver disease or liver cancer
*Development of breasts
*Shrinking of the testicles

Women - If a woman uses steroids, some "masculinization" effects may occur:

Short-term

*Breast reduction
*Excessive hair growth
*Long-term
*Deepened voice
*Enlarged clitoris
*Abnormal menstrual cycles

Physical Effects on Males and Females

Continued use of anabolic steroids can cause the following effects in both sexes:

Short-term

*Acne
*Fluid retention
*Rapid weight gain
*Increased blood pressure and cholesterol levels
*Insomnia (inability to sleep)
*Headaches
*Reduced sexual functioning
*Increase in muscle size
*Swelling of feet and ankles
*Improved healing
*Improved appetite

Long-term

*Blood clotting difficulties
*Heart attacks
*Clotting disorders
*Cardiovascular, liver, and reproductive organ damage
*Premature heart attacks and strokes
*Reduced sexual functioning
Stunted growth in adolescents
*Increased chance of injuring ligaments, tendons and muscles
*When injecting: bacterial infections, abscesses, cellulitis, and HIV/AIDS
*Increase in muscle size

Psychological Effects

Steroids have been reported to increase a persons aggressiveness or lead them to become more violent. This is sometimes called a "roid rage," defined as a manic rage where the user displays episodes of outright aggression and/or violent feelings and actions. Though scientific evidence is hard to find in support of roid rages, there are a large number of individual accounts of users who describe their own uncharacteristic aggressive behavior while under the influence of anabolic steroids.

In addition, many users report feeling good about themselves while on anabolic steroids, but researchers report that extreme mood swings can also occur. Depression is often seen when the drugs are stopped and may contribute to a dependence on anabolic steroids. Researchers further report that users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.


Are Steroids Addictive?

Each user experiences their own unique feelings when using steroids and coming off the drug. When someone chooses to stop using they can experience a variety of withdrawal symptoms linked to addiction. Symptoms can include mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, the desire to take more steroids, and depression. Evidence for steroid addiction is certainly not as strong as it is for other drugs like cocaine or heroin. Though it is clear that people develop a tolerance and dependence on them and willingly experience negative consequences when using steroids - both of which are signs for drug dependence.


Slang-terms for Steroids:

*Juice
*Roids
*Fakes or Basement Drugs - Counterfeit or fake steroids

There are also more than 100 different names for several of types of steroids.
Commonly abused oral steroids include: anadrol, oxandrin, dianobol, and winstrol.
Popular injectable forms include: deca-durabolin, durabolin, depo-testosteron, and equipoise.

Slang Terms for Use and Users:

*Bulking up or Juicing - Using steroids

*Roid Rage - Episodes of rage, aggression, and/or violence.

*Juiced Up or Freaky - A person who is very large and thought to be using steroids

*Blending - Using steroids with other drug(s)

*Doping - Steroid use specific to athletic competition

*Stacking - Using a combination of anabolic steroids, often in combination with other drugs

*Cycling - Taking multiple doses of steroids over a specified period of time, stopping for a time and starting again

*Pyramiding - When users slowly escalate steroid use (increasing the number of drugs used at one time and/or the dose and frequency of one or more steroids) reaching a peak amount at mid-cycle and gradually tapering the dose toward the end of the cycle

Slang Terms for Steroid Paraphernalia:

*Dart, Poke, Ned - Terms for syringes or needles

*Gear - Slang for steroids, syringes, and anything associated with the use of steroids

What is asthma?

Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. The result is difficulty breathing. The bronchial narrowing is usually either totally or at least partially reversible with treatments.
Bronchial tubes that are chronically inflamed may become overly sensitive to allergens (specific triggers) or irritants (nonspecific triggers). The airways may become "twitchy" and remain in a state of heightened sensitivity. This is called "bronchial hyperreactivity" (BHR). It is likely that there is a spectrum of bronchial hyperreactivity in all individuals. However, it is clear that asthmatics and allergic individuals (without apparent asthma) have a greater degree of bronchial hyperreactivity than nonasthmatic and nonallergic people. In sensitive individuals, the bronchial tubes are more likely to swell and constrict when exposed to triggers such as allergens, tobacco smoke, or exercise. Amongst asthmatics, some may have mild BHR and no symptoms while others may have severe BHR and chronic symptoms.
Asthma affects people differently. Each individual is unique in their degree of reactivity to environmental triggers. This naturally influences the type and dose of medication prescribed, which may vary from one individual to another.

From the past to the present
Physicians in ancient Greece used the word asthma to describe breathlessness or gasping. They believed that asthma was derived from internal imbalances, which could be restored by healthy diet, plant and animal remedies, or lifestyle changes.
Allergy jargonAsthma is derived from the Greek word Panos, meaning panting.Chinese healers understood that xiao-chiran, or "wheezy breathing," was a sign of imbalance in the life force they called qi. They restored qi by means of herbs, acupuncture massage, diet, and exercise.The Hindu philosophers connected the soul and breath as part of the mind, body, and spirit connection. Yoga uses control of breathing to enhance meditation. Indian physicians taught these breathing techniques to help manage asthma. Allergy factMaimonides was a renowned 12th-century rabbi and physician who practiced in the court of the sultan of Egypt. He recommended to one of the Royal Princes with asthma that he eat, drink, and sleepless. He also advised that he engage in less sexual activity, avoid the polluted city environment, and eat a specific remedy-chicken soup.
The balance of the "four humors," which was derived from the Greco-Roman times, influenced European medicine until the middle of the 18th century. In a healthy person, the four humors, or bodily fluids -- blood, black bile, yellow bile, and phlegm -- were in balance. An excess of one of these humors determined what kinds of disorders were present. Asthmatics who were noted for their coughing, congestion, and excess mucus (phlegm) production were therefore regarded as "phlegmatic."
By the 1800s, aided by the invention of the stethoscope, physicians began to recognize asthma as a specific disease. However, patients still requested the traditional treatments of the day, such as bloodletting, herbs, and smoking tobacco. These methods were used for a variety of conditions, including asthma. Of the many remedies that were advertised for asthma throughout the 19th century, none were particularly helpful.
Allergy factAs early as 1892, the famous Canadian-American physician Sir William Osler suggested that inflammation played an important role in asthma.
Bronchial dilators first appeared in the 1930s and were improved in the 1950s. Shortly thereafter, corticosteroid drugs that treated inflammation appeared and have become the mainstay of therapy used today.

