Asthma

Asthma Slideshow

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Medical Authors: Alan

Szeftel, MD, FCCP, and
George Schiffman, MD,
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 Myths, facts, and
statistics about
asthma

 What is asthma? From WebMD

 From the past to Asthma and Allergy Resources

the present
 How to Use Your Inhaler
 The scope of the
problem  4 Steps to Creating a Dust Free Bedroom

 Normal bronchial  4 Hidden Asthma Triggers in Your Home

tubes
Featured Centers
 How does
 Which Foods Are Highest in Fiber?
asthma affect
breathing?  How Bad Is Your Diet? Assess Yourself

 The importance  12 Tips to Stay Awake Naturally

of inflammation
Health Solutions From Our Sponsors
 Which triggers
cause an asthma  Depression Med for You?
attack?
 Fibromyalgia Center
  Allergens  MS Rx Options

 Irritants

 The many faces

of asthma Asthma

 Types: allergic Nebulizer for Asthma »

(extrinsic) and
nonallergic Introduction
(intrinsic) asthma An asthma nebulizer, also known as a breathing machine, changes asthma

 Typical medication from a liquid to a mist, so that it can be more easily inhaled
into the lungs. Home nebulizer therapy is particularly effective in
symptoms and
delivering asthma medications to infants and small children and to anyone
signs of asthma
who is unable to use asthma inhalers with spacers.
 Acute asthma
attack To obtain an asthma nebulizer, you need a prescription from your
physician. Home nebulizers vary in cost (approximately $200-250) and are
 What usually covered under the durable medical equipment portion of health
medications are insurance policies. However, most insurance companies will require you to
used in the work with a specified durable medical equipment supplier. Check with
treatment of your insurance company before purchasing or renting to ensure it will be
asthma? covered. Your health care provider should be able to assist you with these
arrangements.
 Asthma At A
Glance How do I use a home nebulizer?

 Patient First, you will need the following s...

Discussions:
Read the Nebulizer for Asthma article »
Asthma -
Effective
Treatments

 Find a local
Asthma & Allergy
Specialist in your
town

What do each of these

individuals have in
common: First, an 18-
year-old suddenly
develops wheezing and
shortness of breath
when visiting his
grandmother who
happens to have a cat.
Second, a 30-year-old
woman has colds that
"always go into her
chest," causing coughing
and difficulty breathing.
Lastly, a 60-year-old man
develops shortness of
breath with only slight
exertion even though he
has never smoked. The
answer is that they all
have asthma. These are
some of the many faces
of asthma.

Most researchers believe

that the different
patterns of asthma are
all related to one
condition. But some
researchers feel that
separate forms of lung
conditions exist. There is
currently no cure for
asthma and no single
exact cause has been
identified. Therefore,
understanding the
changes that occur in
asthma, how it makes
you feel, and how it can
behave over time is vital.
This knowledge can
empower people with
asthma to take an active
role in your own health.

Typical Asthma
Symptoms and Signs

The symptoms of asthma

vary from person to
person and in any
individual from time to
time. It is important to
remember that many of
these symptoms can be
subtle and similar to
those seen in other
conditions. All of the
symptoms mentioned
below can be present in
other respiratory, and
sometimes, in heart
conditions. This potential
confusion makes
identifying the settings in
which the symptoms
occur and diagnostic
testing very important in
recognizing this disorder.

The following are the

four major recognized
asthma symptoms:

 Shortness of
breath,
especially with
exertion or at
night

 Wheezing is a
whistling or
hissing sound
when breathing
out

 Coughing may be
chronic, is
usually worse at
night and early
morning, and
may occur after
exercise or when
exposed to cold,
dry air
  Chest tightness
may occur with
or without the
above symptoms

Learn more about

symptoms and signs of
asthma

Top Searched Asthma

Terms:

treatment, attack, signs

and symptoms, facts,
triggers, management,
statistics, wheezing,
medication, different
types, prevention,
prednisone, allergy,
inhaler, exercise-induced
asthma, causes

Myths, facts, and

statistics about asthma

Before we present the

typical symptoms of
asthma, we should dispel
some common myths
about this condition. This
is best achieved by
conducting a short true
or false quiz.

1. T or F - Asthma is
"all in the mind."

2. T or F - You will
"grow out of it."

3. T or F - Asthma
can be cured, so
it is not serious
and nobody dies
 from it.

4. T or F - You are
likely to develop
asthma if
someone in your
family has it.

5. T or F - You can
"catch" asthma
from someone
else who has it.

6. T or F - Moving
to a different
location, such as
the desert, can
cure asthma.

7. T or F - People
with asthma
should not
exercise.

8. T or F - Asthma
does not require
medical
treatment.

9. T or F -
Medications
used to treat
asthma are
habit-forming.

10. T or F - Someone
with asthma can
provoke
episodes
anytime they
want in order to
get attention.

Here are the answers:

1. F - Asthma is not
a psychological
condition.
 However,
emotional
triggers can
cause flare-ups.

2. F - You cannot
outgrow asthma.
In about 50% of
children with
asthma, the
condition may
become inactive
in the teenage
years. The
symptoms,
however, may
reoccur anytime
in adulthood.

3. F - There is no
cure for asthma,
but the disease
can be controlled
in most patients
with good
medical care.
The condition
should be taken
seriously, since
uncontrolled
asthma may
result in
emergency
hospitalization
and possible
death.

4. T - You have a
6% chance of
having asthma if
neither parent
has the
condition, a 30%
chance if one
parent has it,
and a 70%
 chance if both
parents have it.

5. F - Asthma is not
contagious.

6. F - A new
environment
may temporarily
improve asthma
symptoms, but it
will not cure
asthma. After a
few years in the
new location,
many people
become
sensitized to the
new
environment and
the asthma
symptoms return
with the same or
even greater
intensity than
before.

7. F - Swimming is
an optimal
exercise for
those with
asthma. On the
other hand,
exercising in dry,
cold air may be a
trigger for
asthma in some
people.

8. F - Asthma is
best controlled
by having an
asthma
management
plan designed by
your doctor that
 includes the
medications
used for quick
relief and those
used as
controllers.

9. F - Asthma
medications are
not addictive.

10. F - Asthma
attacks cannot
be faked. In rare
cases, there is a
psychological
condition known
by a variety of
names (factious
asthma, spastic
dysphonia,
globus
hystericus)
where emotional
issues may cause
symptoms that
mimic the
symptoms of
asthma.

 1

 2

 3

 4

 5

 6

 7

 8

 9
  Next »

 Asthma Index

 Glossary

 Find a Local
Doctor

Next: What is asthma? »

Share | | | | | More

Asthma - Effective
Treatments

The MedicineNet
physician editors ask:

What kinds of
treatments have been
effective for your
asthma?

