Asthma Medicines

Having a Treatment Plan

The drop in peak flow to 50 percent of the patient’s best identifies a serious attack. The patient should repeat the maneuver to determine if it is reproducible. Each patient should have a plan of treatment that has been worked out with the physician. This will typically call for immediate use of rapidly acting bronchodilator medication delivered as an aerosol. The plan should contain instructions on the use of corticosteroids and notification of the patient’s physician.

The physician’s knowledge of the patient’s history will prove invaluable at this time. Patients who have required hospitalization and especially those who have required respirator support for treatment of asthmatic attacks in the past will be advised not to delay treatment decisions. This patient group may require emergency room treatment as will patients with severe attacks who do not rapidly increase their peak flows with bronchodilator medication administered as directed (and not overused).

In treatment of bronchial asthma it is necessary to be aggressive early in treatment of severe attacks, including the possible use of an emergency room. With early recognition of a severe attack and aggressive treatment at its onset, fatal or near-fatal episodes can be avoided.

In the patient group with severe attacks who respond promptly to treatment, the patient’s treatment plan may often be continued in the home. With severe attacks this will most certainly require corticosteroids. Communication with the physician is essential and will be more accurate with serial peak flow measurements. Increasing airflows will confirm the effectiveness of treatment and can be used to adjust medication dosage and frequency of administration.

Following a severe attack that has been successfully treated it is important for the physician and patient to reassess maintenance medication and the treatment plan. The diary of peak flows will be extremely helpful since it may identify a downward trend that began before a severe attack was recognized. Emphasis on earlier recognition may prove helpful in avoiding future attacks.

With each significant attack the physician will look for a “trigger” mechanism that might be prevented in the future. An example would be raking moldy leaves or dusting without a face mask. Avoiding allergens will be stressed in sensitive patients who suffer serious attacks on exposure to these substances. Often the trigger for an asthmatic attack is the common cold. Although this infection cannot be prevented, the patient should be alerted to the possible adverse effects that might result and be prepared to institute the treatment plan.

In many instances the trigger for a severe asthmatic attack cannot be identified. If attacks are frequent, a review of the medical evaluation should be made. Additional allergy tests may be indicated and another careful examination of the home and work environment made. The patient’s administration of medication should also be examined and the maintenance medication program reviewed.

What If Avoidance Doesn’t Work?

Despite measures to avoid asthma triggers, the patient may still experience asthmatic attacks. These attacks may be frequent and severe and at times require hospitalization. In a small number of patients these attacks may prove fatal.

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A more accurate and revealing, although more invasive, test of gas exchange by the lung is called an arterial blood gas. In this test, blood is obtained from an artery (commonly the radial artery at the wrist), allowing a more accurate test of not only the oxygen level but carbon dioxide. Carbon dioxide (CO2) is the waste product of the body excreted by the lungs. Severe degrees of lung disease, including asthma, can impair gas exchange mechanisms to the point that levels of CO2 will rise. In bronchial asthma this finding identifies an extremely severe and serious attack that requires hospitalization. These patients will also have lowered oxygen levels and may require mechanical respiratory assistance.

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