Severe attacks can happen suddenly, but more often the asthma sufferer’s condition deteriorates slowly, so he or she delays getting medical help. You can do a lot to naturally relieve asthma symptoms, but if you have any suspicion that you might be in trouble, take whatever actions are necessary to open up your airways.
Asthma Medications: Is the Cure Worse than the Disease?
If you have ever been around somebody with poorly controlled asthma, you’re well aware that it can be a scary, severely limiting illness. The number of people in the United States with asthma has risen steadily since the 1970s, with a 50 percent increase just since 1990. Asthma is a major reason behind emergency room visits and hospitalizations in the United States. Death rates rose rapidly for a while in the 1990s and have stabilized in this decade—probably due to better medical treatments and prevention. Still, far too many are dependent on medications that they might be able to reduce or eliminate with appropriate natural interventions.
Although asthma medications have saved many lives, they temporarily stop symptoms without addressing underlying problems and can worsen the problem over time. Most physicians treat asthma with bronchodilators that open up the airways, or treat the underlying inflammation of the lungs with corticosteroids. The list of dangerous side effects of these two types of drugs is as long as your arm. Some of the most commonly used asthma drugs have earned black-box warnings—prominently displayed cautions about risk of death with these medicines—because of rare but potentially deadly side effects.
The rising number of asthma diagnoses and deaths is a very good indication that these medications aren’t working and may be doing more harm than good. The adverse effects of these drugs seems to go beyond escalating the severity of asthma attacks: a Johns Hopkins study published in the American Journal of Epidemiology suggests a link between beta-agonists, a very popular type of asthma drug, and an increased risk of heart disease.
Cleaning Products and Childhood Asthma
Children with higher levels of exposure to volatile organic compounds (VOCs) appear to have four-times the risk of developing asthma compared to children who are minimally exposed. These airway-irritating chemicals, many of which are also carcinogenic, are found in solvents, paint, cleaning products, floor adhesives, carpets, room fresheners, car exhaust, and polishes.
Krassi Rumchev and her coworkers at the School of Public Health at Curtin University of Technology in Perth, Australia, evaluated the histories of 88 children who were treated for asthma attacks in the emergency room at the Princess Margaret Hospital in Perth. The asthmatic children were compared with a control group (children who didn’t have asthma), based on detailed interviews with family members and measurements of 10 common VOCs (out of about 900 that have been identified) and allergens in the children’s homes. Indoor air can contain up to 1,000 times the concentration of VOCs as outdoor air. They found that at VOC levels above 60 micrograms per cubic meter, the child’s asthma risk quadrupled in comparison to children in homes with VOCs well below this threshold.
Keep VOCs out of your home by minimizing your use of commercial cleaning products and personal care products. That smell of chemically scoured bathrooms and air fresheners is bad for your family’s respiratory systems. Choose cleaning products made from natural ingredients. A simple mix of white vinegar and water in a spray bottle effectively cleans and disinfects most surfaces. If you replace carpets or paint, seek out low-VOC varieties, and if you can’t use them, keep the newly carpeted or painted room well ventilated and keep windows open whenever possible. Be sure that car exhaust is vented away from the house. And of course, don’t ever smoke around children. Tobacco smoke is a primary source of VOCs.
We’ve already looked at a few theories as to why the rate of asthma is rising so fast: food additives, immune systems compromised in childhood by repeated doses of antibiotics and vaccines, and indoor and outdoor air pollution.
One example of a food additive often linked to asthma is tartrazine (yellow dye no. 5). This yellow food coloring is used in some 60 percent of prescription and over-the-counter drugs, as well as in hundreds of processed foods such as cakes, cookies, cereals, soft drinks, ice cream, gelatin, pudding, and pasta. It is well-known to be a potent allergen in many people, commonly provoking breathing difficulties and asthma attacks. If you are allergic to aspirin, you are probably allergic to tartrazine. Children are especially susceptible to tartrazine, and there’s a good chance it’s responsible for many cases of childhood asthma in homes where processed foods are a dietary staple. Consumer groups tried for years to have tartrazine banned from food and drugs, but the food industry lobbyists won. Efforts to remove tartrazine from asthma and allergy drugs have also been unsuccessful. For more about drugs containing tartrazine, see the sidebar “Are You Sensitive to Tartrazine?”