Comment submissions
for this question have
ended.
See 22 Viewer
Comments

View Comments

Suggested Reading by
Our Doctors
 albuterol,
Ventolin,
Proventil,
Proventil-HFA,
AccuNeb,
Vospire, ProAir -
Specifies the
medication
albuterol
(Ventolin,
Proventil,
Proventil-HFA,
AccuNeb,
Vospire, ProAir)
a drug used in
for the
treatment of
asthma,
emphysema, anc
chronic broncitis.
Albuterol
relieves and
prevents of
airway
obstruction
(bronchospasm)
in patients with
asthma and in
patients with
exercise-induced
asthma. Article
includes
descriptions,
uses, drug
interactions, and
side effects.

 Cortisone
Injection - Read
about cortisone
injection
treatment for
inflammation,
allergic reaction,
sciatica and
 arthritis. Learn
about side
effects and
complications of
a cortisone shot.

 Gastroesophage
al Reflux Disease
(GERD,
Heartburn) -
Learn about
gastroesophagea
l reflux disease
(GERD, acid
reflux,
heartburn)
symptoms like
heartburn, chest
pain,
regurgitation,
and nausea.
Causes,
diagnosis,
treatment and
prevention
information is
also included.

Read more Asthma

related articles »

Latest Medical News

 Premature Birth
Rate Is Dropping

 HPV Viruses
Linked to Skin
Cancer

 Childhood
Obesity Boosts
Risk of GERD

 Ancestry May
Affect Lung
Function Tests
Privacy Policy

Allergies & Asthma

Improve treatments &

prevent attacks.

Featured on MedicineNet

 Causes of Fatigue Slideshow

 Living with COPD

 Sleep Disorders Slideshow

Top 10

Asthma Related Articles

 Bronchitis

 Chest X-ray

 Cortisone Injection

 Eczema

 Esophageal pH Monitoring

 Gastroesophageal Reflux Disease (GERD)

 Nebulizer for Asthma

 Pertussis

 Sinusitis

 Skin Test For Allergy

 Complete List »
Asthma Topics

 Asthma

 Asthma in Children

 Albuterol (Ventolin)

 Asthma OTC Treatment

 Adult Complexities

 Churg-Strauss Syndrome

 Asthma RSS

 Take a Quiz

Latest Asthma News

 Vitamin D May Improve Asthma Control

 Cause of Asthma-Like Symptoms Spotted in Mice

 Acetaminophen: Teen Asthma Trigger?

 Gene Mutation May Make People More Prone to Asthma

 Dulera Inhaler Approved for Asthma

 Want More News? Sign Up for MedicineNet Newsletters!

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What is asthma?

Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and
narrowing (constriction) of the airways. The result is difficulty breathing. The bronchial narrowing is
usually either totally or at least partially reversible with treatments.

Bronchial tubes that are chronically inflamed may become overly sensitive to allergens (specific
triggers) or irritants (nonspecific triggers). The airways may become "twitchy" and remain in a state
of heightened sensitivity. This is called "bronchial hyperreactivity" (BHR). It is likely that there is a
spectrum of bronchial hyperreactivity in all individuals. However, it is clear that asthmatics and
allergic individuals (without apparent asthma) have a greater degree of bronchial hyperreactivity
than nonasthmatic and nonallergic people. In sensitive individuals, the bronchial tubes are more
likely to swell and constrict when exposed to triggers such as allergens, tobacco smoke, or exercise.
Amongst asthmatics, some may have mild BHR and no symptoms while others may have severe BHR
and chronic symptoms.

Asthma affects people differently. Each individual is unique in their degree of reactivity to
environmental triggers. This naturally influences the type and dose of medication prescribed, which
may vary from one individual to another.

From the past to the present

Physicians in ancient Greece used the word asthma to describe breathlessness or gasping. They
believed that asthma was derived from internal imbalances, which could be restored by healthy diet,
plant and animal remedies, or lifestyle changes.
Allergy jargon

Asthma is derived from the Greek word Panos, meaning panting.

Chinese healers understood that xiao-chiran, or "wheezy breathing," was a sign of imbalance in the
life force they called qi. They restored qi by means of herbs, acupuncture, massage, diet, and
exercise.

The Hindu philosophers connected the soul and breath as part of the mind, body, and spirit
connection. Yoga uses control of breathing to enhance meditation. Indian physicians taught these
breathing techniques to help manage asthma.

Allergy fact

Maimonides was a renowned 12th-century rabbi and physician who practiced in the court of the
sultan of Egypt. He recommended to one of the Royal Princes with asthma that he eat, drink, and
sleep less. He also advised that he engage in less sexual activity, avoid the polluted city environment,
and eat a specific remedy...chicken soup.

The balance of the "four humors," which was derived from the Greco-Roman times, influenced
European medicine until the middle of the 18th century. In a healthy person, the four humors, or
bodily fluids -- blood, black bile, yellow bile, and phlegm -- were in balance. An excess of one of these
humors determined what kinds of disorders were present. Asthmatics who were noted for their
coughing, congestion, and excess mucus (phlegm) production were therefore regarded as
"phlegmatic."

By the 1800s, aided by the invention of the stethoscope, physicians began to recognize asthma as a
specific disease. However, patients still requested the traditional treatments of the day, such as
bloodletting, herbs, and smoking tobacco. These methods were used for a variety of conditions,
including asthma. Of the many remedies that were advertised for asthma throughout the 19th
century, none were particularly helpful.

Allergy fact

As early as 1892, the famous Canadian-American physician Sir William Osler suggested that
inflammation played an important role in asthma.

Bronchial dilators first appeared in the 1930s and were improved in the 1950s. Shortly thereafter,
corticosteroid drugs that treated inflammation appeared and have become the mainstay of therapy
used today

The scope of the problem

Asthma is now the most common chronic illness in children, affecting one in every 15. In North
America, 5% of adults are also afflicted. In all, there are about 1 million Canadians and 15 million
Americans who suffer from this disease.
The number of new cases and the yearly rate of hospitalization for asthma have increased about
30% over the past 20 years. Even with advances in treatment, asthma deaths among young people
have more that doubled.

Allergy fact

There are about 5,000 deaths annually from asthma in the U.S. and about 500 deaths per year in
Canada.

Normal bronchial tubes

Before we can appreciate how asthma affects the bronchial airways, we should first take a quick
look at the structure and function of normal bronchial tubes.

The air we breathe in through our nose and mouth passes through the vocal cords (larynx) and into
the windpipe (trachea). The air then enters the lungs by way of two large air passages (bronchi), one
for each lung. The bronchi divide within each lung into smaller and smaller air tubes (bronchioles),
just like branches of an inverted tree. Inhaled air is brought through these airways to the millions of
tiny air sacs (alveoli) that are contained in the lungs. Oxygen (O2) passes from the air sacs into the
bloodstream through numerous tiny blood vessels called capillaries. Similarly, the body's waste
product, carbon dioxide (CO2), is returned to the air sacs and then eliminated upon each exhalation.

