Asthma Medicines

Since asthma has been defined as an illness characterized in part by airway obstruction it is essential for diagnosis to demonstrate this by using spirometry. The definition also includes the feature of reversibility; that is, that airflow can improve significantly. To demonstrate this feature spirometry is performed before and after inhaling bronchodilator medication. Th be significant, the physician looks for at least a 15 percent improvement in the spirometry parameters after the patient inhales bronchodilator medication.

Diseases such as emphysema, chronic bronchitis, cystic fibrosis, or bronchiectasis may demonstrate severe degrees of airflow obstruction without any improvement after bronchodilator use. However, it may be difficult to demonstrate reversibility in all asthmatics during a single laboratory session, possibly owing to severe degrees of bronchial narrowing or to inadequate inhalation of medication by the patient. Therefore, the absence of reversibility should never be taken as absolute proof that asthma is not present.

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Many patients fear they will become addicted to their asthma medications and be unable to stop their use. This may partly be due to dependence on medication for the relief of symptoms and attacks. This fear of addiction may explain why some patients do not take their medications.

There is no evidence of the development of addiction to asthma medications. When good control of asthma is achieved, it is often possible to reduce or discontinue medication that is no longer needed. However, good control must come first since withdrawal of medication may result in increased frequency of attacks.

Adrenal Insufficiency

In the case of systemic corticosteroids, the management of reduction and withdrawal of these agents must be closely supervised in view of possible adrenal insufficiency. Patients with severe asthma may become “steroid dependent” for control of their disease, but that does not represent an addiction to medication.

Are There Delay Effects of Asthma Medications?

Patients may be concerned whether long-term use of asthma drugs will have serious adverse effects, another reason why patients may reduce or eliminate medications on their own.

Long-term use in adults of the B-agonists, theophylline, cromolyn sodium, and inhaled corticosteroids have not shown any evidence of delayed adverse effects. In children, inhaled corticosteroids may have adverse effects on growth and bone development. These agents may still be necessary, however, when the risk of severe, uncontrolled asthma out-weighs the possible detrimental effects on bone growth. Nedocromil and ipratropium bromide are still relatively new and long-term experience with these agents is forthcoming. At this time there is no evidence of possible delayed adverse effects of these agents.

Oral Corticosteroids

In both children and adults, long-term effects of the oral corticosteroids must be anticipated. These effects are outlined above and must be weighed against the dangers of uncontrolled asthma. Once systemic steroids are required there should be frequent review of their necessity with the goal of reducing dosage or withdrawal if possible. Alternate-day administration should always be considered if patients must remain on oral corticosteroids.

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