Archive-name: medicine/asthma/general-info URL: http://www.cco.caltech.edu/~wrean/asthma-gen.html alt.support.asthma FAQ: Asthma -- General Information ====================================================== Introduction: ------------ Welcome to alt.support.asthma! This newsgroup provides a forum for the discussion of asthma, its symptoms, causes, and forms of treatment. Please note that postings to alt.support.asthma are intended to be for discussion purposes only and are in no way to be construed as medical advice. Asthma is a serious medical condition requiring direct supervision by a physician. This FAQ attempts to answer the most frequently asked questions on the newsgroup alt.support.asthma. It is maintained by Patricia Wrean . Please be aware that the information in this FAQ is intended for educational purposes only and should not be used as a substitute for consulting with a doctor. Most of the contributors are not health care professionals; this FAQ is a collection of personal experiences, suggestions, and practical information. Please remember when reading this that every asthmatic responds differently; what is true for some asthmatics may or may not be true for you. Although every effort is made to keep this information accurate, this FAQ should not be used as an authoritative reference. Comments, additions, and corrections are requested; if you do not wish your name to be included in the contributors list, please state that explicitly when contributing. I will accept additions upon my own judgement -- I'll warn you right now that I'm a confirmed skeptic and am not a great believer in alternative medicine. All unattributed portions are my own contributions. For more information about asthma medications, there is also an Asthma Medications FAQ that is posted as a companion to this one. * = not added yet + = added since last version & = updated/corrected since last version ====================================================================== Table of Contents: ----------------- General Information: & 1.0 What is asthma? + 1.0.1 What is chronic asthmatic bronchitis? 1.0.2 What is status asthmaticus? 1.0.3 What is anaphylactic shock? + 1.0.4 What is COPD? 1.0.5 What is emphysema? + 1.0.6 What is bronchitis? + 1.0.7 What is pneumonia? + 1.0.8 What is cystic fibrosis? + 1.1 What is an asthma attack? + 1.1.1 What is wheezing? + 1.1.2 Do all asthmatics wheeze? + 1.1.3 What is "coughing asthma"? + 1.1.4 Is asthma hereditary? + 1.2 How is asthma diagnosed? + 1.2.1 What is a spirometer? + 1.2.2 What is a peak flow meter? & 1.3 How is asthma normally treated? & 1.3.1 How is an acute asthma attack treated? + 1.4 What are the most common triggers of asthma? + 1.4.1 What is intrinsic/extrinsic asthma? + 1.4.2 Can gastric reflux trigger asthma? Medications: & 2.0 What are the major classes of asthma medications? 2.1 What are the names of the various asthma medications? 2.1.1 Are salbutamol and albuterol the same drug? 2.2 Are some asthma drugs banned in athletic competitions? 2.3 What kinds of inhalers are there? 2.3.1 Do inhaler propellants bother some asthmatics? 2.3.2 What is a spacer? 2.3.3 What is "thrush mouth" and how can I avoid it? 2.3.4 Is Fisons still making the Intal Spinhaler? 2.3.5 What's the difference between Spinhalers and Rotahalers? 2.3.6 Why are so many asthma drugs taken via inhaler? + 2.3.7 How can I tell when my MDI is empty? 2.4 What kinds of tablets are there? 2.4.1 Why do I need a blood test when taking theophylline? 2.4.2 Why are combination pills not commonly prescribed? 2.5 What is a nebulizer? & 2.6 What medications should asthmatics be careful about taking? Miscellaneous: 3.0 What resources are there for asthmatics? + 3.1 Where can I get the latest copy of the FAQs? ====================================================================== 1.0 What is asthma? -------------------- Asthma is best described by its technical name: Reversible Obstructive Airway Disease (ROAD). In other words, asthma is a condition in which the airways of the lungs become either narrowed or completely blocked, impeding normal breathing. However, in asthma, this obstruction of the lungs is reversible, either spontaneously or with medication. Quickly reviewing the structure of the lung: air reaches the lung by passing through the windpipe (trachea), which divides into two large tubes (bronchi), one for each lung. Each bronchi further divides into many little tubes (bronchioles), which eventually lead to tiny air sacs (alveoli), in which oxygen from the air is transferred to the bloodstream, and carbon dioxide from the bloodstream is transferred to the air. Asthma involves only the airways (bronchi and bronchioles), and not the air sacs. The airways are cleaned by trapping stray particles in a thin layer of mucus which covers the surface of the airways. This mucus is produced by glands inside the lung, and is constantly being renewed. The mucus is then either coughed up or swept up to the windpipe (trachea) by cilia, tiny hairs on the lining of the airways. Once the mucus reaches the throat, it can again be coughed up or, alternatively, swallowed. Although everyone's airways have the potential for constricting in response to allergens or irritants, the asthmatic's airways are oversensitive, or hyperreactive. In response to stimuli, the airways may become obstructed by one of the following: - constriction of the muscles surrounding the airway; - inflammation and swelling of the airway; or - increased mucus production which clogs the airway. Once the airways have become obstructed, it takes more effort to force air through them, so that breathing becomes laboured. This forcing of air through constricted airways can make a whistling or rattling sound, called wheezing. Irritation of the airways by excessive mucus may also provoke coughing. Because exhaling through the obstructed airways is difficult, too much stale air remains in the lungs after each breath. This decreases the amount of fresh air which can be taken in with each new breath, and this lack of fresh air means that less oxygen is available for the whole body. This decreased supply of oxygen is what makes an uncontrolled asthma attack so serious. 1.0.1 What is chronic asthmatic bronchitis? -------------------------------------------- Chronic asthmatic bronchitis is the condition in which the airways in the lungs are obstructed due to both persistent asthma and chronic bronchitis (see sections 1.0 and 1.0.6). People with this disease generally also have a persistent cough which brings up mucus. This condition differs from COPD in that it doesn't involve emphysema. 1.0.2 What is status asthmaticus? ---------------------------------- Status asthmaticus is defined as a severe asthma attack that fails to respond to routine treatment, such as inhaled bronchodilators, injected epinephrine (adrenalin), or intravenous theophylline. 1.0.3 What is anaphylactic shock? ---------------------------------- Anaphylactic shock is defined as a severe and potentially life-threatening allergic reaction throughout the entire body. It occurs when an allergen, instead of provoking a localized reaction, enters the bloodstream and circulates through the entire body, causing a systemic reaction. (There may also be an intrinsic trigger, as some cases of exercise-induced anaphylaxis have been reported.) The symptoms of anaphylactic shock begin with a rapid heartrate, flushing, swelling of the throat, nausea, coughing, and chest tightness. Severe wheezing, cramping, and a rapid drop in blood pressure follow, which may lead to cardiac arrest. The treatment for anaphylaxis is intravenous epinephrine (adrenalin). 1.0.4 What is COPD? -------------------- COPD is chronic obstructive pulmonary disease, also known as either COAD, for chronic obstructive airway disease, or COLD, for chronic obstructive lung disease. COPD is a disease in which the airways are obstructed due to a combination of asthma, emphysema, and chronic bronchitis. The 1987 Merck Manual notes that "the term COPD was introduced because these conditions often coexist, and it may be difficult in an individual case to decide which is the major one producing the obstruction." 