Normal bronchial tubes allow rapid passage of air in and out of the lungs to ensure that the levels of
O2 and CO2 remain constant in the bloodstream. The outer walls of the bronchial tubes are
surrounded by smooth muscles that contract and relax automatically with each breath. This allows
the required amount of air to enter and exit the lungs to achieve this normal exchange of O2 and
CO2. The contraction and relaxation of the bronchial smooth muscles are controlled by two different
nervous systems that work in harmony to keep the airways open.
The inner lining of the bronchial tubes, called the bronchial mucosa, contains: (1) mucus glands that
produce just enough mucus to properly lubricate the airways; and (2) a variety of so-called
inflammatory cells, such as eosinophils, lymphocytes, and mast cells. These cells are designed to
protect the bronchial mucosa from the microorganisms, allergens, and irritants we inhale, and which
can cause the bronchial tissue to swell. Remember, however, that these inflammatory cells are also
important players in the allergic reaction. Therefore, the presence of these cells in the bronchial
tubes causes them to be a prime target for allergic inflammation

How does asthma affect breathing?

Asthma causes a narrowing of the breathing airways, which interferes with the normal movement of
air in and out of the lungs. Asthma involves only the bronchial tubes and does not affect the air sacs
or the lung tissue. The narrowing that occurs in asthma is caused by three major factors:
inflammation, bronchospasm, and hyperreactivity.

Inflammation

The first and most important factor causing narrowing of the bronchial tubes is inflammation. The
bronchial tubes become red, irritated, and swollen. This inflammation increases the thickness of the
wall of the bronchial tubes and thus results in a smaller passageway for air to flow through. The
inflammation occurs in response to an allergen or irritant and results from the action of chemical
mediators (histamine, leukotrienes, and others). The inflamed tissues produce an excess amount of
"sticky" mucus into the tubes. The mucus can clump together and form "plugs" that can clog the
smaller airways. Specialized allergy and inflammation cells (eosinophils and white blood cells), which
accumulate at the site, cause tissue damage. These damaged cells are shed into the airways, thereby
contributing to the narrowing.

Bronchospasm

The muscles around the bronchial tubes tighten during an attack of asthma. This muscle constriction
of the airways is called bronchospasm. Bronchospasm causes the airway to narrow further. Chemical
mediators and nerves in the bronchial tubes cause the muscles to constrict. Bronchospasm can occur
in all humans and can be brought on by inhaling cold or dry air.

Hyperreactivity (hypersensitivity)

In patients with asthma, the chronically inflamed and constricted airways become highly sensitive, or
reactive, to triggers such as allergens, irritants, and infections. Exposure to these triggers may result
in progressively more inflammation and narrowing.

The combination of these three factors results in difficulty with breathing out, or exhaling. As a
result, the air needs to be forcefully exhaled to overcome the narrowing, thereby causing the typical
"wheezing" sound. People with asthma also frequently "cough" in an attempt to expel the thick
mucus plugs. Reducing the flow of air may result in less oxygen passing into the bloodstream, and if
very severe, carbon dioxide may dangerously accumulate in the blood.
The importance of
inflammation

Inflammation, or
swelling, is a normal
response of the body to
injury or infection. The
blood flow increases to
the affected site and
cells rush in and ward
off the offending
problem. The healing
process has begun.
Usually, when the
healing is complete, the
inflammation subsides.
Sometimes, the healing
process causes <script language="JavaScript1.2" type="text/javascript"
scarring. The central src="http://as.webmd.com/js.ng/Params.richmedia=yes&amp;transactionID
issue in asthma, =115342739832&amp;tile=115342739832&amp;xpg=1660&amp;artid=284
however, is that the &amp;site=2&amp;affiliate=22&amp;uri=subject%3Dasthmapage%3D5&am
inflammation does not p;pos=121"></script>
resolve completely on
its own. In the short
term, this results in
recurrent "attacks" of
From WebMD
asthma. In the long
term, it may lead to Asthma and Allergy Resources
permanent thickening
of the bronchial walls,  How to Use Your Inhaler
called airway
 4 Steps to Creating a Dust Free Bedroom
"remodeling." If this
occurs, the narrowing  4 Hidden Asthma Triggers in Your Home
of the bronchial tubes
may become Featured Centers
irreversible and poorly
 Which Foods Are Highest in Fiber?
responsive to
medications.  How Bad Is Your Diet? Assess Yourself
Therefore, the goals of
asthma treatment are:  12 Tips to Stay Awake Naturally
(1) in the short term, to
Health Solutions From Our Sponsors
control airway
inflammation in order  Depression Med for You?
to reduce the reactivity
of the airways; and (2)  Fibromyalgia Center
in the long term, to  MS Rx Options
prevent airway
remodeling.

Allergy assist
Also on MedicineNet
The hallmark of  Living with Obstructive Asthma
managing asthma is the
prevention and  Trouble Breathing? Take the COPD Health Check
treatment of airway
inflammation. It is also
likely that control of
the inflammation will
prevent airway
remodeling and
thereby prevent
permanent loss of lung
function.

Various triggers in
susceptible individuals
result in airway
inflammation.
Prolonged
inflammation induces a
state of airway
hyperreactivity, which
might progress to
airway remodeling
unless treated
effectively.

Which triggers cause

an asthma attack?

Asthma symptoms may

be activated or
aggravated by many
agents. Not all
asthmatics react to the
same triggers.
Additionally, the effect
that each trigger has on
the lungs varies from
one individual to
another. In general, the
severity of your asthma
depends on how many
agents activate your
symptoms and how
sensitive your lungs are
to them. Most of these
triggers can also
worsen nasal or eye
symptoms.

Triggers fall into two

categories:

 allergens
("specific") and

 nonallergens --
mostly irritants
(nonspecific).

Once your bronchial

tubes (nose and eyes)
become inflamed from
an allergic exposure, a
re-exposure to the
offending allergens will
often activate
symptoms. These
"reactive" bronchial
tubes might also
respond to other
triggers, such as
exercise, infections,
and other irritants. The
following is a simple
checklist.

Common Asthma
Triggers:

Allergens

 "seasonal"
pollens

 year-round
dust mites,
molds, pets,
and insect
parts

 foods, such as
fish, egg,
peanuts, nuts,
cow's milk, and
soy

 additives, such
as sulfites

 work-related
agents, such as
latex

Allergy fact

About 80% of children

and 50% of adults with
asthma also have
allergies.

Irritants

 respiratory
infections, such
 as those
caused by viral
"colds,"
bronchitis, and
sinusitis

 drugs, such as
aspirin, other
NSAIDs
(nonsteroidal
antiinflammato
ry drugs), and
beta blockers
(used to treat
blood pressure
and other heart
conditions)

 tobacco smoke

 outdoor
factors, such as
smog, weather
changes, and
diesel fumes

 indoor factors,
such as paint,
detergents,
deodorants,
chemicals, and
perfumes

 nighttime

 GERD
(gastroesophag
 eal reflux
disorder)

 exercise,
especially
under cold dry
conditions

 work-related
factors, such as
chemicals,
dusts, gases,
and metals

 emotional
factors, such as
laughing,
crying, yelling,
and distress

 hormonal
factors, such as
in
premenstrual
syndrome

 « Previous

 1

 2

 3

 4

 5

 6

 7
  8

 9

 Next »

 Asthma Index

 Glossary

 Find a Local
Doctor

Next: The many faces

of asthma »

Share | | | | | More

Asthma - Effective
Treatments

The MedicineNet
physician editors ask:

What kinds of
treatments have been
effective for your
asthma?