What is asthma?
Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. The result is difficulty breathing. The bronchial narrowing is usually either totally or at least partially reversible with treatments.
Bronchial tubes that are chronically inflamed may become overly sensitive to allergens (specific triggers) or irritants (nonspecific triggers). The airways may become "twitchy" and remain in a state of heightened sensitivity. This is called "bronchial hyperreactivity" (BHR). It is likely that there is a spectrum of bronchial hyperreactivity in all individuals. However, it is clear that asthmatics and allergic individuals (without apparent asthma) have a greater degree of bronchial hyperreactivity than nonasthmatic and nonallergic people. In sensitive individuals, the bronchial tubes are more likely to swell and constrict when exposed to triggers such as allergens, tobacco smoke, or exercise. Amongst asthmatics, some may have mild BHR and no symptoms while others may have severe BHR and chronic symptoms.
Asthma affects people differently. Each individual is unique in their degree of reactivity to environmental triggers. This naturally influences the type and dose of medication prescribed, which may vary from one individual to another.

From the past to the present
Physicians in ancient Greece used the word asthma to describe breathlessness or gasping. They believed that asthma was derived from internal imbalances, which could be restored by healthy diet, plant and animal remedies, or lifestyle changes.
Allergy jargonAsthma is derived from the Greek word Panos, meaning panting.Chinese healers understood that xiao-chiran, or "wheezy breathing," was a sign of imbalance in the life force they called qi. They restored qi by means of herbs, acupuncture, massage, diet, and exercise.The Hindu philosophers connected the soul and breath as part of the mind, body, and spirit connection.Yoga uses control of breathing to enhance meditation. Indian physicians taught these breathing techniques to help manage asthma. Allergy factMaimonides was a renowned 12th-century rabbi and physician who practiced in the court of the sultan of Egypt. He recommended to one of the Royal Princes with asthma that he eat, drink, and sleep less. He also advised that he engage in less sexual activity, avoid the polluted city environment, and eat a specific remedy-chicken soup.
The balance of the "four humors," which was derived from the Greco-Roman times, influenced European medicine until the middle of the 18th century. In a healthy person, the four humors, or bodily fluids -- blood, black bile, yellow bile, and phlegm -- were in balance. An excess of one of these humors determined what kinds of disorders were present. Asthmatics who were noted for their coughing, congestion, and excess mucus (phlegm) production were therefore regarded as "phlegmatic."
By the 1800s, aided by the invention of the stethoscope, physicians began to recognize asthma as a specific disease. However, patients still requested the traditional treatments of the day, such as bloodletting, herbs, and smoking tobacco. These methods were used for a variety of conditions, including asthma. Of the many remedies that were advertised for asthma throughout the 19th century, none were particularly helpful.
Allergy factAs early as 1892, the famous Canadian-American physician Sir William Osler suggested that inflammation played an important role in asthma.
Bronchial dilators first appeared in the 1930s and were improved in the 1950s. Shortly thereafter, corticosteroid drugs that treated inflammation appeared and have become the mainstay of therapy used today.