1.0.5 What is emphysema? ------------------------- Emphysema is the disease in which the air sacs themselves, rather than the airways, are either damaged or destroyed. This is an irreversible condition, leading to poor exchange of oxygen and carbon dioxide between the air in the lungs and the bloodstream. 1.0.6 What is bronchitis? ------------------------- Bronchitis is an inflammation of the bronchi, the large airways inside the lungs. (Bronchiolitis is the inflammation of the bronchioles, the small airways.) This inflammation often leads to increased mucus production in the airways. Bronchitis is generally caused either by a virus or by exposure to irritants such as dust, fumes, or cigarette smoke. If caused by a virus, the bronchitis will likely be only temporary. In the case of prolonged exposure to irritants, particularly cigarette smoking, if there is permanent damage to the bronchi, bronchitis may become chronic. 1.0.7 What is pneumonia? ------------------------- Pneumonia is an infection of the tissue inside the lung. In adults, it is generally caused by bacterial infections. Fortunately, there is a pneumococcal pneumonia vaccination available as a preventive measure for the most common of these bacterial infections, streptococcus pneumoniae. In children, pneumonia is most commonly caused by viruses. 1.0.8 What is cystic fibrosis? ------------------------------- Cystic fibrosis is a disease in which excessive amounts of unusually thick mucus are produced throughout the body. Because this mucus production also occurs in the lungs, people with cystic fibrosis are extraordinarily prone to bacterial infections which result in progressive lung damage. Cystic fibrosis can be diagnosed by a "sweat test" as people with cystic fibrosis have elevated chloride levels in their perspiration. This condition often resembles asthma in children. 1.1 What is an asthma attack? ------------------------------ An asthma attack, also known as an asthma episode or flare, is any shortness of breath which interrupts the asthmatic's routine and requires either medication or some other form of intervention for the asthmatic to breathe normally again. 1.1.1 What is wheezing? ------------------------ Wheezing is the whistling or rattling sound that occurs when air flows through obstructed airways. At the start of an asthma attack, wheezing usually only occurs while exhaling, or breathing out, but as the attack progresses, wheezing may then be heard both while inhaling and exhaling. If after the attack progresses further, the asthmatic then stops wheezing, this may indicate that many bronchioles (small airways) have become completely blocked, which is a very serious condition. 1.1.2 Do all asthmatics wheeze? -------------------------------- No, not all asthmatics wheeze. Although wheezing is extremely common in asthmatics, in _All About Asthma_, Dr. Paul says, "It is important to note that not all asthmatic symptoms need be present for one to experience an asthma attack. For instance, not all asthmatics wheeze. And sometimes wheezing is so slight, it can only be heard with a stethoscope. With some asthmatics, coughing is the only symptom present." Similarly, in _Children with Asthma_, Dr. Plaut states that children with chronic coughs "may have asthma even though no wheezing is present." He diagnoses such children with asthma if their peak flow improves when given an inhaled bronchodilator. 1.1.3 What is "coughing asthma"? --------------------------------- In _Children with Asthma_, Dr. Plaut defines "coughing asthma" as "a form of asthma in which coughing is the only symptom and there is no abnormality in any lung function test." This condition is also known as "cough variant asthma." Coughing asthma often improves when standard asthma medications are taken. 1.1.4 Is asthma hereditary? ---------------------------- Yes, there seems to be a hereditary component to the tendency to develop asthma. In _All About Asthma_, Dr. Paul states that if neither parent has asthma, the chances of each of their children having asthma are less than 10%. When one parent has asthma, the chances rise to 25%, and when both parents have asthma, the chances climb to 50%. (Actually, there is considerable disagreement among my sources as to the exact numbers, but all agree that the chances climb dramatically if one or both parents have asthma.) Similarly, if one or both parents have allergies, the chances of each of their children having allergies are 35% and 65%, respectively, compared to a less than 10% chance if neither parent has allergies. However, Dr. Paul cautions that "children don't inherit asthma itself, but the tendency to develop it." Whether or not an individual develops asthma is also influenced by their exposure to various other factors such as infections, irritants, and allergens. 1.2 How is asthma diagnosed? ----------------------------- Asthma is diagnosed based on a physical examination, personal history, and possibly lung function tests. The physical examination looks for typical asthma symptoms such as wheezing or coughing, and the personal history provides additional clues such as allergies or a familial tendency towards asthma. Lung function tests may be as simple as measuring peak flow with a peak flow meter, or using a simple spirometer, or may involve a battery of spirometry tests in a pulmonary function lab. In general, though, if the peak flow or lung volume increases significantly after use of a short-acting, inhaled bronchodilator, the diagnosis is probably that of asthma. 1.2.1 What is a spirometer? ---------------------------- A spirometer is a machine for testing lung function that you breathe in and out of through a hose attached to a mouthpiece. You are usually given nose clips so that all the air you breathe goes through the machine. One I've been tested on had a little expanding tank surrounded by water into which the air goes, and I could see the top rising and falling as I breathed out and in. It can measure a fair number of characteristics of your lungs, including FVC, FEV1, and PEPR. FVC, or forced vital capacity, is the amount of air that you can exhale forcefully after taking a deep breath. FEV1, or forced expiratory volume in one second, is the amount of air that you can be exhale in one second. Peak flow, or PEPR, is described in section 1.2.2. The sophisticated spirometers I've seen have a PC attached, and have neat little curves generated with each breath, which apparently have characteristic shapes for different respiratory diseases. There is a slightly less sophisticated machine that I've blown into, and I'm not sure if this is also classed as a spirometer or not, but you take a deep breath and blow into it, much like a peak flow meter, except that it draws a little graph of how much volume you've blown out, and I'd imagine that you can get the FVC and FEV1 off this graph. For more information, I recommend the book by Drs. Haas, _The Essential Asthma Book_, which goes into more detail about the various things you can find out from spirometry. úÿ 1.2.2 What is a peak flow meter? --------------------------------- A peak flow meter is a little plastic device which you blow hard into, after having taken a deep breath. It records the rate at which you've blown into it in litres exhaled per minute (L/min) -- this is called the peak expiratory flow rate (PEF or PEFR). The meter is essentially a cylinder with a mouthpiece at one end, a place for the air to escape at the other end, and a calibrated meter along the side. When you blow into it, a marker is pushed along the scale and comes to rest at a point which indicates your PEF. Since you want to measure your maximum peak flow, it is important to take a deep breath and blow as hard and as fast as you can. Many asthmatics find that their maximum peak flow provides a good objective measure of how their asthma is doing, so peak flow meters now are used extensively for self-monitoring of asthma, and also for monitoring the effectiveness of asthma medications. 