Comment submissions
for this question have
ended.
See 22 Viewer
Comments

View Comments

Suggested Reading by
Our Doctors

 albuterol,
Ventolin,
Proventil,
Proventil-HFA,
AccuNeb,
Vospire, ProAir
- Specifies the
medication
albuterol
(Ventolin,
Proventil,
Proventil-HFA,
AccuNeb,
Vospire, ProAir)
a drug used in
for the
treatment of
asthma,
emphysema,
anc chronic
broncitis.
Albuterol
relieves and
prevents of
airway
obstruction
(bronchospasm
) in patients
with asthma
and in patients
with exercise-
induced
asthma. Article
includes
descriptions,
uses, drug
interactions,
and side
effects.

 Cortisone
 Injection - Read
about cortisone
injection
treatment for
inflammation,
allergic
reaction,
sciatica and
arthritis. Learn
about side
effects and
complications
of a cortisone
shot.

 Gastroesophag
eal Reflux
Disease (GERD,
Heartburn) -
Learn about
gastroesophag
eal reflux
disease (GERD,
acid reflux,
heartburn)
symptoms like
heartburn,
chest pain,
regurgitation,
and nausea.
Causes,
diagnosis,
treatment and
prevention
information is
also included.

Read more Asthma

related articles »

Latest Medical News

 Premature
Birth Rate Is
Dropping
  HPV Viruses
Linked to Skin
Cancer

 Childhood
Obesity Boosts
Risk of GERD

 Ancestry May
Affect Lung
Function Tests

Privacy Policy

Allergies & Asthma

Improve treatments &

prevent attacks.

Featured on MedicineNet

 Causes of Fatigue Slideshow

 Living with COPD

 Sleep Disorders Slideshow

Top 10

Asthma Related Articles

 Bronchitis

 Chest X-ray

 Cortisone Injection

 Eczema

 Esophageal pH Monitoring
  Gastroesophageal Reflux Disease (GERD)

 Nebulizer for Asthma

 Pertussis

 Sinusitis

 Skin Test For Allergy

 Complete List »

Asthma Topics

 Asthma

 Asthma in Children

 Albuterol (Ventolin)

 Asthma OTC Treatment

 Adult Complexities

 Churg-Strauss Syndrome

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The many faces of asthma

The many potential triggers of asthma largely explain the different ways in which asthma can
present. In most cases, the disease starts in early childhood from 2-6 years of age. In this age group,
the cause of asthma is often linked to exposure to allergens, such as dust mites, tobacco smoke, and
viral respiratory infections. In very young children, less than 2 years of age, asthma can be difficult to
diagnose with certainty. Wheezing at this age often follows a viral infection and might disappear
later, without ever leading to asthma. Asthma, however, can develop again in adulthood. Adult-
onset asthma occurs more often in women, mostly middle-aged, and frequently follows a respiratory
tract infection. The triggers in this group are usually nonallergic in nature.

Types: allergic (extrinsic) and nonallergic (intrinsic) asthma

Your doctor may refer to asthma as being "extrinsic" or "intrinsic." A better understanding of the
nature of asthma can help explain the differences between them. Extrinsic, or allergic asthma, is
more common (90% of all cases) and typically develops in childhood. Approximately 80% of children
with asthma also have documented allergies. Typically, there is a family history of allergies.
Additionally, other allergic conditions, such as nasal allergies or eczema, are often also present.
Allergic asthma often goes into remission in early adulthood. However, in 75% of cases, the asthma
reappears later.

Intrinsic asthma represents about 10% of all cases. It usually develops after the age of 30 and is not
typically associated with allergies. Women are more frequently involved and many cases seem to
follow a respiratory tract infection. The condition can be difficult to treat and symptoms are often
chronic and year-round.

Typical symptoms and signs of asthma

The symptoms of asthma vary from person to person and in any individual from time to time. It is
important to remember that many of these symptoms can be subtle and similar to those seen in
other conditions. All of the symptoms mentioned below can be present in other respiratory, and
sometimes, in heart conditions. This potential confusion makes identifying the settings in which the
symptoms occur and diagnostic testing very important in recognizing this disorder.

The following are the four major recognized asthma symptoms:

 Shortness of breath, especially with exertion or at night

 Wheezing is a whistling or hissing sound when breathing out

 Coughing may be chronic, is usually worse at night and early morning, and may occur after
exercise or when exposed to cold, dry air

 Chest tightness may occur with or without the above symptoms

Asthma fact

Asthma is classified according to the frequency and severity of symptoms, or "attacks," and the
results of pulmonary (lung) function tests.

 30% of affected patients have mild, intermittent (less than two episodes a week) symptoms
of asthma with normal breathing tests

 30% have mild, persistent (two or mores episodes a week) symptoms of asthma with normal
or abnormal breathing tests

 40% have moderate or severe, persistent (daily or continuous) symptoms of asthma with
abnormal breathing tests
Acute asthma attack

An acute, or sudden, asthma attack is usually caused by an exposure to allergens or an upper-

respiratory-tract infection. The severity of the attack depends on how well your underlying
asthma is being controlled (reflecting how well the airway inflammation is being controlled).
An acute attack is potentially life-threatening because it may continue despite the use of your
usual quick-relief medications (inhaled bronchodilators). Asthma that is unresponsive to
treatment with an inhaler should prompt you to seek medical attention at the closest hospital
emergency room or your asthma specialist office, depending on the circumstances and time
of day. Asthma attacks do not stop on their own without treatment. If you ignore the early
warning signs, you put yourself at risk of developing status asthmaticus.

Allergy fact

Prolonged attacks of asthma that do not respond to treatment with bronchodilators are a
medical emergency. Physicians call these severe attacks "status asthmaticus," and they
require immediate emergency care.

The symptoms of severe asthma are persistent coughing and the inability to speak full
sentences or walk without shortness of breath. Your chest may feel closed, and your lips may
have a bluish tint. In addition, you may feel agitation, confusion, or an inability to
concentrate. You may hunch your shoulders, sit or stand up to breathe more easily, and strain
your abdominal and neck muscles. These are signs of an impending respiratory system
failure. At this point, it is unlikely that inhaled medications will reverse this process. A
mechanical ventilator may be needed to assist the lungs and respiratory muscles. A face mask
or a breathing tube is inserted in the nose or mouth for this treatment. These breathing aids
are temporary and are removed once the attack has subsided and the lungs have recovered
sufficiently to resume the work of breathing on their own. A short hospital stay in an
intensive-care unit may be a result of a severe attack that has not been promptly treated. To
avoid such hospitalization, it is best, at the onset of symptoms, to begin immediate early
treatment at home or in your doctor's office.