What medications are used in the treatment of asthma?
Most asthma medications work by relaxing bronchospasm (bronchodilators) or reducing inflammation (corticosteroids). In the treatment of asthma, inhaled medications are generally preferred over tablet or liquid medicines, which are swallowed (oral medications). Inhaled medications act directly on the airway surface and airway muscles where the asthma problems initiate. Absorption of inhaled medications into the rest of the body is minimal. Therefore, adverse side effects are fewer as compared to oral medications. Inhaled medications include beta-2 agonists, anticholinergics, corticosteroids, and cromolyn sodium. Oral medications include aminophylline, leukotriene antagonists, beta-2 agonists, and corticosteroid tablets.
Historically, one of the first medications used for asthma was adrenaline (epinephrine). Adrenaline has a rapid onset of action in opening the airways (bronchodilation). It is still often used in emergency situations for asthma. Unfortunately, adrenaline has many side effects, including rapid heart rate, headache, nausea, vomiting, restlessness, and a sense of panic.
Medications chemically similar to adrenaline have been developed. These medications, called beta-2 agonists, have the bronchodilating benefits of adrenaline without many of its unwanted side effects. Beta-2 agonists are inhaled bronchodilators which are called "agonists" because they promote the action of the beta-2 receptor of bronchial wall muscle. This receptor acts to relax the muscular wall of the airways (bronchi), resulting in bronchodilation. The bronchodilator action of beta-2 agonists starts within minutes after inhalation and lasts for about four hours. Examples of these medications include albuterol (Ventolin HFA, Proventil HFA), levalbuterol(Xopenex), metaproterenol (Alupent), pirbuterol acetate (Maxair), and terbutaline sulfate (Brethaire). Recently, chlorofluorocarbons (CFCs) have been removed from all MDI inhalers because of the environmental effects on the ozone layer. These have been replaced by a new propellant, hydroflouroalkane (HFA). Patients may notice that the jet they feel in the back of their throat is less intense when compared with the CFC inhaler. They should be instructed that they are still receiving the same amount of medication though it may feel different than their older inhaler. Another very important point that patients must be aware of is that "floating" these new inhalers does not help in determining the amount of medication left in the MDI. In the past, the CFC devices could be floated in a bowl of water. With more medicine in the inhaler, the canister would sink and gradually float as it emptied. This is not the case with the HFA inhalers, as floating will actually clog the inhaler. The number of accuations must be counted to determine if medication is still left in the inhaler. Shaking the inhaler is not an effective method of determining how much medication is left. Often propellant (HFA) will continue to come out of the inhaler even after the medication is used up. At the present, only one albuterol inhaler comes with a counter device and this is Ventolin HFA.
A new group of long-acting beta-2 agonists has been developed with a sustained duration of effect of 12 hours. These inhalers can be taken twice a day. Salmeterol xinafoate (Serevent) and formoterol (Foradil) are examples of this group of medications. The long-acting beta-2 agonists should not used for acute attacks. Beta-2 agonists can have side effects, such as anxiety, tremor, palpitations or fast heart rate, and lowering of blood potassium. There is data to suggest that taking long-acting beta-2 agonists alone may be life-threatening. They are best taken along with inhaled corticosteroids (see below).
Just as beta-2 agonists can dilate the airways, beta blocker medications impair the relaxation of bronchial muscle by beta-2 receptors and can cause constriction of airways, aggravating asthma. Therefore, beta blockers, such as the blood pressure medications propanolol (Inderal) and atenolol (Tenormin), should be avoided by asthma patients if possible.
The anticholinergic agents act on a different type of nerves than the beta-2 agonists to achieve a similar relaxation and opening of the airway passages. These two groups of bronchodilator inhalers when used together can produce an enhanced bronchodilation effect. An example of a commonly used anticholinergic agent is ipratropium bromide (Atrovent). Ipratropium takes longer to work as compared with the beta-2 agonists, with peak effectiveness occurring two hours after intake and lasting six hours. These agents are more effective in patients with COPD.
When symptoms of asthma are difficult to control with beta-2 agonists, inhaled corticosteroids (cortisone) are often added. Corticosteroids can improve lung function and reduce airway obstruction over time. Examples of inhaled corticosteroids include beclomethasone dipropionate (Beclovent, Qvar, and Vanceril), triamcinolone acetonide (Azmacort), budesonide (Pulmocort), and flunisolide (Aerobid). The ideal dose of corticosteroids is still unknown. The side effects of inhaled corticosteroids include hoarseness, loss of voice, and oral yeast infections. Early use of inhaled corticosteroids may prevent irreversible damage to the airways.
To decrease the deposition of medications on the throat and increase the amount reaching the airways, spacers can be helpful. Spacers are tube-like chambers attached to the outlet of the MDI canister. Spacer devices can hold the released medications long enough for patients to inhale them slowly and deeply into the lungs. A spacing device placed between the mouth and the MDI can improve medication delivery and reduce the side effects on the mouth and throat. Rinsing out the mouth after use of a steroid inhaler also can decrease these side effects.
Combination inhaler therapy is now available for the treatment of asthma. These medications include Advair (fluticasone and salmeterol) and Symbicort (budesonide and formoteral). Symbicort uses the standard MDI inhaler device (a counter device will be added in the near future). Advair has a unique powdered delivery system with a built-in counter.
Cromolyn sodium (Intal) prevents the release of certain chemicals in the lungs, such as histamine, which can cause asthma. Exactly how cromolyn works to prevent asthma needs further research. Cromolyn is not a corticosteroid and is usually not associated with significant side effects. Cromolyn is useful in preventing asthma but has limited effectiveness once acute asthma starts. Cromolyn can help prevent asthma triggered by exercise, cold air, and allergic substances, such as cat dander. Cromolyn may be used in children as well as adults.
Theophylline (Theodur, Theoair, Slo-bid, Uniphyl, Theo-24) and aminophylline are examples of methylxanthines. Methylxanthines are administered orally or intravenously. Before the inhalers became popular, methylxanthines were the mainstay of treatment of asthma. Caffeine that is in common coffee and soft drinks is also a methylxanthine drug! Theophylline relaxes the muscles surrounding the air passages and prevents certain cells lining the bronchi (mast cells) from releasing chemicals, such as histamine, which can cause asthma. Theophylline can also act as a mild diuretic, causing an increase in urination. For asthma that is difficult to control, methylxanthines can still play an important role. Dosage levels of theophylline or aminophylline are closely monitored. Excessive levels can lead to nausea, vomiting, heart-rhythm problems, and even seizures. In certain medical conditions, such as heart failure or cirrhosis, dosages of methylxanthines are lowered to avoid excessive blood levels. Drug interactions with other medications, such as cimetidine (Tagamet), calcium channel blockers (Procardia), quinolones (Cipro), and allopurinol (Xyloprim) can further affect drug blood levels.
Corticosteroids are given orally for severe asthma unresponsive to other medications. Unfortunately, high doses of corticosteroids over long periods can have serious side effects, including osteoporosis, bone fractures, diabetes mellitus, high blood pressure, thinning of the skin and easy bruising, insomnia, emotional changes, and weight gain.
Expectorants help thin airway mucus, making it easier to clear the mucus by coughing. Potassium iodide is not commonly used and has the potential side effects of acne, increased salivation, hives, and thyroid problems. Guaifenesin (Entex, Humibid) can increase the production of fluid in the lungs and help to decrease the apparent thickness of the mucus but can also be an airway irritant for some people.
In addition to bronchodilator medications for those patients with atopic asthma, avoiding allergens or other irritants can be very important. In patients who cannot avoid the allergens, or in those whose symptoms cannot be controlled by medications, allergy shots are considered. The benefits of allergy shots (desensitization) in the prevention of asthma has not been firmly established. Some doctors are still concerned about the risk of anaphylaxis, which occurs in one in 2 million doses given. Allergy shots most commonly benefit children allergic to house dust mites. Other benefits can be seen with pollens and animal dander.
In some asthma patients, avoidance of aspirin, or other NSAIDs (commonly used in treating arthritis inflammation) is important. In other patients, adequate treatment of backflow of stomach acid (esophageal reflux) prevents irritation of the airways. Measures to prevent esophageal reflux include medications, weight loss, dietary changes, and stopping cigarettes, coffee, and alcohol. Examples of medications used to reduce reflux include omeprazole (Prilosec) and ranitidine (Zantac). Patients with severe reflux problems causing lung problems may need surgery to strengthen the esophageal sphincter in order to prevent acid reflux (fundoplication surgery). For further information, please read the Gastroesophageal Reflux Disease article.
Asthma At A Glance
Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. The bronchial narrowing is usually either totally or at least partially reversible with treatments.
Asthma is now the most common chronic illness in children, affecting one in every 15.
Asthma involves only the bronchial tubes and usually does not affect the air sacs or the lung tissue. The narrowing that occurs in asthma is caused by three major factors: inflammation, bronchospasm, and hyperreactivity.
Allergy can play a role in some, but not all, asthma patients.
Many factors can precipitate asthma attacks and are they are classified as either allergens or irritants.
Symptoms of asthma include shortness of breath, wheezing, cough, and chest tightness.
Asthma is usually diagnosed based on the presence of wheezing and confirmed with breathing tests.
Chest X-rays are usually normal in asthma patients.
Avoiding precipitating factors is important in the management of asthma.
Medications can be used to reverse or prevent bronchospasm in patients with asthma.