1.3 How is asthma normally treated? ------------------------------------ Treatment of mild asthma usually tries to relieve occasional symptoms as they occur by use of short-acting, inhaled bronchodilators. Treatment of moderate or severe asthma, however, attempts to alleviate both the constriction and inflammation of the airways, through the use of both bronchodilators and anti-inflammatories. Bronchodilators are drugs which open up or dilate the constricted airways, while drugs aimed at reducing inflammation of the airways are called anti-inflammatories. Avoidance of irritants and allergens are also good treatment measures, and if the asthma is strongly triggered by allergies, then taking anti-allergic medication or taking shots for allergy desensitization are other alternatives. Taking anti-inflammatory drugs (usually inhaled corticosteroids) daily for moderate to severe asthma is a relatively new approach to treating asthma. The idea behind it is that if the underlying inflammation of the airways is reduced, the bronchi may become less hyperreactive, making future attacks less likely. Such anti-inflammatory therapy, however, must be taken regularly in order to be effective. 1.3.1 How is an acute asthma attack treated? --------------------------------------------- An acute asthma attack is usually treated by us of bronchodilators to reduce the constriction of the airways. Intravenous adrenalin and theophylline are often given in emergency rooms for this purpose, if short-acting bronchodilators given by nebuliser haven't sufficiently controlled the attack. Once the acute attack is over, anti-inflammatories may be used to reduce the inflammation of the airways. Inhaled steroids are usually the first choice, but for a sufficiently severe attack, oral steroids such as prednisone may also be given. 1.4 What are the most common triggers of asthma? -------------------------------------------- The most common triggers of asthma are: - viral respiratory infections, such as influenza (the flu) or bronchitis; - bacterial infections, including sinus infections; - irritants, such as pollution, cigarette smoke, perfumes, dust, or chemicals; - sudden changes in either temperature or humidity; - allergens, for people with allergies; - emotional upsets, such as stress; and - exercise. 1.4.1 What is intrinsic/extrinsic asthma? ------------------------------------------ Intrinsic asthma is asthma which seems to be triggered by non-allergic factors. Similarly, extrinsic asthma seems to be triggered by the presence of allergens in allergic individuals. According to the 1987 Merck Manual, about 30-50% of adult asthmatics have intrinsic asthma alone, 10-20% have extrinsic asthma alone, and the remainder have a combination of the two. In _All About Asthma_, Dr. Paul states that "asthma triggers tend to be extrinsic in younger people and intrinsic in older people. However, for both kinds of asthma, the symptoms are generally the same." 1.4.2 Can gastric reflux trigger asthma? ---------------------------------------- Yes, gastric reflux can act as an irritant which triggers asthma. Reflux, properly known as gastroesophageal reflux, occurs when the liquids in the stomach pass up the esophagus, or feeding tube. Because these liquids are usually highly acidic, they can irritate and inflame the esophagus, and also the airways of the lung, should any of this liquid be aspirated. This irritation can trigger an asthma attack. Asthma flares caused by reflux are more common at night, for it is easier for material to pass up the esophagus when one is lying down. Some simple treatments to prevent reflux include raising the head of the bed, not eating close to bedtime, or using either antacids or medications such as ranitidine (Zantac) which reduce the amount of acid produced by the stomach. ====================================================================== 2.0 What are the major classes of asthma medications? ------------------------------------------------------ There are six major classes of asthma medications: - steroidal anti-inflammatories, - non-steroidal anti-inflammatories, - beta-agonists, - xanthines, - anti-cholinergics, and - anti-allergics. The first two categories of drug treat the underlying inflammation of the lung. All steroidal anti-inflammatories are glucocorticosteroids, which are entirely different from the anabolic steroids that have become notorious for their abuse by athletes. There are many different corticosteroids available for the treatment of asthma, almost all available via inhaler to reduce the amount of side effects (see section 2.2.6). The only non-steroidal anti-inflammatory currently available is nedocromil sodium. The second two classes of asthma medications, beta-agonists and xanthines, are both bronchodilators. Beta-agonists are chemically related to adrenalin. They are usually taken in inhaled form, and all but one (salmeterol) are short-acting. The major xanthine, theophylline, is present in coffee and tea, and is taken orally. Theophylline is chemically related to caffeine, since caffeine is also a xanthine derivative. Anti-cholinergics are also bronchodilators, and like the beta-agonists they block the contraction of the underlying smooth muscle of the bronchi. Although used to treat asthma in Canada, the anti-cholinergic ipratropium bromide (Atrovent) has not approved by the US Food and Drug Administration for the treatment of asthma, but is used for the treatment of COPD. (It is interesting to note, however, that in the April 1982 issue of The FDA Drug Bulletin, the FDA states that "the FD&C Act does not, however, limit the manner in which a physician may use an approved drug. Once a product has been approved for marketing, a physician may prescribe it for uses or in treatment regimens or patient populations that are not included in a approved labeling." The FD&C Act is the Food, Drug, and Cosmetic Act.) The last class, the anti-allergics, has been included because the two anti-allergic drugs, cromolyn sodium and zaditen, are commonly taken for the prevention of extrinsic asthma, asthma that has a strong allergy component. Although cromolyn sodium is commonly thought of as a non-steroidal anti-inflammatory, it is actually anti-allergic, and both the Physicians' Desk Reference and the Compendium of Pharmaceuticals and Specialties state firmly that cromolyn sodium has no intrinsic anti-inflammatory properties. Zaditen, used mostly for pediatric allergic asthma, is not currently available in the United States. 2.1 What are the names of the various asthma medications? ---------------------------------------------------------- For a complete listing of asthma medications, please see the alt.support.asthma FAQ: Asthma Medications. It is posted monthly as the companion to this general information FAQ. 2.1.1 Are salbutamol and albuterol the same drug? -------------------------------------------------- Ventolin is the brand name of salbutamol, which is the WHO (World Health Organization) recommended name for the medication. Unfortunately, in the US this same drug is called albuterol, leading to endless confusion. In fact, it's one of the few drugs in which the brand name stays the same from country to country, while the chemical name changes! Ventolin is made in the U.S. by Allen & Hanburys, and Proventil is the same drug manufactured by Schering. You can also get this drug in a sustained-action tablet, called either Repetabs (by Schering, again) or Volmax (Muro). 