Allergy fact

The presence of wheezing or coughing in and of itself is not a reliable standard for judging
the severity of an asthma attack. Very severe attacks may clog the tubes to such a degree that
the lack of air in and out of your lungs fails to produce wheezing or coughing
What medications are
used in the treatment
of asthma?

Most asthma
medications work by
relaxing bronchospasm
(bronchodilators) or
reducing inflammation
(corticosteroids). In the
treatment of asthma,
inhaled medications
are generally preferred
over tablet or liquid
medicines, which are
swallowed (oral
medications). Inhaled
medications act directly
on the airway surface
and airway muscles
where the asthma <script language="JavaScript1.2" type="text/javascript"
problems initiate. src="http://as.webmd.com/js.ng/Params.richmedia=yes&amp;transactionID
Absorption of inhaled =643954037483&amp;tile=643954037483&amp;xpg=1660&amp;artid=284
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minimal. Therefore,
adverse side effects are
fewer as compared to
oral medications. From WebMD
Inhaled medications
include beta-2 agonists, Asthma and Allergy Resources
anticholinergics,  How to Use Your Inhaler
corticosteroids, and
cromolyn sodium. Oral  4 Steps to Creating a Dust Free Bedroom
medications include
 4 Hidden Asthma Triggers in Your Home
aminophylline,
leukotriene Featured Centers
antagonists, beta-2
agonists, and  Which Foods Are Highest in Fiber?
corticosteroid tablets.
 How Bad Is Your Diet? Assess Yourself
Historically, one of the
 12 Tips to Stay Awake Naturally
first medications used
for asthma was Health Solutions From Our Sponsors
adrenaline
(epinephrine).  Depression Med for You?
Adrenaline has a rapid
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onset of action in
opening the airways  MS Rx Options
(bronchodilation). It is
still often used in
emergency situations
for asthma.
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Unfortunately,
adrenaline has many  Living with Obstructive Asthma
side effects, including
rapid heart rate,  Trouble Breathing? Take the COPD Health Check
headache, nausea,
vomiting, restlessness,
and a sense of panic.

Medications chemically
similar to adrenaline
have been developed.
These medications,
called beta-2 agonists,
have the
bronchodilating
benefits of adrenaline
without many of its
unwanted side effects.
Beta-2 agonists are
inhaled
bronchodilators which
are called "agonists"
because they promote
the action of the beta-2
receptor of bronchial
wall muscle. This
receptor acts to relax
the muscular wall of
the airways (bronchi),
resulting in
bronchodilation. The
bronchodilator action
of beta-2 agonists
starts within minutes
after inhalation and
lasts for about four
hours. Examples of
these medications
include albuterol
(Ventolin HFA,
Proventil HFA),
levalbuterol (Xopenex),
metaproterenol
(Alupent), pirbuterol
acetate (Maxair), and
terbutaline sulfate
(Brethaire). Recently,
chlorofluorocarbons
(CFCs) have been
removed from all MDI
inhalers because of the
environmental effects
on the ozone layer.
These have been
replaced by a new
propellant,
hydroflouroalkane
(HFA). Patients may
notice that the jet they
feel in the back of their
throat is less intense
when compared with
the CFC inhaler. They
should be instructed
that they are still
receiving the same
amount of medication
though it may feel
different than their
older inhaler. Another
very important point
that patients must be
aware of is that
"floating" these new
inhalers does not help
in determining the
amount of medication
left in the MDI. In the
past, the CFC devices
could be floated in a
bowl of water. With
more medicine in the
inhaler, the canister
would sink and
gradually float as it
emptied. This is not the
case with the HFA
inhalers, as floating will
actually clog the
inhaler. The number of
accuations must be
counted to determine if
medication is still left in
the inhaler. Shaking the
inhaler is not an
effective method of
determining how much
medication is left.
Often propellant (HFA)
will continue to come
out of the inhaler even
after the medication is
used up. At the
present, only one
albuterol inhaler comes
with a counter device
and this is Ventolin
HFA.

A new group of long-

acting beta-2 agonists
has been developed
with a sustained
duration of effect of 12
hours. These inhalers
can be taken twice a
day. Salmeterol
xinafoate (Serevent)
and formoterol
(Foradil) are examples
of this group of
medications. The long-
acting beta-2 agonists
should not used for
acute attacks. Beta-2
agonists can have side
effects, such as anxiety,
tremor, palpitations or
fast heart rate, and
lowering of blood
potassium. There is
data to suggest that
taking long-acting beta-
2 agonists alone may
be life-threatening.
They are best taken
along with inhaled
corticosteroids (see
below).

Just as beta-2 agonists

can dilate the airways,
beta blocker
medications impair the
relaxation of bronchial
muscle by beta-2
receptors and can
cause constriction of
airways, aggravating
asthma. Therefore,
beta blockers, such as
the blood pressure
medications
propranolol (Inderal)
and atenolol
(Tenormin), should be
avoided by asthma
patients if possible.

The anticholinergic
agents act on a
different type of nerves
than the beta-2
agonists to achieve a
similar relaxation and
opening of the airway
passages. These two
groups of
bronchodilator inhalers
when used together
can produce an
enhanced
bronchodilation effect.
An example of a
commonly used
anticholinergic agent is
ipratropium bromide
(Atrovent). Ipratropium
takes longer to work as
compared with the
beta-2 agonists, with
peak effectiveness
occurring two hours
after intake and lasting
six hours. These agents
are more effective in
patients with COPD.

When symptoms of
asthma are difficult to
control with beta-2
agonists, inhaled
corticosteroids
(cortisone) are often
added. Corticosteroids
can improve lung
function and reduce
airway obstruction over
time. Examples of
inhaled corticosteroids
include
beclomethasone
dipropionate
(Beclovent, Qvar, and
Vanceril),
triamcinolone
acetonide (Azmacort),
budesonide
(Pulmocort), and
flunisolide (Aerobid).
The ideal dose of
corticosteroids is still
unknown. The side
effects of inhaled
corticosteroids include
hoarseness, loss of
voice, and oral yeast
infections. Early use of
inhaled corticosteroids
may prevent
irreversible damage to
the airways.

To decrease the
deposition of
medications on the
throat and increase the
amount reaching the
airways, spacers can be
helpful. Spacers are
tube-like chambers
attached to the outlet
of the MDI canister.
Spacer devices can hold
the released
medications long
enough for patients to
inhale them slowly and
deeply into the lungs. A
spacing device placed
between the mouth
and the MDI can
improve medication
delivery and reduce the
side effects on the
mouth and throat.
Rinsing out the mouth
after use of a steroid
inhaler also can
decrease these side
effects.

Combination inhaler
therapy is now
available for the
treatment of asthma.
These medications
include Advair
(fluticasone and
salmeterol) and
Symbicort (budesonide
and formoteral).
Symbicort uses the
standard MDI inhaler
device (a counter
device will be added in
the near future). Advair
has a unique powdered
delivery system with a
built-in counter.