Notes: zantac, corticosteroid, acupuncture, yoga, cromolyn, epinephrine, albuterol, metaproterenol

What is asthma?

Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. The result is difficulty breathing. The bronchial narrowing is usually either totally or at least partially reversible with treatments.
Bronchial tubes that are chronically inflamed may become overly sensitive to allergens (specific triggers) or irritants (nonspecific triggers). The airways may become "twitchy" and remain in a state of heightened sensitivity. This is called "bronchial hyperreactivity" (BHR). It is likely that there is a spectrum of bronchial hyperreactivity in all individuals. However, it is clear that asthmatics and allergic individuals (without apparent asthma) have a greater degree of bronchial hyperreactivity than nonasthmatic and nonallergic people. In sensitive individuals, the bronchial tubes are more likely to swell and constrict when exposed to triggers such as allergens, tobacco smoke, or exercise. Amongst asthmatics, some may have mild BHR and no symptoms while others may have severe BHR and chronic symptoms.
Asthma affects people differently. Each individual is unique in their degree of reactivity to environmental triggers. This naturally influences the type and dose of medication prescribed, which may vary from one individual to another.

From the past to the present
Physicians in ancient Greece used the word asthma to describe breathlessness or gasping. They believed that asthma was derived from internal imbalances, which could be restored by healthy diet, plant and animal remedies, or lifestyle changes.
Allergy jargonAsthma is derived from the Greek word Panos, meaning panting.Chinese healers understood that xiao-chiran, or "wheezy breathing," was a sign of imbalance in the life force they called qi. They restored qi by means of herbs, acupuncture massage, diet, and exercise.The Hindu philosophers connected the soul and breath as part of the mind, body, and spirit connection. Yoga uses control of breathing to enhance meditation. Indian physicians taught these breathing techniques to help manage asthma. Allergy factMaimonides was a renowned 12th-century rabbi and physician who practiced in the court of the sultan of Egypt. He recommended to one of the Royal Princes with asthma that he eat, drink, and sleepless. He also advised that he engage in less sexual activity, avoid the polluted city environment, and eat a specific remedy-chicken soup.
The balance of the "four humors," which was derived from the Greco-Roman times, influenced European medicine until the middle of the 18th century. In a healthy person, the four humors, or bodily fluids -- blood, black bile, yellow bile, and phlegm -- were in balance. An excess of one of these humors determined what kinds of disorders were present. Asthmatics who were noted for their coughing, congestion, and excess mucus (phlegm) production were therefore regarded as "phlegmatic."
By the 1800s, aided by the invention of the stethoscope, physicians began to recognize asthma as a specific disease. However, patients still requested the traditional treatments of the day, such as bloodletting, herbs, and smoking tobacco. These methods were used for a variety of conditions, including asthma. Of the many remedies that were advertised for asthma throughout the 19th century, none were particularly helpful.
Allergy factAs early as 1892, the famous Canadian-American physician Sir William Osler suggested that inflammation played an important role in asthma.
Bronchial dilators first appeared in the 1930s and were improved in the 1950s. Shortly thereafter, corticosteroid drugs that treated inflammation appeared and have become the mainstay of therapy used today.

What is asthma?
Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. The result is difficulty breathing. The bronchial narrowing is usually either totally or at least partially reversible with treatments.
Bronchial tubes that are chronically inflamed may become overly sensitive to allergens (specific triggers) or irritants (nonspecific triggers). The airways may become "twitchy" and remain in a state of heightened sensitivity. This is called "bronchial hyperreactivity" (BHR). It is likely that there is a spectrum of bronchial hyperreactivity in all individuals. However, it is clear that asthmatics and allergic individuals (without apparent asthma) have a greater degree of bronchial hyperreactivity than nonasthmatic and nonallergic people. In sensitive individuals, the bronchial tubes are more likely to swell and constrict when exposed to triggers such as allergens, tobacco smoke, or exercise. Amongst asthmatics, some may have mild BHR and no symptoms while others may have severe BHR and chronic symptoms.
Asthma affects people differently. Each individual is unique in their degree of reactivity to environmental triggers. This naturally influences the type and dose of medication prescribed, which may vary from one individual to another.

From the past to the present
Physicians in ancient Greece used the word asthma to describe breathlessness or gasping. They believed that asthma was derived from internal imbalances, which could be restored by healthy diet, plant and animal remedies, or lifestyle changes.
Allergy jargonAsthma is derived from the Greek word Panos, meaning panting.Chinese healers understood that xiao-chiran, or "wheezy breathing," was a sign of imbalance in the life force they called qi. They restored qi by means of herbs, acupuncture, massage, diet, and exercise.The Hindu philosophers connected the soul and breath as part of the mind, body, and spirit connection.Yoga uses control of breathing to enhance meditation. Indian physicians taught these breathing techniques to help manage asthma. Allergy factMaimonides was a renowned 12th-century rabbi and physician who practiced in the court of the sultan of Egypt. He recommended to one of the Royal Princes with asthma that he eat, drink, and sleep less. He also advised that he engage in less sexual activity, avoid the polluted city environment, and eat a specific remedy-chicken soup.
The balance of the "four humors," which was derived from the Greco-Roman times, influenced European medicine until the middle of the 18th century. In a healthy person, the four humors, or bodily fluids -- blood, black bile, yellow bile, and phlegm -- were in balance. An excess of one of these humors determined what kinds of disorders were present. Asthmatics who were noted for their coughing, congestion, and excess mucus (phlegm) production were therefore regarded as "phlegmatic."
By the 1800s, aided by the invention of the stethoscope, physicians began to recognize asthma as a specific disease. However, patients still requested the traditional treatments of the day, such as bloodletting, herbs, and smoking tobacco. These methods were used for a variety of conditions, including asthma. Of the many remedies that were advertised for asthma throughout the 19th century, none were particularly helpful.
Allergy factAs early as 1892, the famous Canadian-American physician Sir William Osler suggested that inflammation played an important role in asthma.
Bronchial dilators first appeared in the 1930s and were improved in the 1950s. Shortly thereafter, corticosteroid drugs that treated inflammation appeared and have become the mainstay of therapy used today.