2.2 Are some asthma drugs banned in athletic competitions? ----------------------------------------------------------- Banned substances in athletic competitions are not defined by whether they are medically necessary. Instead, the determination of whether a substance is banned or allowed is based on whether it can enhance athletic performance and thus potentially give an unfair competitive advantage. Many asthma drugs are BANNED in athletic competitions, and positive drug tests may result in disqualification of an athlete from competition for a 2 year period for the first offense. The United States Olympic Committee and International Olympic Committee follow similar protocols for American amateur athletes competing in events held in the United States and internationally. A partial list of banned substances includes: ephedrine, bitolterol, metaproterenol, orciprenaline, rimiterol, pirbuterol, and salmeterol. Oral use of many selective beta-2 agonists such as albuterol is banned. However, inhaler or nasal vehicles containing many beta-2 agonists [e.g. albuterol and terbutaline] as well as steroid preparations [e.g. beclomethasone, dexamethasone, and triamcinolone] are allowed for use in competition with written notification from the treating physician. Such notification must be on file with the United States Olympic Committee [USOC] Doping Control prior to competition. All forms of cromolyn sodium and theophylline are allowed. Asthma medications do not cause false positives for substances assayed for in athletic competition. Athletes should be aware that recommendations regarding the use of asthma medications (i.e. allowed vs. banned) in athletic competition may be revised. Ultimately, it is the athlete's responsibility to check with his or her National Governing Body [NGB] and coaches to identify whether any substance is allowed in athletic competition where drug testing may occur. The USOC Drug Hotline, (800) 233-0393, can provide assistance for the most current recommendations. In addition, the USOC Drug control program has a wide range of literature for athletes on what asthma medications are banned, allowed, and allowed with prior notification. Contributed by: Lyn Frumkin, M.D., Ph.D. lrfrum@u.washington.edu 2.3 What kinds of inhalers are there? -------------------------------------- aerosol inhalers: ---------------- MDI - metered-dose inhaler, consisting of an aerosol unit and plastic mouthpiece. This is currently the most common type of inhaler, and is widely available. autohaler - MDI made by 3M which is activated by one's breath, and doesn't need the breath-hand coordination that a regular MDI does. Available in U.S. for Maxair. respihaler - aerosol inhaler for Decadron. I have no idea how this differs from the usual MDI. Available in the U.S. syncroner - MDI with elongated mouthpiece, used as training device to see if medication is being inhaled properly. Available in Canada for Intal. dry powder inhalers: ------------------- insufflator - dry powder nasal inhaler used with Rynacrom cartridges. Each cartridge contains one dose; the inhaler opens the cartridge, allowing the powder to be blown into the nose by squeezing the bulb. Available in Canada. rotahaler - dry powder inhaler used with Rotacaps capsules. Each capsule contains one dose; the inhaler opens the capsule such that the powder may be inhaled through the mouthpiece. Available in the U.S., Canada, and UK for Ventolin. In Canada, Beclovent Rotacaps are also available. spinhaler - dry powder inhaler used with Intal capsules for spinhaler. Each capsule contains one dose; the inhaler opens the capsule such that the powder may be inhaled through the mouthpiece. Available in Canada, UK, and the U.S. diskhaler - dry powder inhaler. The drug is kept in a series of little pouches on a disk; the diskhaler punctures the pouch and drug is inhaled through the mouthpiece. Currently available in Canada and UK, not in U.S. turbuhaler - dry powder inhaler. The drug is in form of a pellet; when body of inhaler is rotated, prescribed amount of drug is ground off this pellet. The powder is then inhaled through a fluted aperture on top. Available in Australia and Canada. 2.3.1 Do inhaler propellants bother some asthmatics? ----------------------------------------------------- Some asthmatics find the dry powder inhalers more effective than their MDI (aerosol) counterparts. It is suspected that the aerosol or propellant in the MDI may act as an irritant to some asthmatics, as in the following article: J.R.W. Wilkinson et al., Paradoxical bronchoconstriction in asthmatic patients after salmeterol by metered dose inhaler, British Medical Journal 305 (1992) 931. The first sentence in the conclusion is: "Bronchoconstriction after both salmeterol and placebo by metered dose inhaler but not after salmeterol by diskhaler suggests that the irritant is not the salmeterol itself." . . . "The similarity in characteristics of bronchoconstriction after beclomethasone by metered dose inhalers implicates one or both chlorofluorocarbons . . . as the irritant. That salbutamol caused no bronchoconstriction was attributed to its faster onset of action opposing any bronchoconstrictor effects of the propellants." However, according to the 1994 Physicians' Desk Reference, Intal Spinhaler capsules are "contraindicated in those patients who have shown hypersensitivity to . . . lactose." So asthmatics who are lactose-intolerant may not have this form of cromolyn sodium as an option. 2.3.2 What is a spacer? ------------------------ A spacer is a device that simplifies the inhalation of aerosol metered-dose-inhalers (MDIs). Most people find it difficult (at least initially) to time the spraying of an MDI and the inhalation of the medicine, and, thus, most of the medicine is deposited in their mouths or the backs of their throats instead of their lungs. Besides being less effective, this can lead to other side effects (e.g., for inhaled steroids, an increased potential for thrush, an oral fungal infection). The spacer is basically a temporary holding chamber for the medication. You spray the medicine into the chamber where it temporarily remains suspended, and then you inhale deeply and SLOWLY. The column of medication rapidly passes through the mouth and goes into the lungs. There are a few different types of spacers. The one I'm most familiar with is the Aerochamber. It's a plastic tube with a mouthpiece on one end and a place to insert the MDI on the other. The mouthpiece has a delicate one-way valve built in so that you can exhale without displacing the medication in the chamber and then inhale. Some spacers are clear, some have a little whistle built in that tells you if you're inhaling too fast. I've read (and believe) that the medication is more efficiently delivered using a spacer than if it were merely inhaled directly from the MDI. Some packages (AeroBID, I believe, and others) come with a spacer built into its MDI housing. There are special spacers for younger children. There's an Aerochamber that has a mask built in; the child breathes normally for a few seconds with the mask held over his/her mouth and nose. This is typically used when a nebulizer is not available or not required, and for medications that cannot be nebulized, such as Beclovent or Vanceril. There is also a device for children called InspirEase, which is kind of like a plastic bellows or balloon with a plastic mouthpiece. The child inflates it, the medicine is sprayed into it, and the child inhales, holds his/her breath for the count of 5 (or whatever the doctor recommends), exhales into the device, and then repeats. It's really helpful for younger children who don't really know about breathing in and breathing out or how to hold their breath or breathe evenly and slowly. It gives them immediate physical feedback, and also has a whistle built in to tell them when they're breathing too fast (although they seem to like making it whistle, so it's positive reinforcement for something that they shouldn't be doing). As the child grows, the Inspirease becomes less effective, since it has a limited capacity. Although spacers are sometimes provided by some HMOs and covered by some insurers, I don't believe that a prescription is required. Contributed by: Mark Feblowitz mfeblowitz@GTE.com 2.3.3 What is "thrush mouth" and how can I avoid it? ----------------------------------------------------- Thrush, or thrush mouth, is the popular term for a yeast infection (candida albicans) in the back of throat. The major symptom of thrush is a white film located at the back of the throat and tonsil area. It is usually cured by the use of an antifungal mouthwash. Thrush is a very common side effect of taking inhaled corticosteroids. The way to avoid this complication is to ensure that the back of the throat doesn't remain coated with corticosteroid after use of the inhaler, either by using a spacer or by rinsing the mouth very thoroughly afterwards. úÿ Unfortunately, some people still get it even when they are very thorough about rinsing. 