Cromolyn sodium
(Intal) prevents the
release of certain
chemicals in the lungs,
such as histamine,
which can cause
asthma. Exactly how
cromolyn works to
prevent asthma needs
further research.
Cromolyn is not a
corticosteroid and is
usually not associated
with significant side
effects. Cromolyn is
useful in preventing
asthma but has limited
effectiveness once
acute asthma starts.
Cromolyn can help
prevent asthma
triggered by exercise,
cold air, and allergic
substances, such as cat
dander. Cromolyn may
be used in children as
well as adults.

Theophylline (Theodur,
Theoair, Slo-bid,
Uniphyl, Theo-24) and
aminophylline are
examples of
methylxanthines.
Methylxanthines are
administered orally or
intravenously. Before
the inhalers became
popular,
methylxanthines were
the mainstay of
treatment of asthma.
Caffeine that is in
common coffee and
soft drinks is also a
methylxanthine drug!
Theophylline relaxes
the muscles
surrounding the air
passages and prevents
certain cells lining the
bronchi (mast cells)
from releasing
chemicals, such as
histamine, which can
cause asthma.
Theophylline can also
act as a mild diuretic,
causing an increase in
urination. For asthma
that is difficult to
control,
methylxanthines can
still play an important
role. Dosage levels of
theophylline or
aminophylline are
closely monitored.
Excessive levels can
lead to nausea,
vomiting, heart-rhythm
problems, and even
seizures. In certain
medical conditions,
such as heart failure or
cirrhosis, dosages of
methylxanthines are
lowered to avoid
excessive blood levels.
Drug interactions with
other medications,
such as cimetidine
(Tagamet), calcium
channel blockers
(Procardia), quinolones
(Cipro), and allopurinol
(Xyloprim) can further
affect drug blood
levels.

Corticosteroids are
given orally for severe
asthma unresponsive
to other medications.
Unfortunately, high
doses of corticosteroids
over long periods can
have serious side
effects, including
osteoporosis, bone
fractures, diabetes
mellitus, high blood
pressure, thinning of
the skin and easy
bruising, insomnia,
emotional changes, and
weight gain.

Expectorants help thin

airway mucus, making
it easier to clear the
mucus by coughing.
Potassium iodide is not
commonly used and
has the potential side
effects of acne,
increased salivation,
hives, and thyroid
problems. Guaifenesin
(Entex, Humibid) can
increase the production
of fluid in the lungs and
help to decrease the
apparent thickness of
the mucus but can also
be an airway irritant for
some people.

In addition to
bronchodilator
medications for those
patients with atopic
asthma, avoiding
allergens or other
irritants can be very
important. In patients
who cannot avoid the
allergens, or in those
whose symptoms
cannot be controlled by
medications, allergy
shots are considered.
The benefits of allergy
shots (desensitization)
in the prevention of
asthma has not been
firmly established.
Some doctors are still
concerned about the
risk of anaphylaxis,
which occurs in one in
2 million doses given.
Allergy shots most
commonly benefit
children allergic to
house dust mites.
Other benefits can be
seen with pollens and
animal dander.

In some asthma
patients, allergy
antibodies of one form
known as
immunoglobulin E (IgE)
may play a key role. If
these substances are
elevated in the blood, a
new form of
medication may be
helpful for severe
asthma. An antibody to
IgE, known as
omalizumab (Xolair)
has been developed.
This must be
administered by
injection in a doctor's
office. This is extremely
expensive. However,
for patients with
asthma that is difficult
to manage, this option
may be helpful.

In some asthma
patients, avoidance of
aspirin, or other
NSAIDs (commonly
used in treating
arthritis inflammation)
is important. In other
patients, adequate
treatment of backflow
of stomach acid
(esophageal reflux)
prevents irritation of
the airways. Measures
to prevent esophageal
reflux include
medications, weight
loss, dietary changes,
and stopping
cigarettes, coffee, and
alcohol. Examples of
medications used to
reduce reflux include
omeprazole (Prilosec)
and ranitidine (Zantac).
Patients with severe
reflux problems causing
lung problems may
need surgery to
strengthen the
esophageal sphincter in
order to prevent acid
reflux (fundoplication
surgery).

Asthma At A Glance

 Asthma is a
chronic
inflammation
of the
bronchial tubes
(airways) that
causes swelling
 and narrowing
(constriction)
of the airways.
The bronchial
narrowing is
usually either
totally or at
least partially
reversible with
treatments.

 Asthma is now
the most
common
chronic illness
in children,
affecting one in
every 15.

 Asthma
involves only
the bronchial
tubes and
usually does
not affect the
air sacs or the
lung tissue. The
narrowing that
occurs in
asthma is
caused by
three major
factors:
inflammation,
bronchospasm,
and
hyperreactivity.

 Allergy can play

a role in some,
but not all,
asthma
patients.

 Many factors
can precipitate
 asthma attacks
and they are
classified as
either allergens
or irritants.

 Symptoms of
asthma include
shortness of
breath,
wheezing,
cough, and
chest tightness.

 Asthma is
usually
diagnosed
based on the
presence of
wheezing and
confirmed with
breathing tests.

 Chest X-rays
are usually
normal in
asthma
patients.

 Avoiding
precipitating
factors is
important in
the
management
of asthma.

 Medications
can be used to
reverse or
prevent
bronchospasm
in patients with
asthma.

References: Murray, J.
and Nadel, J. (2000).
Textbook of Respiratory
Medicine. Third edition.
Philadelphia: W.B.
Saunders Company.

Davies, S. Peak
expiratory flow rate
monitoring in asthma.
In: UpToDate, Rose, BD
(Ed), UpToDate,
Wellesley, MA, 2005.

Kohler, C. Metered
dose inhaler
techniques in adults. In:
UpToDate, Rose, BD
(Ed), UpToDate,
Wellesley, MA, 2005.

Medically reviewed by:

Ellen Reich, MD, Board
Certified in Allergy and
Immunology, Board
Certified in Pediatrics

Last Editorial Review:

5/13/2009

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Asthma - Effective
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The MedicineNet
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What kinds of
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Suggested Reading by
Our Doctors

 albuterol,
Ventolin,
Proventil,
Proventil-HFA,
AccuNeb,
 Vospire, ProAir
- Specifies the
medication
albuterol
(Ventolin,
Proventil,
Proventil-HFA,
AccuNeb,
Vospire, ProAir)
a drug used in
for the
treatment of
asthma,
emphysema,
anc chronic
broncitis.
Albuterol
relieves and
prevents of
airway
obstruction
(bronchospasm
) in patients
with asthma
and in patients
with exercise-
induced
asthma. Article
includes
descriptions,
uses, drug
interactions,
and side
effects.

 Cortisone
Injection - Read
about cortisone
injection
treatment for
inflammation,
allergic
reaction,
sciatica and
arthritis. Learn
 about side
effects and
complications
of a cortisone
shot.

 Gastroesophag
eal Reflux
Disease (GERD,
Heartburn) -
Learn about
gastroesophag
eal reflux
disease (GERD,
acid reflux,
heartburn)
symptoms like
heartburn,
chest pain,
regurgitation,
and nausea.
Causes,
diagnosis,
treatment and
prevention
information is
also included.