What medications are used in the treatment of asthma?
Most asthma medications work by relaxing bronchospasm (bronchodilators) or reducing inflammation (corticosteroids). In the treatment of asthma, inhaled medications are generally preferred over tablet or liquid medicines, which are swallowed (oral medications). Inhaled medications act directly on the airway surface and airway muscles where the asthma problems initiate. Absorption of inhaled medications into the rest of the body is minimal. Therefore, adverse side effects are fewer as compared to oral medications. Inhaled medications include beta-2 agonists, anticholinergics, corticosteroids, and cromolyn sodium. Oral medications include aminophylline, leukotriene antagonists, beta-2 agonists, and corticosteroid tablets.
Historically, one of the first medications used for asthma was adrenaline (epinephrine). Adrenaline has a rapid onset of action in opening the airways (bronchodilation). It is still often used in emergency situations for asthma. Unfortunately, adrenaline has many side effects, including rapid heart rate, headache, nausea, vomiting, restlessness, and a sense of panic.
Medications chemically similar to adrenaline have been developed. These medications, called beta-2 agonists, have the bronchodilating benefits of adrenaline without many of its unwanted side effects. Beta-2 agonists are inhaled bronchodilators which are called "agonists" because they promote the action of the beta-2 receptor of bronchial wall muscle. This receptor acts to relax the muscular wall of the airways (bronchi), resulting in bronchodilation. The bronchodilator action of beta-2 agonists starts within minutes after inhalation and lasts for about four hours. Examples of these medications include albuterol (Ventolin HFA, Proventil HFA), levalbuterol(Xopenex), metaproterenol (Alupent), pirbuterol acetate (Maxair), and terbutaline sulfate (Brethaire). Recently, chlorofluorocarbons (CFCs) have been removed from all MDI inhalers because of the environmental effects on the ozone layer. These have been replaced by a new propellant, hydroflouroalkane (HFA). Patients may notice that the jet they feel in the back of their throat is less intense when compared with the CFC inhaler. They should be instructed that they are still receiving the same amount of medication though it may feel different than their older inhaler. Another very important point that patients must be aware of is that "floating" these new inhalers does not help in determining the amount of medication left in the MDI. In the past, the CFC devices could be floated in a bowl of water. With more medicine in the inhaler, the canister would sink and gradually float as it emptied. This is not the case with the HFA inhalers, as floating will actually clog the inhaler. The number of accuations must be counted to determine if medication is still left in the inhaler. Shaking the inhaler is not an effective method of determining how much medication is left. Often propellant (HFA) will continue to come out of the inhaler even after the medication is used up. At the present, only one albuterol inhaler comes with a counter device and this is Ventolin HFA.
A new group of long-acting beta-2 agonists has been developed with a sustained duration of effect of 12 hours. These inhalers can be taken twice a day. Salmeterol xinafoate (Serevent) and formoterol (Foradil) are examples of this group of medications. The long-acting beta-2 agonists should not used for acute attacks. Beta-2 agonists can have side effects, such as anxiety, tremor, palpitations or fast heart rate, and lowering of blood potassium. There is data to suggest that taking long-acting beta-2 agonists alone may be life-threatening. They are best taken along with inhaled corticosteroids (see below).
Just as beta-2 agonists can dilate the airways, beta blocker medications impair the relaxation of bronchial muscle by beta-2 receptors and can cause constriction of airways, aggravating asthma. Therefore, beta blockers, such as the blood pressure medications propanolol (Inderal) and atenolol (Tenormin), should be avoided by asthma patients if possible.
The anticholinergic agents act on a different type of nerves than the beta-2 agonists to achieve a similar relaxation and opening of the airway passages. These two groups of bronchodilator inhalers when used together can produce an enhanced bronchodilation effect. An example of a commonly used anticholinergic agent is ipratropium bromide (Atrovent). Ipratropium takes longer to work as compared with the beta-2 agonists, with peak effectiveness occurring two hours after intake and lasting six hours. These agents are more effective in patients with COPD.
When symptoms of asthma are difficult to control with beta-2 agonists, inhaled corticosteroids (cortisone) are often added. Corticosteroids can improve lung function and reduce airway obstruction over time. Examples of inhaled corticosteroids include beclomethasone dipropionate (Beclovent, Qvar, and Vanceril), triamcinolone acetonide (Azmacort), budesonide (Pulmocort), and flunisolide (Aerobid). The ideal dose of corticosteroids is still unknown. The side effects of inhaled corticosteroids include hoarseness, loss of voice, and oral yeast infections. Early use of inhaled corticosteroids may prevent irreversible damage to the airways.
To decrease the deposition of medications on the throat and increase the amount reaching the airways, spacers can be helpful. Spacers are tube-like chambers attached to the outlet of the MDI canister. Spacer devices can hold the released medications long enough for patients to inhale them slowly and deeply into the lungs. A spacing device placed between the mouth and the MDI can improve medication delivery and reduce the side effects on the mouth and throat. Rinsing out the mouth after use of a steroid inhaler also can decrease these side effects.
Combination inhaler therapy is now available for the treatment of asthma. These medications include Advair (fluticasone and salmeterol) and Symbicort (budesonide and formoteral). Symbicort uses the standard MDI inhaler device (a counter device will be added in the near future). Advair has a unique powdered delivery system with a built-in counter.
Cromolyn sodium (Intal) prevents the release of certain chemicals in the lungs, such as histamine, which can cause asthma. Exactly how cromolyn works to prevent asthma needs further research. Cromolyn is not a corticosteroid and is usually not associated with significant side effects. Cromolyn is useful in preventing asthma but has limited effectiveness once acute asthma starts. Cromolyn can help prevent asthma triggered by exercise, cold air, and allergic substances, such as cat dander. Cromolyn may be used in children as well as adults.
Theophylline (Theodur, Theoair, Slo-bid, Uniphyl, Theo-24) and aminophylline are examples of methylxanthines. Methylxanthines are administered orally or intravenously. Before the inhalers became popular, methylxanthines were the mainstay of treatment of asthma. Caffeine that is in common coffee and soft drinks is also a methylxanthine drug! Theophylline relaxes the muscles surrounding the air passages and prevents certain cells lining the bronchi (mast cells) from releasing chemicals, such as histamine, which can cause asthma. Theophylline can also act as a mild diuretic, causing an increase in urination. For asthma that is difficult to control, methylxanthines can still play an important role. Dosage levels of theophylline or aminophylline are closely monitored. Excessive levels can lead to nausea, vomiting, heart-rhythm problems, and even seizures. In certain medical conditions, such as heart failure or cirrhosis, dosages of methylxanthines are lowered to avoid excessive blood levels. Drug interactions with other medications, such as cimetidine (Tagamet), calcium channel blockers (Procardia), quinolones (Cipro), and allopurinol (Xyloprim) can further affect drug blood levels.
Corticosteroids are given orally for severe asthma unresponsive to other medications. Unfortunately, high doses of corticosteroids over long periods can have serious side effects, including osteoporosis, bone fractures, diabetes mellitus, high blood pressure, thinning of the skin and easy bruising, insomnia, emotional changes, and weight gain.
Expectorants help thin airway mucus, making it easier to clear the mucus by coughing. Potassium iodide is not commonly used and has the potential side effects of acne, increased salivation, hives, and thyroid problems. Guaifenesin (Entex, Humibid) can increase the production of fluid in the lungs and help to decrease the apparent thickness of the mucus but can also be an airway irritant for some people.
In addition to bronchodilator medications for those patients with atopic asthma, avoiding allergens or other irritants can be very important. In patients who cannot avoid the allergens, or in those whose symptoms cannot be controlled by medications, allergy shots are considered. The benefits of allergy shots (desensitization) in the prevention of asthma has not been firmly established. Some doctors are still concerned about the risk of anaphylaxis, which occurs in one in 2 million doses given. Allergy shots most commonly benefit children allergic to house dust mites. Other benefits can be seen with pollens and animal dander.
In some asthma patients, avoidance of aspirin, or other NSAIDs (commonly used in treating arthritis inflammation) is important. In other patients, adequate treatment of backflow of stomach acid (esophageal reflux) prevents irritation of the airways. Measures to prevent esophageal reflux include medications, weight loss, dietary changes, and stopping cigarettes, coffee, and alcohol. Examples of medications used to reduce reflux include omeprazole (Prilosec) and ranitidine (Zantac). Patients with severe reflux problems causing lung problems may need surgery to strengthen the esophageal sphincter in order to prevent acid reflux (fundoplication surgery). For further information, please read the Gastroesophageal Reflux Disease article.
Asthma At A Glance
Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. The bronchial narrowing is usually either totally or at least partially reversible with treatments.
Asthma is now the most common chronic illness in children, affecting one in every 15.
Asthma involves only the bronchial tubes and usually does not affect the air sacs or the lung tissue. The narrowing that occurs in asthma is caused by three major factors: inflammation, bronchospasm, and hyperreactivity.
Allergy can play a role in some, but not all, asthma patients.
Many factors can precipitate asthma attacks and are they are classified as either allergens or irritants.
Symptoms of asthma include shortness of breath, wheezing, cough, and chest tightness.
Asthma is usually diagnosed based on the presence of wheezing and confirmed with breathing tests.
Chest X-rays are usually normal in asthma patients.
Avoiding precipitating factors is important in the management of asthma.
Medications can be used to reverse or prevent bronchospasm in patients with asthma.