2.3.4 Is Fisons still making the Intal Spinhaler? -------------------------------------------------- Yes, Fisons is still manufacturing both the Intal Spinhaler (a dry powder inhaler for cromolyn sodium) and the capsules for it. Many pharmacists in the U.S. are under the impression that it is unobtainable, probably due to the fact that the Spinhaler was unavailable for a short time in the U.S. some while back due to a change in formulation. During this time, some wholesalers stopped buying the inhaler, and didn't restock it once the Spinhaler was back in production. So your pharmacist's regular wholesaler still may not be carrying this product. For further information, Fisons Corporation's number for Rx Customer Service is (800) 334-6433. 2.3.5 What's the difference between Spinhalers and Rotahalers? --------------------------------------------------------------- [Maintainer's note: the Rotahaler is a dry powder inhaler for Ventolin (albuterol), manufactured by Allen & Hanburys, while the Spinhaler is a dry powder inhaler for Intal (cromolyn sodium), manufactured by Fisons Corporation. Both inhalers are available in the U.S.] The Rotahaler and the Spinhaler are very different animals. The Rotahaler is a pussycat, the Spinhaler a ferocious lion. The Rotahaler is a two-part mouthpiece that you snap apart, put a capsule in, twist, and inhale. When you twist the device, the capsule breaks open. When you inhale, the medicine lands in your lungs. The Spinhaler is a three-piece device: a mouthpiece, a tiny fan, and a cap to cover the fan. You open it, put the capsule in a space on the fan, close it, push down then up on the cap (this breaks the capsule) and then tilt your head back, put the mouthpiece in your mouth, and inhale. The fan throws the medicine into the back of your throat. Then you gag. I don't like the propellants in MDIs, so I was highly motivated to get a Spinhaler. It took me a month to get my drugstore to find it, and now I must admit I'm disappointed. I tried using an Intal capsule in the Ventolin Rotahaler, since that device works so well, but the medicine seems to be of the wrong consistency, and the capsule is too large for the space it should go into. Another difference: The Spinhaler comes in a little container like a medicine bottle, but the lid doesn't stay on very well in a purse. The Rotahaler comes in a little plastic case sort of like a compact and stays shut (i.e. clean) in a purse, backpack, or jeans pocket. Contributed by: Paula Ford pxf3@psuvm.psu.edu 2.3.6 Why are so many asthma drugs taken via inhaler? ------------------------------------------------------ Medications taken orally almost always have a much higher systemic concentration (concentration in your entire body) than inhaled medications. So if the side effects are due to systemic concentrations, then an inhaled drug is less likely to have these side effects, or may have them much less severely. The idea behind an inhaler is that the full dose is delivered to the lungs, where it is immediately absorbed by the lung tissue, and starts to take effect locally. Excess drug may be absorbed by the bloodstream and delivered to the rest of your body, but this amount tends to be minimal. So your lungs receive an immediate, high concentration of the drug, and the rest of your body receives very little. If you take the drug orally in tablet or capsule form, then you need a much higher dose. The reason is that for the same amount of drug to reach the lungs through the bloodstream, you need the same concentration of drug in the rest of your body. For example, most people take one or two puffs of albuterol (Ventolin or Proventil) every four to six hours, and each puff is 90 micrograms of albuterol. The usual dosage of Ventolin in tablets is 2-4 milligrams three or four times a day, which is something like 200 times the amount inhaled. However, one advantage that tablets have is that the medication may be available in a time-release format. So for a short-acting medication like albuterol, the inhaled version might need to be taken every four to six hours, while a extended-release tablet such as Volmax would need to be taken only every twelve hours. 2.3.7 How can I tell when my MDI is empty? ------------------------------------------- You can tell whether an MDI (metered dose inhaler) canister is empty by taking the canister out of the mouthpiece and placing it in a container of water. If the canister sinks, and lies horizontally on the bottom, then it is full. If it floats horizontally at the top, it is empty. The intermediate stages, floating vertically at the bottom of the container, floating vertically at the top of the container, and floating at the top at an angle of 30 to 40 degrees, indicate that it is roughly 3/4 full, 1/2 full, and 1/4 full, respectively. However, Dr. Thomas Plaut warns in the September 1994 issue of Prevention magazine that this technique doesn't work for the cromolyn sodium inhaler: "That's a perfect example of how fast asthma information changes. The float test doesn't work with the cromolyn inhaler because the powder in the MDI valve stem swells up when in comes in contact with water. This blocks the medicine from leaving." The last-ditch alternative, of course, is to count the doses as you take them, and discard the canister for a new one once the number of doses on the label has been reached. One variation of this, for medications that are taken regularly, is to calculate the date on which the medication will be used up, and discard the old canister for a new one on this date. 2.4 What kinds of tablets are there? ------------------------------------- CR - controlled release. This means that the drug has a constant rate of release. DR - delayed release. This generally refers to enteric- coated tablets which are designed to release the drug in the intestine where the pH is in the alkaline range. ER - extended release. Dosage forms which are designed to release the drug over an extended period of time, such as implants which release the drug over a period of months or years. SA - sustained action. Used interchangeably with CR (above), except that SA usually refers to the pharmacologic action while CR refers to the drug release process. TD - time delayed. This is slightly different from DR in that the drug release is designed to occur after a certain period of time, such as pellets coated to a certain thickness, multi-layered tablets, tablets within a capsule, or double-compressed tablets. Contributed by: Susan Graham sgraham@hpb.hwc.ca 2.4.1 Why do I need a blood test when taking theophylline? ----------------------------------------------------------- Theophylline is a very effective drug but unfortunately its therapeutic level is quite close to its toxic level. This means that the dose that the asthmatic needs to get the full benefit of the drug is not very much lower than the dose which causes side effects which range from unpleasant to dangerous. This would not be such a problem if there weren't such large variations in the rate at which people metabolize theophylline. Apparently, if a group of people are given the same dose of theophylline, the concentration of the drug in their bloodstreams may vary by up to a factor of seven. Therefore, the best way to monitor that the asthmatic is receiving the optimal amount of theophylline is to take a blood level concentration. 