Read more Asthma

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 Albuterol (Ventolin)

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Latest Asthma News

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Asthma: Over-the-Counter Treatment

Asthma Slideshow

Hidden Home Hazards That Can Harm Your Lungs

Trouble Breathing? Take the COPD Health Check

Medical Author: George Schiffman, MD, FCCP

Medical Editor: William C. Shiel Jr., MD, FACP, FACR

 What is asthma?

 What medications are used to treat asthma?

 How do over-the-counter (OTC) medicines for asthma work?

 What factors should be considered in choosing and using OTC epinephrine or ephedrine?

 What side effects and drug interactions are there with OTC asthma medicines?

 What are additional measures in the management of asthma?

 Find a local Asthma & Allergy Specialist in your town

Asthma is a disease in which there is a brief, temporary narrowing of the airways in the lungs,
referred to as bronchospasm. This narrowing prevents air from moving in and out of the lungs easily.
As a result, an asthmatic patient has episodes when breathing is difficult. An asthmatic episode can
resolve spontaneously or may require treatment.

Asthmatic patients and their physicians may select from a wide variety of prescription medications.
This is not true for over-the-counter (OTC) medicines, which are limited to epinephrine (adrenaline)
and ephedrine. In addition, many asthmatic patients should not use epinephrine or ephedrine
because of their relatively weak effectiveness or side effects.

To decide whether or not an OTC epinephrine or ephedrine product may be useful, viewers should
understand (1) the abnormal conditions that exist in the airways of asthmatics, (2) the effects of
epinephrine and ephedrine, (3) the specific factors that should be considered when choosing and
using epinephrine and ephedrine, and (4) the side effects of these drugs.

The advantages of using OTC medications for asthma include their affordability and accessibility (lack
of need for a prescription and/or health-insurance approval). Unfortunately, these medications are
less effective at controlling asthma and sometimes can be more dangerous.

What is asthma?

The cause of asthma is unknown. More is known about the abnormal conditions that occur in
asthma. These conditions include (1) hyper-responsiveness (contraction) of the muscles of the
breathing airways in response to many stimuli such as exercise or allergies (for example, drugs, food
additives, dust mites, animal fur, and mold), (2) inflammation of the airways, (3) shedding of the
tissue lining the airways, (4) increased secretion of mucus in the airways, and (5) swelling of the
walls of the airways with fluid. All of these conditions narrow the airways and make breathing
difficult. Symptoms of asthma include wheezing (the hallmark of asthma), coughing, difficulty
breathing, and tightness of the chest. Asthma is diagnosed by the presence of wheezing, but it can
be confirmed by breathing tests (spirometry) that evaluate the movement of air into and out of the
lungs.

What medications are used to treat asthma?

Epinephrine and ephedrine once were the only effective medications for treating asthma. Beginning
in the 1980s, newer medications were introduced that target more of the abnormal conditions in
asthma and do so more effectively than epinephrine or ephedrine. For example, prescription-inhaler
forms of beta2-agonists (albuterol and metaproterenol [Proventil and Alupent]), corticosteroids
(beclomethasone and flunisolide [Beclovent and Aerobid]), anticholinergics (ipratropium bromide
[Atrovent]), and other medicines are now widely used because of their greater effectiveness and
fewer side effects. The use of inhaled antiinflammatory medications that include steroid agents such
as fluticasone, budesonide, beclomethasone, and flunisolide have become the mainstay of initial
asthma therapy. Unfortunately, none of these medications are available without a prescription

How do over-the-counter (OTC) medicines for asthma work?

Epinephrine acts by relaxing the muscles of the airways, thereby opening up the airways and
allowing air to flow in and out of the lungs more easily. Ephedrine also relaxes the muscles of the
airways.
What factors should be considered in choosing and using OTC epinephrine or ephedrine?

Despite the development of newer medications, epinephrine and ephedrine remain available as OTC
medications. The choice of epinephrine or ephedrine should involve consideration of several factors.
Most importantly, the asthma should be mild and less frequent, defined as occurring less than once
per week and lasting from a few hours to a few days at most. OTC epinephrine or ephedrine is best
used under the guidance of a physician. A patient should seek medical attention and prepare to
switch to a prescription asthma medication if (1) moderate to severe asthma develops, (2) frequent
or regular doses of epinephrine or ephedrine are needed to relieve symptoms, (3) episodes of
asthma occur once or more per week, or (4) asthmatic episodes develop at night.

OTC epinephrine is available in various concentrations for oral inhalation or as a solution in

vaporized form (nebulization). Both forms may or may not contain alcohol or sulfite as preservatives.
For example, AsthmaHaler Mist does not contain alcohol. Alcohol and sulfite preservatives may
trigger an attack of asthma, and therefore, patients whose asthma is sensitive to these preservatives
should read product labels carefully. The nebulized epinephrine solutions may or may not require
diluting with a separate saline (salt) solution before use. Several saline solutions are available OTC in
various concentrations. Again, careful reading of the label will provide information about combining
an epinephrine solution for nebulization with a specific saline solution. Oral epinephrine is
unavailable because it is rapidly broken down in the digestive system before it can reach the lungs.
Once inhaled, epinephrine should provide rapid relief of symptoms (within five to 10 minutes) and
continue working for one to three hours. Good inhaler and nebulizing techniques are critical in the
use of epinephrine. If epinephrine is used frequently, tolerance to its effects occurs; that is, repeated
inhalations provide progressively less and less benefit. Some of these inhalers use a
chlorofluorcarbon (CFC) propellant. These gases have been shown to damage the ozone layer. The
FDA is likely to expand the ban on CFC propellants making these agents unavailable in the near
future.

OTC ephedrine is available only as an oral medication in combination with guaifenesin as caplets,
tablets, or syrup. (Guaifenesin is an expectorant that loosens mucus in the airways and facilitates its
removal by coughing.) Caution should be used when first starting these products since they
occasionally irritate the airways of some patients and may make the asthma worse. OTC ephedrine
should provide relief of symptoms within 15-60 minutes and may continue to be effective for three
to five hours. Continued use of ephedrine, like frequent use of epinephrine, leads to tolerance.

Neither epinephrine or ephedrine should be continued if thick mucus or sputum (colored mucus)
develops and/or a persistent or chronic cough occurs with the asthma. These may be signs of
infection in the lungs and require immediate medical attention. If OTC asthma drugs do not relieve
an episode of asthma within 10 (for epinephrine) or 60 minutes (for ephedrine) or the symptoms
worsen, medical attention should be sought immediately

What side effects and drug interactions are there with OTC asthma medicines?

Ephedrine poses a greater chance of causing adverse drug effects or drug interactions than
epinephrine because it must be absorbed into the body to be effective. Nervousness, sleeplessness,
anxiety, nausea, reduced appetite, rapid heart beat, tremors (the "shakes"), and urinary retention
are the most common adverse effects. Immediate medical attention may be necessary for these side
effects.