Notes: zantac, corticosteroid, acupuncture, yoga, cromolyn, epinephrine, albuterol, metaproterenol

What is asthma?

Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. The result is difficulty breathing. The bronchial narrowing is usually either totally or at least partially reversible with treatments.
Bronchial tubes that are chronically inflamed may become overly sensitive to allergens (specific triggers) or irritants (nonspecific triggers). The airways may become "twitchy" and remain in a state of heightened sensitivity. This is called "bronchial hyperreactivity" (BHR). It is likely that there is a spectrum of bronchial hyperreactivity in all individuals. However, it is clear that asthmatics and allergic individuals (without apparent asthma) have a greater degree of bronchial hyperreactivity than nonasthmatic and nonallergic people. In sensitive individuals, the bronchial tubes are more likely to swell and constrict when exposed to triggers such as allergens, tobacco smoke, or exercise. Amongst asthmatics, some may have mild BHR and no symptoms while others may have severe BHR and chronic symptoms.
Asthma affects people differently. Each individual is unique in their degree of reactivity to environmental triggers. This naturally influences the type and dose of medication prescribed, which may vary from one individual to another.

From the past to the present
Physicians in ancient Greece used the word asthma to describe breathlessness or gasping. They believed that asthma was derived from internal imbalances, which could be restored by healthy diet, plant and animal remedies, or lifestyle changes.
Allergy jargonAsthma is derived from the Greek word Panos, meaning panting.Chinese healers understood that xiao-chiran, or "wheezy breathing," was a sign of imbalance in the life force they called qi. They restored qi by means of herbs, acupuncture massage, diet, and exercise.The Hindu philosophers connected the soul and breath as part of the mind, body, and spirit connection. Yoga uses control of breathing to enhance meditation. Indian physicians taught these breathing techniques to help manage asthma. Allergy factMaimonides was a renowned 12th-century rabbi and physician who practiced in the court of the sultan of Egypt. He recommended to one of the Royal Princes with asthma that he eat, drink, and sleepless. He also advised that he engage in less sexual activity, avoid the polluted city environment, and eat a specific remedy-chicken soup.
The balance of the "four humors," which was derived from the Greco-Roman times, influenced European medicine until the middle of the 18th century. In a healthy person, the four humors, or bodily fluids -- blood, black bile, yellow bile, and phlegm -- were in balance. An excess of one of these humors determined what kinds of disorders were present. Asthmatics who were noted for their coughing, congestion, and excess mucus (phlegm) production were therefore regarded as "phlegmatic."
By the 1800s, aided by the invention of the stethoscope, physicians began to recognize asthma as a specific disease. However, patients still requested the traditional treatments of the day, such as bloodletting, herbs, and smoking tobacco. These methods were used for a variety of conditions, including asthma. Of the many remedies that were advertised for asthma throughout the 19th century, none were particularly helpful.
Allergy factAs early as 1892, the famous Canadian-American physician Sir William Osler suggested that inflammation played an important role in asthma.
Bronchial dilators first appeared in the 1930s and were improved in the 1950s. Shortly thereafter, corticosteroid drugs that treated inflammation appeared and have become the mainstay of therapy used today.