2.4.2 Why are combination pills not commonly prescribed? --------------------------------------------------------- The combination drugs such as Tedral and Marax commonly contain theophylline, ephedrine, and some form of sedative such as phenobarbital. These combination pills are no longer commonly prescribed because the amount of theophylline in the pill cannot be varied with respect to the other drugs. Since there is great variation in the rate at which an individual metabolizes theophylline, it is now considered better to take theophylline separately, for better adjustment of theophylline levels. In fact, Tedral is no longer manufactured by Parke-Davis in the US. Also, ephedrine is no longer considered the bronchodilator of choice. From Drs. Haas, _The Essential Asthma Book_, "ephedrine initiates the release of catecholamines -- including adrenaline -- that are already stored in the body. This is its biggest drawback. Its effects depend on the availability of catecholamine in the body at the time it is given, and these concentrations vary." Since much better bronchodilators are now available, ephedrine is no longer commonly prescribed. 2.5 What is a nebulizer? ------------------------- A nebulizer is a device that uses pressurized air to turn a liquid medication into a fine mist for inhalation. If you've ever received emergency treatment for asthma, they've probably used a nebulizer on you. The term nebulizer is often used to describe both the pump that pressurizes the air, and the part that holds and "nebulizes" the medication. There are hand-held nebulizer units and ones with masks that you strap onto your face. The pressurized air typically comes from a portable pump unit that internally consists of a motor-driven air pump that resembles the fancier types of aquarium pumps. It forces air through a plastic tube into the plastic nebulizer unit. Inside, the nebulizer unit acts much like a perfume atomizer, creating a fine mist that is directed either through a tube that you inhale through or a mask that directs the mist into your nose and mouth. Since the nebulizer takes a few minutes to deliver the medication, you inhale it over a longer period of time than if you were using an inhaler. This can really help, especially if your passages are not fully open and you're taking a bronchodilator. As you breathe the medication, your lungs can gradually accept more and more of the medication. In addition to the medication, many people find the accompanying mist (typically a sterile saline solution) to be soothing. For very young children, the nebulizer is the only practical means of administering inhaled medications. Older children and adults have the options of using inhalers and a variety of spacers to make the timing a bit easier. The doctor overseeing the treatment decides which is the most effective/appropriate delivery mechanism. At least in Massachusetts, the nebulizer pump unit, the hand-held nebulizers, the medications, and the sterile saline inhalation solution are all prescription items. Replacement parts for the pumps are not available to the general public (if there are sources, I'd like to hear about them). The portable nebulizer pump units cost little ($100-$300) relative to the cost of an emergency room visit, so some health plans / insurers provide them to patients for times when an asthma episode is "manageable but not dangerous." This seems to be a trend in the management of pediatric asthma. Our family has been able to successfully avoid a few trips to the ER, and have even been able to head off some more severe allergic asthma episodes with early intervention. After a few rather gruesome visits to the Mass. General Hospital's waiting room on a Saturday night, we welcome opportunity to treat our children at home, when it's safe. We tend to go in to the doctor or ER for the more severe episodes or those that don't respond well enough to early intervention. Contributed by: Mark Feblowitz mfeblowitz@GTE.com 2.6 What medications should asthmatics be careful about taking? ---------------------------------------------------------------- Aspirin can trigger an asthma attack in approximately one in five asthmatics. This is especially common in those asthmatics who also have nasal polyps. As acetominophen (Tylenol) doesn't have this effect, it may be used as an alternative for anyone who suspects that they might have aspirin sensitivity. Cough medicines should also be treated with caution. In general, suppressing a productive cough (one which is bringing up mucus) is not a good idea, since the mucus can obstruct the airways and also irritate them further. Also, in _Asthma: Stop Suffering, Start Living_, the authors caution that "prescription cough suppressants (including those with codeine) are potentially dangerous for asthmatics. They may make you sleepy and reduce your breathing effort. They may also dry out your secretions, making mucus harder to raise." Antihistamines, however, should not pose a problem for most asthmatics, in spite of many warning labels. In _Children with Asthma_, Dr. Plaut states, "Most asthma experts see no problems with using antihistamines between or during asthmatics . . . Theoretically these drugs might dry up the mucus in the windpipes, thus making it harder to cough it up, but this has never been proved." Asthmatics taking theophylline should be careful when taking any of the following medications: the ulcer medications cimetidine (Tagamet) and troleandomycin (TAO), beta-blocker drugs such as propranolol, and the antibiotics erythromycin and ciprofloxacin. These medications may increase the concentration of theophylline in the bloodstream, possibly even to the toxic level (see section 2.4.1). People taking theophylline should be alert for signs of possible toxicity such as rapid or irregular heartrate, nervousness, or nausea, when taking these or other additional medications with theophylline. Beta-blockers, usually taken for hypertension, can pose problems even for those asthmatics not taking theophylline. Beta-blockers work by blocking the hormone adrenalin, but as adrenalin and other adrenergic drugs help keep airways dilated, the use of beta-blockers may aggravate asthma symptoms. ====================================================================== 3.0 What resources are there for asthmatics? --------------------------------------------- Please see the alt.support.asthma Reading/Resource List. It is maintained by Lynn Short , and is posted monthly to alt.support.asthma, alt.med.allergy, sci.med, and misc.kids. I highly recommend it! 3.1 Where can I get the latest copy of the FAQs? ------------------------------------------------- The two FAQs I maintain, alt.support.asthma FAQ: Asthma -- General Information alt.support.asthma FAQ: Asthma Medications are posted once a month, on or about the 17th, to the following newsgroups: alt.support.asthma, alt.med.allergy, sci.med, If these FAQs have already expired at your site, you can get them by sending mail to mail-server@rtfm.mit.edu, with a blank subject line, and with one or both of the following commands in the message: Alternatively, if you're really in a hurry, you can get them via anonymous ftp from rtfm.mit.edu, with the path names: The general information FAQ is also available in html format on the World Wide Web, with URL: http://www.cco.caltech.edu/~wrean/asthma-gen.html ====================================================================== Contributors: ------------ + Kevin Ball kb036@seqeb.gov.au Mark Delany markd@bushwire.apana.org.au Mark Feblowitz mfeblowitz@GTE.com Paula Ford pxf3@psuvm.psu.edu Lyn Frumkin, M.D., Ph.D. lrfrum@u.washington.edu + Joe Gems jgems@cais.com Ruth Ginzberg rginzberg@eagle.wesleyan.edu Susan Graham sgraham@hpb.hwc.ca + Gwenith Jones gaj5m@virginia.edu ====================================================================== References: ---------- The Physicians' Desk Reference is published annually by: Medical Economics Data Production Company Montvale, NJ 07645-1742 ISBN 1-56363-061-3 It is a compendium of official, FDA-approved prescription drug labeling. The FDA is the U.S. Food and Drug Administration. The Compendium of Pharmaceuticals and Specialties is published annually by: Canadian Pharmaceutical Association Ottawa, Ontario, Canada K1G 3Y6 ISBN 0-919115-94-2 Robert Berkow, M.D., editor in chief, _The Merck Manual of Diagnosis and Therapy_, 15th ed., (Merck & Co., Inc., USA) 1987. ISBN 0911910-06-09 The Merck Manual provides an overview of the diagnosis and therapy of the whole range of medical disorders that can occur in infants, children, and adults. M. Eric Gershwin, M.D., and E.L. Klingelhofer, Ph.D., _Asthma: Stop Suffering, Start Living_, (Addison-Wesley, USA) 1986. ISBN 0-201-11581-6 The first author is Chief of Allergy and Immunology, University of California, Davis, Medical School. He is board-certified in internal medicine, allergy, and clinical immunology. Drs. Francois Haas and Sheila Sperber Haas, _The Essential Asthma Book_, (Ballentine Books, USA) 1987. ISBN 0-8041-0287-2 Dr. Francois Haas is the director of the Pulmonary Function Laboratory at the Medical Center of the New York University School of Medicine, and is on the faculty of the Department of Physiology there. úÿ Paul J. Hannaway, M.D. _The Asthma Self Help Book: how to live a normal life in spite of your condition_, 2nd ed., (Prima Publishing, USA) 1992. ISBN 1-55958-166-2, 1-55958-434-3 paperback The author is Assistant Clinical Professor of Tufts University School of Medicine. The first edition of this book won an American Medical Writers Association Award. Glennon H. Paul, M.D. and Barbara A. Fafoglia, _All About Asthma & How to Live with It: the complete guide to understanding and controlling asthma_, (Sterling Publishing Co., NY, USA) 1988. ISBN 0-8069-6808-7, 0-8069-6809-5 paperback Dr. Paul is the medical director of respiratory therapy at St. John's Hospital in Springfield, Illinois, and specializes in allergy and respiratory diseases. Thomas F. Plaut, _Children with Asthma -- A Manual for Parents_, (Pedipress, Inc., Amherst, Massachusetts, USA) 1988. ISBN 0-914625-03-9 Richard N. Podell, M.D. and William Proctor, _When Your Doctor Doesn't Know Best: medical mistakes that even the best doctors make -- and how to protect yourself_, (Simon & Schuster, USA) 1995. ISBN 0-671-87112-9 Nancy Sander, _A Parent's Guide to Asthma_, (Doubleday, USA) 1989. ISBN 0-385-24478-9 The author is the founder of Mothers of Asthmatics. Genell Subak-Sharpe, _Breathing Easy -- A Handbook for Asthmatics_, (Doubleday, NY, USA) 1988. ISBN 0-385-23440-6 This book was written in consultation with the National Jewish Center for Immunology and Respiratory Medicine. Allan M. Weinstein, M.D., _Asthma - The Complete Guide to Self- Management of Asthma and Allergies for Patients and their Families_, (Fawcett Crest, NY, USA) 1987. ISBN 0-449-21562-8 The author is Assistant Clinical Professor of Medicine at Georgetown University, and is a board-certified allergist who practices in Washington, D.C. Stuart H. Young, M.D. with Susan A. Shulman and Martin D. Shulman, _The Asthma Handbook -- A Complete Guide for Patients and Their Families_, (Bantam Books, USA) 1985. ISBN 0-553-24797-2 Dr. Young is the Chief of Allergy Clinics in both the Department of Medicine and Department of Pediatrics at the Mount Sinai Medical Center. He is also a clinical assistant professor of Medicine and a clinical associate professor of Pediatrics at the Mount Sinai Medical School. ====================================================================== Disclaimer: I am not a physician; I am only a reasonably well-informed asthmatic. This information is for educational purposes only, and should be used only as a supplement to, not a substitute for, professional medical advice. Copyright 1995 by Patricia Wrean. Permission is given to freely copy or distribute this FAQ provided that it is distributed in full without modification, and that such distribution is not intended for profit. -- Patricia Wrean wrean@caltech.edu Archive-name: medicine/asthma/medications alt.support.asthma FAQ: Asthma Medications =========================================== This FAQ attempts to list the most commonly prescribed medications for the prevention and treatment of asthma, both in the U.S. and overseas. It is maintained by Patricia Wrean . The following information came from three sources: most of the drugs available in the U.S. are listed in the 1994 Physicians' Desk Reference (full citation at end of post); many of the drugs available in Canada are listed in the 1995 Compendium of Pharmaceuticals and Specialities (full citation at end of post); the remainder of the information, including those medications available overseas, came from the many helpful contributors listed at the end of the post. If you do not wish your name to be included in the contributors list, please state that explicitly when contributing. Also, if I have left anyone's name out, please let me know so that I may include it. Although the maintainer and contributors do their best to keep this FAQ updated, it is by no means an authoritative work. Asthma is a serious illness requiring supervision by a physician. Please do not attempt to change your medication regime without consulting your doctor. Corrections, additions, and comments are requested; please include the name of the country in which the medication is available, as it isn't always obvious from the user-id. If the drug is available as an inhaler, please specify it as a MDI or one of the other types mentioned in the glossary, or add a description of the inhaler if it is not present already. Abbreviations are explained in the glossary at the end of the table. If the medication is followed by a country name in brackets, then to the best of my knowledge it is only available in that country, and not in the U.S. If the drug is available in a nasal form for allergies, I've included it for completeness. I haven't covered oral steroids, only inhaled, or antihistamines at the present time. + = added since last version & = updated/corrected since last version ---------------------------------------------------------------------- Type of drug Chemical name Brand name Comments ---------------------- ---------- -------- Anti-allergic & cromolyn sodium Intal available as MDI, (sodium cromoglycate neb soln, capsules is WHO recommended for Spinhaler name generally in (US, elsewhere), + use outside the Syncroner (Can) U.S.) Nasalcrom nasal spray + Novo-Cromolyn neb soln (Can) + Rynacrom nasal spray, cartridges for nasal insufflator (Can) + ketotifen fumarate Zaditen tablets, syrup (Can) sodium cromoglycate -- see cromolyn sodium Anti-inflammatory, non-steroidal nedocromil Tilade MDI & sodium Tilade Mint MDI (UK) Anti-inflammatory, steroidal (inhaled) beclomethasone Beclovent MDI (US, elsewhere), + dipropionate Rotacaps for + Rotahaler (Can) Beclodisk diskhaler (Can) & Becloforte MDI (Can, Sw, UK), & 5 times larger dose & than Beclovent Becotide MDI (UK) Beconase nasal MDI Beconase AQ nasal spray Respocort MDI, autohaler (NZ) Vanceril MDI Vancenase Pockethaler (nasal MDI) Vancenase AQ nasal spray budesonide Pulmicort turbuhaler (Aus, Can), neb soln (UK, Can) Rhinocort nasal MDI & (US, elsewhere), nasal turbuhaler, + nasal spray (Can) Nebuamp neb soln (Can) dexamethasone Decadron Respihaler sodium phosphate Phosphate flunisolide Aerobid MDI Aerobid-M MDI, with menthol as flavouring agent & Bronalide MDI (Can) Nasalide nasal spray Rhinalar nasal spray (Can) fluticasone Flixotide MDI, diskhaler (UK) + propionate Flonase nasal spray triamcinolone Azmacort MDI acetonide Nasacort nasal MDI Anticholinergics (bronchodilators) ipratropium Atrovent MDI, inh soln bromide (US, elsewhere), + nasal MDI (Can) Beta-agonists (bronchodilators) albuterol* Airet inh soln + (salbutamol is Asmavent inh soln (Can) WHO recommended Proventil MDI, inh soln, syrup, name generally tablets, in use outside Repetabs (SA tablets) the U.S.) Respolin MDI, autohaler (NZ) Ventolin MDI, inh soln, tablets, neb soln, Rotacaps, for Rotahaler, syrup (US, elsewhere) + injection (Can) Ventodisk diskhaler (Can, UK) Volmax ER tablets * MDI uses albuterol, all other forms (tablets, etc.) use albuterol sulfate bitolterol mesylate Tornalate MDI