In adults, asthma is more common in women, which gives us a clue that some part of it is hormonally related. Excessive estrogen, especially when not balanced by progesterone (not the synthetic progestins), can aggravate an existing asthma problem or even bring it on. Although natural progesterone tends to improve asthma symptoms, the synthetic progestins can cause or aggravate asthma. We highly recommend that you read What Your Doctor May Not Tell You About Menopause, by John R. Lee, M.D., for detailed information on natural versus synthetic hormones.
Many premenopausal women also suffer from tired adrenal glands and are unable to produce the necessary steroid hormones such as cortisol and adrenaline that the body would naturally produce to ward off asthma.
Drugs for Asthma
Bronchodilating inhalers are popular among asthma sufferers because they are very quick and effective at relieving the symptoms of an asthma attack and opening up the bronchial tubes for four to six hours. A sympathomimetic drug mimics the action of the sympathetic nervous system, which is responsible for the fight-or-flight reaction. They work on the same receptor sites as the body’s natural hormone adrenaline, a substance released when you are under severe stress. Beta-agonist drugs work through one aspect of the fight-or-flight system, so they are classified as sympathomimetic drugs. While not all sympathomimetic drugs are beta-agonists, the most commonly used of these medications belong to this subclass. You will learn more about the beta-agonists in coming sections.
Sympathomimetics increase heart rate and blood pressure, and can cause anxiety, restlessness, and insomnia. Bronchodilators are meant to be used occasionally to relieve “mild acute” asthma attacks. The reality of how they are used is far different: many asthmatics come to depend on them, using them many times a day. This is dangerous, because they become less effective over time, and the risk of serious side effects is increased.
Drugs that Can Cause or Aggravate Asthma
ACE inhibitors such as lisonopril (Zestril) and enalapril (Vasotec)
Antiarrhythmia drugs for the heart such as the beta-blockers (e.g., propranolol, timolol) and moricizine
Antinausea drug dimenhydrinate (Dramamine, Dimetabs)
Anti-Parkinson’s drugs
Antipsychotic drugs such as the phenothiazines and lithium
Antiviral drugs mainly used to treat HIV such as cidofovir and protease inhibitors
Aspirin
Barbiturates
Benzodiazepines, antianxiety drugs (Valium, Dalmane)
Cephalosporin, sulfonamide antibiotics
Cholinesterase inhibitors used to treat Alzheimer’s
Drugs to lower blood pressure such as guanethi-dine (Ismelin)
Ibuprofen-related family of nonsteroidal anti-inflammatory drugs (NSAIDs)
Narcotics
Over-the-counter sleeping pills such as diphenhydramine (Nytol, Sleep-Eze, Sominex, Tylenol PM)
Selective serotonin reuptake inhibitors (SSRIs), antidepressants such as fluoxetine (Prozac), fluvoxamine (Luvox), and paroxetine (Paxil)
Tricyclic antidepressants
Weight-loss drugs such as dexfenfluramine
At an annual meeting of the American College of Alle
rgy, Asthma and Immunology, it was acknowledged that misuse of one class of bronchodilator drug, the beta-agonists, may actually worsen asthma control and may even be responsible for the increase in asthma and asthma-related deaths. A large Canadian study confirmed this view. Overuse of these inhalers decreases the body’s ability to respond to their bronchodilating effects. Over time, too-frequent puffing on beta-agonist inhalers can send asthma sufferers into a downward spiral that ends up putting them in the emergency room with a severe attack.
Examples of Beta-Agonists
Short acting: albuterol (Proventil, Ventolin, Repetabs, Volmax, Airet), bitolterol mesylate (Tornalate), isoetharine (Arm-a-med Isoetharine, Beta-2, Bronkosol), isoproterenol (Isuprel Glossets, Isuprel, Medihaler-Iso, Dispos-a-Med), levalbuterol (Xopenex), metaproterenol sulfate (Alupent, Metaprel), pirbuterol acetate (Maxair Inhaler, Maxair Autohaler), terbutaline sulfate (Brethine, Bricanyl)
Long-acting: arformoterol (Brovana), bambuterol (Bambec, Oxeol), formoterol (Foradil, Perforomist, Oxis), salmeterol (Serevent)
Using an Inhaler for Asthma
If you regularly use fast-acting inhalers to control your asthma, keep track of your usage. If you find yourself needing to use your inhaler more and more frequently to feel like your symptoms are controlled, heed it as a warning. Many studies have shown that more frequent inhaler use leads to a downward spiral of worsening bronchoconstriction and possibly a life-threatening attack.