What is asthma?
Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. The result is difficulty breathing. The bronchial narrowing is usually either totally or at least partially reversible with treatments.
Bronchial tubes that are chronically inflamed may become overly sensitive to allergens (specific triggers) or irritants (nonspecific triggers). The airways may become "twitchy" and remain in a state of heightened sensitivity. This is called "bronchial hyperreactivity" (BHR). It is likely that there is a spectrum of bronchial hyperreactivity in all individuals. However, it is clear that asthmatics and allergic individuals (without apparent asthma) have a greater degree of bronchial hyperreactivity than nonasthmatic and nonallergic people. In sensitive individuals, the bronchial tubes are more likely to swell and constrict when exposed to triggers such as allergens, tobacco smoke, or exercise. Amongst asthmatics, some may have mild BHR and no symptoms while others may have severe BHR and chronic symptoms.
Asthma affects people differently. Each individual is unique in their degree of reactivity to environmental triggers. This naturally influences the type and dose of medication prescribed, which may vary from one individual to another.

From the past to the present
Physicians in ancient Greece used the word asthma to describe breathlessness or gasping. They believed that asthma was derived from internal imbalances, which could be restored by healthy diet, plant and animal remedies, or lifestyle changes.
Allergy jargonAsthma is derived from the Greek word Panos, meaning panting.Chinese healers understood that xiao-chiran, or "wheezy breathing," was a sign of imbalance in the life force they called qi. They restored qi by means of herbs, acupuncture, massage, diet, and exercise.The Hindu philosophers connected the soul and breath as part of the mind, body, and spirit connection.Yoga uses control of breathing to enhance meditation. Indian physicians taught these breathing techniques to help manage asthma. Allergy factMaimonides was a renowned 12th-century rabbi and physician who practiced in the court of the sultan of Egypt. He recommended to one of the Royal Princes with asthma that he eat, drink, and sleep less. He also advised that he engage in less sexual activity, avoid the polluted city environment, and eat a specific remedy-chicken soup.
The balance of the "four humors," which was derived from the Greco-Roman times, influenced European medicine until the middle of the 18th century. In a healthy person, the four humors, or bodily fluids -- blood, black bile, yellow bile, and phlegm -- were in balance. An excess of one of these humors determined what kinds of disorders were present. Asthmatics who were noted for their coughing, congestion, and excess mucus (phlegm) production were therefore regarded as "phlegmatic."
By the 1800s, aided by the invention of the stethoscope, physicians began to recognize asthma as a specific disease. However, patients still requested the traditional treatments of the day, such as bloodletting, herbs, and smoking tobacco. These methods were used for a variety of conditions, including asthma. Of the many remedies that were advertised for asthma throughout the 19th century, none were particularly helpful.
Allergy factAs early as 1892, the famous Canadian-American physician Sir William Osler suggested that inflammation played an important role in asthma.
Bronchial dilators first appeared in the 1930s and were improved in the 1950s. Shortly thereafter, corticosteroid drugs that treated inflammation appeared and have become the mainstay of therapy used today.