ephedrine Ephedrine inh soln (Can) epinephrine Bronkaid Mist MDI, OTC, epinephrine in form of nitrate and hydrochloride Bronkaid Mist MDI, OTC** Suspension Medihaler-Epi MDI, OTC** Primatene Mist MDI, OTC Primatene Mist MDI, OTC** Suspension Sus-Phrine injection as epinephrine bitartrate fenoterol Berotec MDI, inh soln, tablets hydrobromide (Can, Aus, NZ) + Berotec Forte MDI (Can), 2 times + larger dose than + Berotec isoetharine Bronkosol inh soln hydrochloride Bronkometer MDI Isoetharine inh soln Arm-a-Med & isoproterenol Medihaler-Iso MDI, as sulfate Isuprel MDI, neb soln (Can), as hydrochloride metaproterenol Alupent MDI, inh soln, tablets, sulfate neb soln, syrup (orciprenaline Metaprel MDI, inh soln, syrup, sulfate is WHO tablets recommended name Metaproterenol inh soln generally in use Sulfate outside the U.S.) Arm-a-Med + orciprenaline sulfate -- see metaproterenol sulfate pirbuterol acetate Maxair MDI, autohaler procaterol HCl Pro-Air MDI (Can) salbutamol -- see albuterol salmeterol Serevent MDI (US, elsewhere), xinafoate diskhaler (UK) terbutaline Brethaire MDI sulfate Brethine tablets, neb soln, injection Bricanyl tablets, injection (US, elsewhere), & turbuhaler (Aus, Can) Xanthines (bronchodilators) theophylline Aerolate TD capsules, liquid Quibron-T tablets, SA tablets (see also combinations) Respbid SR tablets Slo-bid ER capsules Slo-phylline ER capsules T-Phyl CR tablets Theo-24 ER capsules Theo-Dur ER tablets Theo-Dur SA capsules Sprinkle Theo-X tablets Theolair tablets, SR tablets, liquid Uniphyl CR tablets dyphylline*** Lufyllin tablets, injection, syrup * similar to theophylline oxtriphylline**** Choledyl DR tablets, SA tablets ** oxtriphylline is the choline salt of theophylline, and 400 mg of it is equivalent to 254 mg of anhydrous theophylline ---------------------------------------------------------------------- Combination Medications: Brand name Chemical names of ingredients Comments ---------- ----------------------------- -------- Asbron G theophylline sodium glycinate, elixir, tablets guaifenesin (expectorant) Bronkaid Caplets ephedrine sulfate, guaifenesin tablets, OTC Congess guaifenesin, pseudoephedrine tablets Duo-Medihaler isoproterenol hydrochloride, MDI phenylephrine bitartrate Duovent fenoterol hydrobromide, MDI (UK) ipratropium bromide Marax ephedrine sulfate, tablets theophylline, Atarax (hydroxyzine HCl) Primatene Tablets theophylline, ephedrine HCl tablets, OTC Quadrinal theophylline calcium salicylate, tablets ephedrine HCl, phenobarbital, potassium iodide Rynatuss carbetapentane tannate, tablets, syrup chlorpheniramine tannate, ephedrine tannate, phenylephrine tannate Tedral theophylline, ephedrine HCl, tablets (Can), phenobarbital no longer manufactured in US Ventolin-Plus albuterol, beclomethasone MDI (Sw) dipropionate ---------------------------------------------------------------------- Glossary -------- aerosol inhalers: MDI - metered-dose inhaler, consisting of an aerosol unit and & plastic mouthpiece. This is currently the most common type of inhaler, and is widely available. autohaler - MDI made by 3M which is activated by one's breath, and doesn't need the breath-hand coordination that a & regular MDI does. Available in U.S. for Maxair. respihaler - aerosol inhaler for Decadron (see table above). I have no idea how this differs from the usual MDI. + syncroner - MDI with elongated mouthpiece, used as training device + to see if medication is being inhaled properly. + Available in Canada for Intal. dry powder inhalers: + insufflator - dry powder nasal inhaler used with Rynacrom cartridges. + Each cartridge contains one dose; the inhaler opens the + cartridge, allowing the powder to be blown into the + nose by squeezing the bulb. Available in Canada. & rotahaler - dry powder inhaler used with Rotacaps capsules. Each capsule contains one dose; the inhaler opens the capsule such that the powder may be inhaled through the mouthpiece. Available in the U.S., + Canada, and UK for Ventolin. In Canada, Beclovent + Rotacaps are also available. spinhaler - dry powder inhaler used with Intal capsules for spinhaler. Each capsule contains one dose; the inhaler opens the capsule such that the powder may be inhaled through the mouthpiece. Available in Canada, UK, and the U.S. diskhaler - dry powder inhaler. The drug is kept in a series of little pouches on a disk; the diskhaler punctures the pouch and drug is inhaled through the mouthpiece. Currently available in Canada and UK, not in U.S. turbuhaler - dry powder inhaler. The drug is in form of a pellet; when body of inhaler is rotated, prescribed amount of drug is ground off this pellet. The powder is then inhaled through a fluted aperture on top. Available in Australia and Canada. forms of tablets: CR - controlled release. This means that the drug has a constant rate of release. DR - delayed release. This generally refers to enteric- coated tablets which are designed to release the drug in the intestine where the pH is in the alkaline range. ER - extended release. Dosage forms which are designed to release the drug over an extended period of time, such as implants which release drug over a period of one or two months or years. SA - sustained action. Used interchangeably with CR (above), except that SA usually refers to the pharmacologic action while CR refers to the drug release process. TD - time delayed. This is slightly different from DR in that the drug release is designed to occur after a certain period of time, such as pellets coated to a certain thickness, multi-layered tablets, tablets within a capsule, or double-compressed tablets. forms of solutions: neb soln - nebulizer solution. Drug comes in nebules for use with nebulizer. inh soln - inhalation solution. Some manufacturers use this as a synonym for neb soln; others use it to mean that drug comes in bottle with dropper, distinct from neb soln. country abbreviations: Aus - Australia Can - Canada NZ - New Zealand Sw - Switzerland UK - United Kingdom US - United States úÿ misc: OTC - over-the-counter, all other medications are prescription-only in the U.S. ---------------------------------------------------------------------- The Physicians' Desk Reference is published annually by: Medical Economics Data Production Company Montvale, NJ 07645-1742 ISBN 1-56363-061-3 It is a compendium of official, FDA-approved prescription drug labeling. The FDA is the U.S. Food and Drug Administration. The Compendium of Pharmaceuticals and Specialties is published annually by: Canadian Pharmaceutical Association Ottawa, Ontario, Canada K1G 3Y6 ISBN 0-919115-94-2 ---------------------------------------------------------------------- Contributors: ------------ + Andrew Benham A.D.S.Benham@bnr.co.uk Lawrence M. (Larry) Bezeau BEZEAU@UNB.CA Daniel Canonica d_canonica@trzcl1.mrgate.mailer.umc.alcatel.ch John Connett jrc@concurrent.co.uk Mark Delany markd@bushwire.apana.org.au Walter de Wit dewit@hamilton.niwa.cri.nz Steve Dyer dyer@spdcc.com Ian Ford ianford@dircon.co.uk Susan Graham sgraham@hpb.hwc.ca Rick Hughes richardh@Newbridge.COM Simon Kelley srk@sanger.ac.uk Rick Nopper nopperrw@esvax.dnet.dupont.com Kevin A. Nunan pp000165@interramp.com Janet Pierson JPierson@highlands.com Matt Ray M.J.Ray@bradford.ac.uk John Saunders John@gemini.demon.co.uk Stephan Seillier seillier@on.bell.ca John R. Strohm strohm@mksol.dseg.ti.com + Elaine Turner, M.D. elturn@richmond.infi.net John Underhay junderhay@upei.ca David Williams exudnw@exu.ericsson.se Travis Lee Winfrey travis.winfrey@fi.gs.com ---------------------------------------------------------------------- Disclaimer: I am not a physician; I am only a reasonably well-informed asthmatic. This information is for educational purposes only, and should be used only as a supplement to, not a substitute for, professional medical advice. Copyright 1995 by Patricia Wrean. Permission is given to freely copy or distribute this FAQ provided that it is distributed in full without modification, and that such distribution is not intended for profit. -- Patricia Wrean wrean@caltech.edu