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Asthma Medications and their Delivery Devices
Two general classes of medicines for asthma There are two general classes of medicines used to treat asthma: reliever medicines and controller medicines. The reliever medicines are taken during coughing or wheezing attacks as a “quick fix” to stop those symptoms. The controller medicines are taken every day, or every day during certain seasons or during colds, to help to decrease lung inflammation. For some people, it's enough to have just the reliever medicine if symptoms are mild and infrequent. If they have more frequent attacks or severe but infrequent episodes, they may need to be on a controller medicine, as well.Frank Twarog, MD, PhD, Senior Associate, Department of Medicine, Division of Immunology The steroid medicines that cause kids to be a little hyper are taken by mouth. When kids get really severe attacks and have to come to the hospital, we will give them oral steroids that they may take for a short period of time (usually between four and seven days). There are some kids who have such severe asthma that they have to be on oral steroids all the time, but that's rare. When kids take the oral steroids I warn parents that their child may be a little more hyper than usual, but that it's short-lived and that not all kids have that reaction. As long as parents know that that's what will happen and that it's a relatively short-lived effect, I think most parents are comfortable managing that for that short period of time.Shari Nethersole, MD, Pediatrician, Department of Medicine Some parents are really hesitant about using the controller medicines, the inhaled steroids, because they have the word “steroids” in their name. I make sure that parents understand that these inhaled cortical steroids are different than the steroids they hear about on the news, that they are not the same steroids that some athletes abuse and that they don't do the same kinds of things or have the same kinds of side effects. Parents often worry that if their child takes steroids every day that the steroids will build up over time. There is some absorption you get of the inhaled steroids into your body, but the amount is much less than is absorbed during a five-or-six-day course of oral steroids which are used during asthma attacks. In other words, if a child has two bad asthma attacks over the course of a year and they need to come into the hospital and take the oral steroids for several days each time, the amount of steroids absorbed during those two asthma attacks is more than the kid would get using inhaled controller steroids every single day for a year. I explain to parents that these steroids have been studied and there are no significant side effects from using inhaled steroids on a daily basis. So I try to point out that it's a risk/benefit thing: there are very few risks and a lot of benefits.Shari Nethersole, MD, Pediatrician, Department of Medicine Most patients can be controlled with inhaled steroids The majority of patients with asthma can be controlled without oral steroids. Most patients can be brought under control with inhaled steroids, such as medicines called Flovent or Advair, and they don't have the same kind of toxicity that the oral steroids do.Hans Oettgen, MD, PhD, Associate Chief, Division of Immunology, Children's Hospital Boston Side effects of preventative medicines The most common preventative medicines that we use are steroid inhalers, and families have concerns about giving their children steroids every day. So we talk with them about the fact that the steroids only go to the lungs and are not absorbed systemically, that there isn't a lot of published data saying that they negatively affect the child's health, and there is a lot of published data that says that they really help control the child's asthma.Joanne Cox, MD, Medical Director Children's Hospital Primary Care Center, Associate Chief, Division of General Pediatrics, Children's Hospital Boston What is this steroid business? Parents all have concerns about medications: “What is this controller medication steroid business?” We hear a lot of that, and so we spend a lot of time overcoming the myths associated with inhaled steroid use. We make sure parents know that the inhaled steroids we use to treat asthma aren't the “roids” that the athletes use, and that their kids won't build muscle, bulk up or have the other dangerous side effects associated with anabolic steroids.Amy Burack, RN, MA, AE-C, Community Asthma Programs Manager, Children's Hospital Boston When kids are feeling well they may think they don't need their medications, and tend to stop taking them. For patients who participate in sports, we encourage them to take their medication explaining that it will allow them to play their best during the sport. I will discuss with patients “If you want to play the best in your sport you need to take your medication even if you're feeling well.” A lot of them are like “Yeah, really?” This approach seems to catch their attention! Kathleen Waddicor, RN, BSN, Nurse, Adolescent Medicine How spacers deliver asthma medicine I think people are surprised to learn that everyone needs a spacer with their inhaler. They don't realize when the medicine gets squirted through an inhaler it comes out at about 65 miles per hour. Nobody can coordinate squirting and breathing in at that speed— we don't inhale at 65 miles per hour!By squirting the medicine into the spacer, though, inhaling can be much more controlled and more of the medication can make it into a person's lungs, instead of getting deposited in the backs of their throats. This also decreases the chances of getting a horse voice or thrush. Thrush is a fungal infection of the mouth and can be a side effect of inhaled steroids. Beth Klements, MS, APRN, BC, Asthma Clinical Nurse Specialist, Pediatric Nurse Practitioner Nebulizers are a passive way to deliver medicine, and are usually easier to use than an inhaler or an inhaler and a spacer. The asthma medication goes in a compartment, and then you attach the tubing to it and it attach it to a compressor. When you turn the compressor on, put on a mask, and the medication will come out like steam or a mist and you just breathe it the medicine until it's gone— it usually takes between five and ten minutes. Nebulizers are really helpful during acute asthma attacks when the lungs are really tight. During those times, it is difficult for inhalers to work because the lungs are too tight for the medicine to get in and open them up. The mist from the nebulizers, though, works gradually, little by little, so they help to get into the lungs to dilate them and open them up more and more. Beth Klements, MS, APRN, BC, Asthma Clinical Nurse Specialist, Pediatric Nurse Practitioner |
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Copyright © 2007, Children's
Hospital Boston Department of Psychiatry. All Rights Reserved. The information on this website should not be taken as medical advice, which can only be given to you by your personal health care professional. Updated: June 5, 2007 |
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