Using your inhaler properly when you do have to use it will enable you to get the optimal dosage of your medicine and to get it where it needs to go. Have your doctor show you exactly how to get the medication into your airways efficiently, and ask him or her for a spacer—a long plastic canister that you attach to your inhaler that helps distribute the medication so that it goes into your lungs rather than onto the back of your throat.
What Do They Do in the Body? The Beta-agonist bronchodilating drugs work by stimulating receptors that cause opening of the bronchial tubes that lead to the lungs. Beta-agonists inhibit the release of histamine from mast cells in the airways and increase the movement of the tiny cilia that help propel allergens out of the lungs. Short-acting versions have more intense, less persistent effects; long-acting versions aren’t effective for stopping an acute attack but are used prophylactically on a regular schedule, usually twice a day, to maintain open airways and prevent attacks.
What Are They Used For? Beta-agonists reverse the constriction of the bronchial tubes that occurs during an asthma attack, exercise-induced asthma, chronic bronchitis, emphysema, and other chronic obstructive pulmonary diseases (COPDs). Short-acting beta-agonists are used alone, as needed, for mild, well-controlled asthma; they are also known as “rescue inhalers.” Long-acting beta-agonists (LABAs) are used long-term for symptoms that prove more difficult to control. In more severe cases, beta-agonists may be taken as a pill or inhaler along with another anti-inflammatory drug such as theophylline or cromolyn sodium. The popular drug Advair pairs a long-acting beta-agonist, salmeterol, with an inhaled steroid, fluticasone propionate; Symbicort is a similar combination, with the steroid budesonide and the LABA formoterol. More on these combinations later.
Are You Sensitive to Tartrazine?
In the United States, any product that contains tartrazine has to say so on the label. Avoid drugs containing tartrazine for respiratory problems, and choose an alternative that does not contain this allergenic dye. Also avoid pills that have red coloring in them. Both red dyes and the iron oxides used to color some pills can cause allergic reactions.
What Are the Possible Side Effects/Adverse Effects? All beta-agonists stimulate the central nervous system, which can give you a case of the “jitters,” as if you’ve had too much coffee. Mood swings, increased appetite, fatigue, nightmares, and aggressive behavior are other possible side effects. Bronchitis, nasal congestion, increased secretion of saliva, nosebleed, muscle cramps, conjunctivitis, or discoloration of the teeth may occur.
The most common side effects of the long-acting beta-agonists are shakiness, nervousness, tension, inflammation of the nasal passageways and throat, sinus problems, and upper and lower respiratory tract infection. Others include palpitations, rapid heartbeat, chest tightness, angina (heart pains), tremor, dizziness, vertigo, headache, nausea, vomiting, diarrhea, joint and back pain, muscle cramping, generalized muscle aches, giddiness, susceptibility to flu virus and viral gastroenteritis, itching, dental pain, fatigue, rash, menstrual irregularities, nasal allergies, runny nose, laryngitis, bronchitis, dry mouth, and cough.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You have ever had any kind of dangerous cardiac arrhythmias or heart blockage. If you have had arrhythmias or heart blockages due to use of digitalis, you will want to be especially cautious about using LABAs.
• You have narrow-angle glaucoma.
• You are going to have surgery. Tell your physician that you use this drug. Beta-agonists can interact dangerously with general anesthesia.
• You have diabetes, high blood pressure, heart disease, history of stroke, congestive heart failure, or hyperthyroidism; are elderly; or have a history of seizures or psychoneurotic illness. Dosages may need to be adjusted.
Diabetics who use beta-agonists should be aware that the jittery feeling they get when blood sugar is too low is hard to distinguish from the side effects of the drug.
