What are the respiratory medications?
Most respiratory problems involve some problem of airway inflammation with spasm of muscles in the airways, and accumulation of mucus. There is an "itis" of the bronchi (airways), hence the term "bronchitis". Asthma, emphysema, and sometimes pneumonia have an element of "bronchitis". Therefore we use drugs known as bronchodilators. They all work by different mechanisms to accomplish certain tasks, such as opening or dilating the airways (bronchodilators), bringing up mucus, or reducing inflammation (redness, swelling). We tend to use combinations of the drugs because their combined power is better than any one of them alone. We also find that inhaled medicines have fewer side effects, plus they are sprayed directly where they have to work, in the airways. Unfortunately most do not work as long as some of the oral medications.
Beta agonists
These drugs are chemically related to adrenalin, a powerful bronchodilator. We use long acting versions, either as pills, or inhaled forms. The major side effects are shaking, rapid heartbeat, and nervousness. In an acute asthma reaction we often give an injection of adrenalin or a similar drug called Brethine. The inhaled versions, which are a mainstay of anti-asthma therapy are available in metered dose inhalers or aerosol nebulizers. Despite the side effects, these medications, if used properly under supervision, can be considered not only safe but also life-saving and essential. Common names - Proventil, Ventolin, generic Albuterol, Serevent, Alupent, Volmax.
Theophylline
These drugs are chemically related to caffeine, another powerful bronchodilator. They are only used orally or intravenously. At high doses they can cause tremor, rapid heartbeat, nausea, ulcers, headache, and even seizures. Some patients need to have the blood level checked periodically. There is a myth that at low blood levels the drug is ineffective. That is all wrong. Some patients do well with a small dose in the evening to carry them through the night. Common names - Unidur, Uniphyl, Theodur, Slobid, Theo-24, Aminophylline.
Parasympathetic agents
The only drug available in this country is Atrovent. It is an effective, somewhat long acting bronchodilator that does not cause rapid heartbeat or shaking. It can cause some dryness of the mouth. It is only used in the inhaled forms, either by metered dose inhaler or aerosol nebulizer.
Steroids
These drugs are used to reduce the inflammation and edema in the airways. Though incredibly powerful, the side effects of the oral and injected forms can be quite a problem. They include high blood sugar, mood changes, weight gain, osteoporosis, hypertension, fluid retention, easy bruising, ulcers, and cataracts. Of course the risk of side effects depends on the dose and duration. Using prednisone by a sliding scale based on the peak flow can reduce oneís overall need for steroids over a long period of time. Sometimes we have no choice but to use steroids for a number of weeks in certain diseases, such as sarcoid, bronchiolitis obliterans, pulmonary fibrosis, allergic bronchopulmonary aspergillosis. Inhaled steroids are an excellent choice for long term prophylactic steroid therapy in asthma and chronic bronchitis. Side effects are minimal. Common names - Prednisone, Prelone, Medrol, Deltasone, Flovent, Vanceril, Beclovent, Aerobid, Azmacort.
Leukotriene inhibitors
Leukotrienes are powerful chemicals released in the body that cause and promote the continuation of asthmatic and other acute inflammatory reactions. New drugs prevent the action of these chemicals. Presently in the U.S. there are two such medications, Accolate, and Singulair, taken as pills, for chronic prevention of asthma. They are not used in acute disease, though.
Antihistamines
Antihistamines are medicines that deal with allergic reactions by blocking the effects or release of a potent allergy chemical in the blood known as histamine. Some can be taken by the inhaled route, others by pill. Some of the newer oral antihistamines do not cause drowsiness. Though not for everybody with asthma, some patients with asthma and allergic rhinitis can achieve significant relief by using this family of drugs on a PREVENTIVE basis. Common oral antihistamines include - Claritin, Allegra, Zyrtec, Chlortrimeton, Benadryl. The inhaled medicine that works differently but can be thought of as a type of antihistamine is cromolyn, marketed under the names Intal, Nasalcrom, and Crolom.
Important general instructions
- Take the medications as scheduled on a regular basis
- Rinse the mouth after using inhaled medications. Some of the inhaled medications may cause hoarseness
- Take the following medications with food as they can cause stomach upset- Theophylline, Prednisone
- The following medications cause rapid heartbeat, shaking, nervousness: Theophylline (Theodur, Unidur, Uniphyl, Slobid, Theo-24), Beta agonists (Proventil, Ventolin, Alupent, Brethine, Serevent), Decongestants with pseudoephedrine or phenylephrine.
- Nasal spray medications should be inhaled deeply to work effectively and prevent nosebleeds.
- Check the peak flow every morning and keep a chart of the results. Use the peak flow log.
- The following medications may be used by either the nebulizer or the metered dose inhaler: Proventil, Atrovent, Ventolin, Intal.
- Antibiotics may cause diarrhea and yeast infections. Some may interact with theophylline or some antihistamines.