What medications are used in the treatment of asthma?
Most asthma medications work by relaxing bronchospasm (bronchodilators) or reducing inflammation (corticosteroids). In the treatment of asthma, inhaled medications are generally preferred over tablet or liquid medicines, which are swallowed (oral medications). Inhaled medications act directly on the airway surface and airway muscles where the asthma problems initiate. Absorption of inhaled medications into the rest of the body is minimal. Therefore, adverse side effects are fewer as compared to oral medications. Inhaled medications include beta-2 agonists, anticholinergics, corticosteroids, and cromolyn sodium. Oral medications include aminophylline, leukotriene antagonists, beta-2 agonists, and corticosteroid tablets.
Historically, one of the first medications used for asthma was adrenaline (epinephrine). Adrenaline has a rapid onset of action in opening the airways (bronchodilation). It is still often used in emergency situations for asthma. Unfortunately, adrenaline has many side effects, including rapid heart rate, headache, nausea, vomiting, restlessness, and a sense of panic.
Medications chemically similar to adrenaline have been developed. These medications, called beta-2 agonists, have the bronchodilating benefits of adrenaline without many of its unwanted side effects. Beta-2 agonists are inhaled bronchodilators which are called "agonists" because they promote the action of the beta-2 receptor of bronchial wall muscle. This receptor acts to relax the muscular wall of the airways (bronchi), resulting in bronchodilation. The bronchodilator action of beta-2 agonists starts within minutes after inhalation and lasts for about four hours. Examples of these medications include albuterol (Ventolin HFA, Proventil HFA), levalbuterol(Xopenex), metaproterenol (Alupent), pirbuterol acetate (Maxair), and terbutaline sulfate (Brethaire). Recently, chlorofluorocarbons (CFCs) have been removed from all MDI inhalers because of the environmental effects on the ozone layer. These have been replaced by a new propellant, hydroflouroalkane (HFA). Patients may notice that the jet they feel in the back of their throat is less intense when compared with the CFC inhaler. They should be instructed that they are still receiving the same amount of medication though it may feel different than their older inhaler. Another very important point that patients must be aware of is that "floating" these new inhalers does not help in determining the amount of medication left in the MDI. In the past, the CFC devices could be floated in a bowl of water. With more medicine in the inhaler, the canister would sink and gradually float as it emptied. This is not the case with the HFA inhalers, as floating will actually clog the inhaler. The number of accuations must be counted to determine if medication is still left in the inhaler. Shaking the inhaler is not an effective method of determining how much medication is left. Often propellant (HFA) will continue to come out of the inhaler even after the medication is used up. At the present, only one albuterol inhaler comes with a counter device and this is Ventolin HFA.
A new group of long-acting beta-2 agonists has been developed with a sustained duration of effect of 12 hours. These inhalers can be taken twice a day. Salmeterol xinafoate (Serevent) and formoterol (Foradil) are examples of this group of medications. The long-acting beta-2 agonists should not used for acute attacks. Beta-2 agonists can have side effects, such as anxiety, tremor, palpitations or fast heart rate, and lowering of blood potassium. There is data to suggest that taking long-acting beta-2 agonists alone may be life-threatening. They are best taken along with inhaled corticosteroids (see below).
Just as beta-2 agonists can dilate the airways, beta blocker medications impair the relaxation of bronchial muscle by beta-2 receptors and can cause constriction of airways, aggravating asthma. Therefore, beta blockers, such as the blood pressure medications propanolol (Inderal) and atenolol (Tenormin), should be avoided by asthma patients if possible.
The anticholinergic agents act on a different type of nerves than the beta-2 agonists to achieve a similar relaxation and opening of the airway passages. These two groups of bronchodilator inhalers when used together can produce an enhanced bronchodilation effect. An example of a commonly used anticholinergic agent is ipratropium bromide (Atrovent). Ipratropium takes longer to work as compared with the beta-2 agonists, with peak effectiveness occurring two hours after intake and lasting six hours. These agents are more effective in patients with COPD.
When symptoms of asthma are difficult to control with beta-2 agonists, inhaled corticosteroids (cortisone) are often added. Corticosteroids can improve lung function and reduce airway obstruction over time. Examples of inhaled corticosteroids include beclomethasone dipropionate (Beclovent, Qvar, and Vanceril), triamcinolone acetonide (Azmacort), budesonide (Pulmocort), and flunisolide (Aerobid). The ideal dose of corticosteroids is still unknown. The side effects of inhaled corticosteroids include hoarseness, loss of voice, and oral yeast infections. Early use of inhaled corticosteroids may prevent irreversible damage to the airways.
To decrease the deposition of medications on the throat and increase the amount reaching the airways, spacers can be helpful. Spacers are tube-like chambers attached to the outlet of the MDI canister. Spacer devices can hold the released medications long enough for patients to inhale them slowly and deeply into the lungs. A spacing device placed between the mouth and the MDI can improve medication delivery and reduce the side effects on the mouth and throat. Rinsing out the mouth after use of a steroid inhaler also can decrease these side effects.
Combination inhaler therapy is now available for the treatment of asthma. These medications include Advair (fluticasone and salmeterol) and Symbicort (budesonide and formoteral). Symbicort uses the standard MDI inhaler device (a counter device will be added in the near future). Advair has a unique powdered delivery system with a built-in counter.
Cromolyn sodium (Intal) prevents the release of certain chemicals in the lungs, such as histamine, which can cause asthma. Exactly how cromolyn works to prevent asthma needs further research. Cromolyn is not a corticosteroid and is usually not associated with significant side effects. Cromolyn is useful in preventing asthma but has limited effectiveness once acute asthma starts. Cromolyn can help prevent asthma triggered by exercise, cold air, and allergic substances, such as cat dander. Cromolyn may be used in children as well as adults.
Theophylline (Theodur, Theoair, Slo-bid, Uniphyl, Theo-24) and aminophylline are examples of methylxanthines. Methylxanthines are administered orally or intravenously. Before the inhalers became popular, methylxanthines were the mainstay of treatment of asthma. Caffeine that is in common coffee and soft drinks is also a methylxanthine drug! Theophylline relaxes the muscles surrounding the air passages and prevents certain cells lining the bronchi (mast cells) from releasing chemicals, such as histamine, which can cause asthma. Theophylline can also act as a mild diuretic, causing an increase in urination. For asthma that is difficult to control, methylxanthines can still play an important role. Dosage levels of theophylline or aminophylline are closely monitored. Excessive levels can lead to nausea, vomiting, heart-rhythm problems, and even seizures. In certain medical conditions, such as heart failure or cirrhosis, dosages of methylxanthines are lowered to avoid excessive blood levels. Drug interactions with other medications, such as cimetidine (Tagamet), calcium channel blockers (Procardia), quinolones (Cipro), and allopurinol (Xyloprim) can further affect drug blood levels.
Corticosteroids are given orally for severe asthma unresponsive to other medications. Unfortunately, high doses of corticosteroids over long periods can have serious side effects, including osteoporosis, bone fractures, diabetes mellitus, high blood pressure, thinning of the skin and easy bruising, insomnia, emotional changes, and weight gain.
Expectorants help thin airway mucus, making it easier to clear the mucus by coughing. Potassium iodide is not commonly used and has the potential side effects of acne, increased salivation, hives, and thyroid problems. Guaifenesin (Entex, Humibid) can increase the production of fluid in the lungs and help to decrease the apparent thickness of the mucus but can also be an airway irritant for some people.
In addition to bronchodilator medications for those patients with atopic asthma, avoiding allergens or other irritants can be very important. In patients who cannot avoid the allergens, or in those whose symptoms cannot be controlled by medications, allergy shots are considered. The benefits of allergy shots (desensitization) in the prevention of asthma has not been firmly established. Some doctors are still concerned about the risk of anaphylaxis, which occurs in one in 2 million doses given. Allergy shots most commonly benefit children allergic to house dust mites. Other benefits can be seen with pollens and animal dander.
In some asthma patients, avoidance of aspirin, or other NSAIDs (commonly used in treating arthritis inflammation) is important. In other patients, adequate treatment of backflow of stomach acid (esophageal reflux) prevents irritation of the airways. Measures to prevent esophageal reflux include medications, weight loss, dietary changes, and stopping cigarettes, coffee, and alcohol. Examples of medications used to reduce reflux include omeprazole (Prilosec) and ranitidine (Zantac). Patients with severe reflux problems causing lung problems may need surgery to strengthen the esophageal sphincter in order to prevent acid reflux (fundoplication surgery). For further information, please read the Gastroesophageal Reflux Disease article.
Asthma At A Glance
Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. The bronchial narrowing is usually either totally or at least partially reversible with treatments.
Asthma is now the most common chronic illness in children, affecting one in every 15.
Asthma involves only the bronchial tubes and usually does not affect the air sacs or the lung tissue. The narrowing that occurs in asthma is caused by three major factors: inflammation, bronchospasm, and hyperreactivity.
Allergy can play a role in some, but not all, asthma patients.
Many factors can precipitate asthma attacks and are they are classified as either allergens or irritants.
Symptoms of asthma include shortness of breath, wheezing, cough, and chest tightness.
Asthma is usually diagnosed based on the presence of wheezing and confirmed with breathing tests.
Chest X-rays are usually normal in asthma patients.
Avoiding precipitating factors is important in the management of asthma.
Medications can be used to reverse or prevent bronchospasm in patients with asthma.


Notes: zantac, corticosteroid, acupuncture, yoga, cromolyn, epinephrine, albuterol, metaproterenol