With repeated, excessive use of short-acting beta-agonist inhalers, your body may begin to respond with what’s known as paradoxical bronchoconstriction. Instead of opening your airways, use of the inhaler causes them to constrict even further. If you think this is happening to you, or if you find yourself using your rescue inhaler more than twice a week, see a doctor as soon as possible. Your asthma may be spiraling out of control.
With short-acting beta-agonists, tolerance may occur; temporary discontinuation should bring back the drug’s original potency. Lower doses may be required for elderly people because of heightened sensitivity to nervous system stimulation.
Although the LABAs are good at controlling asthma symptoms, studies show a small increase in risk of death and hospitalization due to asthma-related breathing problems with salmeterol (Serevent) and formoterol (Foradil), when they are used alone. They are almost always prescribed as combination drugs, with each dose containing a LABA and a corticosteroid drug. Two such combination drugs are Advair and Symbicort. The danger of a life-threatening attack with LABAs alone has earned these drugs, as well as Advair and Symbicort, black-box warnings. The risk is small, but it does appear that some people have a paradoxical reaction to the LABAs, in which their airways constrict instead of opening in response to the medication. In 2008, the Food and Drug Administration (FDA) ordered that a new safety review be conducted into the LABAs.
An inhaled steroid drug alone is the best alternative for long-term control if short-acting beta-agonists don’t do the trick; if this approach doesn’t work, then a combination drug like Advair or Symbicort may be your doctor’s next recommendation. Monitor yourself carefully and see your doctor right away if you suspect your asthma symptoms are worsening while you are on these drugs. You’ll learn more about these combination drugs later in this chapter.
LABAs are not for treatment of an acute asthma attack. They are meant to be taken twice a day on an ongoing basis. Increasing the dose on your own to try to alleviate worsening symptoms is dangerous. Keep albuterol, epinephrine, or another fast-acting inhaler with you to open airways during an attack. If you find that your need for these fast-acting drugs is increasing despite your continued use of your long-acting beta-agonist, see your doctor as soon as possible.
Beta-blocking drugs typically used to control blood pressure should not be taken with beta-agonist drugs, as their actions directly oppose one another in the body. In fact, a person with asthma should not take beta-blockers unless absolutely necessary, as research shows that these drugs can actually bring on an asthma attack.
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sp; Taking nonpotassium-sparing diuretics with beta-agonists can deplete potassium in the body, possibly leading to changes in heart rhythm—especially if the beta-agonist is overused.
Examples of Epinephrines
Epinephrine (Adrenalin Chloride, Asthma Nefrin, microNefrin, Nephron, S-2, Vaponefrin, AsthmaHaler Mist, Bronitin Mist, Primatene Mist, Bronkaid Mist, Sus-Phrine)
Ephedrine sulfate
Ethylnorepinephrine (Bronkephrine)
What Do They Do in the Body? Like albuterol, the epinephrines are bronchodilating drugs that work quickly by stimulating receptors that cause opening of the bronchial tubes that lead to the lungs. They also work as nasal decongestants when inhaled through the nose.
What Are They Used For? Epinephrines are mainly used in inhalers but may be used in an injection to offset a severe allergic reaction. Inhalers are useful for treatment of an acute asthma attack or nasal congestion, while the injectable form is only for emergency situations where there is threat of complete closure of the bronchial tubes due to asthma attack or anaphylaxis (a life-threatening allergic reaction that involves swelling of the airways).
What Are the Possible Side Effects? These are extremely potent stimulant drugs that can cause sharp increases in blood pressure and heart pains. Rupture of the blood vessels in the brain and rupture of blood vessels around the heart have been reported in people using epinephrines. Heartbeat irregularities develop in some people even with low doses. Epinephrines have caused permanent electrocardiogram changes in healthy people, indicating some very significant effects on the conduction system that keeps the heart beating.
Bronchial irritation, nervousness, restlessness, and sleeplessness may be signs that you need to have your dosage of epinephrine reduced. If you do not feel your asthma symptoms have been relieved within 20 minutes after your usual dose, don’t keep taking it. Seek medical assistance immediately.
Prescription Alternatives Page 24