Monoamine oxidase inhibitors (phenelzine, isocarboxazid), clonidine, selegiline, guanethidine, and

ergotamines (ergotamine tartrate, dihydroergotamine mesylate) may increase blood pressure when
used at the same time as ephedrine. Methyldopa or reserpine may reduce ephedrine levels in the
blood and thereby lessen the effectiveness of ephedrine. Tricyclic antidepressants (desipramine,
amitriptyline, doxepin, and imipramine) may block the effect of ephedrine. The carbonic anydrase
inhibitors acetazolamide and dichlorphenamide may raise ephedrine blood levels and increase the
risk of side effects from ephedrine. Patients taking any medications should consult with their
physician or pharmacist before starting OTC ephedrine.

Since epinephrine is inhaled directly into the lungs and little is absorbed into other organs of the
body, there is less risk for side effects. Epinephrine rarely causes rapid heartbeat, irregular heart
rhythms, high blood pressure, tremor, or anxiety.

Since there are specific risks with epinephrine or ephedrine in certain medical conditions, physician
advice and supervision should be sought before taking epinephrine or ephedrine if there is heart
disease (coronary artery disease, congestive heart failure, irregular heart rhythms), high blood
pressure, thyroid disease, diabetes, or difficulty urinating due to enlargement of the prostate. In
addition, patients should seek medical advice before taking ephedrine if they already are taking
antidepressants

What are additional measures in the management of asthma?

1. Patients should avoid known triggers of asthma attacks (for example, exercise or allergens).

2. Good control of allergic rhinitis (nasal allergies) helps to control asthma.

3. Approximately 2%-10% of patients with asthma must avoid aspirin and other nonsteroidal
antiinflammatory drugs (NSAIDs) like ibuprofen and Motrin since they may induce an
episode of asthma.

4. All asthma patients should avoid beta-blocker drugs (Inderal, Tenormin, Visken, and
Lopressor) because they may worsen asthma or precipitate an episode.

5. All patients with asthma should seek professional advise from their physicians on how to
optimally manage their condition
GENERIC NAME: EPHEDRINE - ORAL (eh-FED-rin)

Warning | Medication Uses | Other Uses | How To Use | Side Effects | Precautions | Drug
Interactions | Overdose | Notes | Missed Dose | Storage

WARNING: This drug should not be used in combination with other stimulant products
(e.g., caffeine), other cough-and-cold products, or as a dietary supplement for the purpose of
weight loss or body building. Doing so may increase your risk of unlikely but potentially fatal
side effects including: stroke, heart attack, seizures, or severe mental disorders (see Side
Effects section and Precautions section). In addition, dietary supplements containing
ephedrine should not exceed 8 mg as a single ephedrine dose, 24 mg of ephedrine per day (24
hours), or be given for longer than 7 days, as recommended by the FDA. Exceeding the
recommended ephedrine dose increases your risk of the side effects noted above. For detailed
information, consult your pharmacist. Check all product labels carefully to see if they contain
ephedrine or ephedra/ma huang.

USES: Ephedrine is a central nervous system stimulant used to treat breathing problems (as a
bronchodilator), nasal congestion (as a decongestant), low blood pressure problems
(orthostatic hypotension), or myasthenia gravis.

OTHER USES: This drug has also been used to treat certain sleep disorders (narcolepsy),
menstrual problems (dysmenorrhea), or urine-control problems (incontinence or enuresis).

HOW TO USE: Take this medication by mouth usually every 4 hours as needed; or as
directed by your doctor. The dosage is based on your medical condition and response to
therapy. For prescription ephedrine, do not exceed 150 mg per day in adults or 75 mg per day
in children. Do not combine prescription ephedrine with ephedrine/ephedra/ma huang from
dietary supplement products, since they are the same medicine. Use this medication exactly
as prescribed. Do not increase your dose, take it more frequently, or use it for a longer period
of time than prescribed because this drug can be habit-forming and you may increase for your
risk for serious side effects. When used for an extended period, this medication may not work
as well and may require different dosing. Talk with your doctor if this medication stops
working well. Your doctor may recommend "drug holidays" where your medication is
stopped temporarily. Doing so may help this medication work more effectively

SIDE EFFECTS: Nervousness, anxiety, dizziness, headache, nausea, loss of appetite, or trouble
sleeping may occur. If any of these effects persist or worsen, notify your doctor promptly. Tell your
doctor immediately if any of these serious side effects occur: chest pain, unusually fast or irregular
heartbeat, vomiting, tremor/shakiness, sweating, severe weight loss, difficult or painful urination,
stomach pain. Tell your doctor immediately if any of these unlikely but serious side effects occur:
severe mental/mood changes, fever, trouble breathing, one-sided weakness, confusion, vision
problems, slurred speech. If you notice other effects not listed above, contact your doctor or
pharmacist.

PRECAUTIONS: This medication is not recommended for use if you have the following medical
conditions: glaucoma (closed-angle type), certain psychiatric conditions (e.g., psychoneurosis). Tell
your doctor your medical history, especially of: heart problems (e.g., arrhythmias, chest pain), blood
vessel problems (e.g., stroke or TIA), diabetes, over-active thyroid (hyperthyroidism), prostate
problems, high blood pressure (hypertension), kidney problems, any allergies. This medication
should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your
doctor. It is not known whether this drug passes into breast milk. Due to the potential risk to the
infant, breast-feeding while using this drug is not recommended.

DRUG INTERACTIONS: This drug is not recommended for use with other adrenalin-like drugs (e.g.,
caffeine, epinephrine, methylphenidate, pseudoephedrine). Also, avoid taking any MAO inhibitors
(e.g., furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, selegiline,
tranylcypromine) for at least 2 weeks before or after using this drug. Ask your doctor or pharmacist
for more details. Tell your doctor of all prescription and nonprescription medication you may use,
especially: beta-blockers (e.g., metoprolol, propranolol), other blood pressure medicine (e.g.,
guanethidine, methyldopa, reserpine, or alpha-blockers such as prazosin and terazosin), tricyclic
antidepressants (e.g., amitriptyline, desipramine), "water pills" (e.g., furosemide,
hydrochlorothiazide), digoxin, atropine, theophylline, oxytocin, certain anesthetics used in surgery
(e.g., cyclopropane, halothane), certain herbal/natural medications (e.g., ma huang, St John's wort).
Check the labels on all your medicines (e.g., cough-and-cold products, diet aids, natural products)
because they may contain ingredients that could increase your heart rate or blood pressure. The use
of ephedrine with these products is not recommended. Do not start or stop any medicine without
doctor or pharmacist approval

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room
immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian
residents should call their local poison control center directly. Symptoms of overdose may include:
seizures, cold sweats, vision problems (dilated pupils).

NOTES: Do not share this medication with others, it is against the law. Laboratory and/or medical
tests (e.g., blood pressure) will be performed to monitor your progress.

MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next
dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch
up.

STORAGE: Store at room temperature between 59 and 86 degrees F (15 and 30 degrees C) away
from light

GENERIC NAME: flunisolide nasal spray

BRAND NAME: Nasalide

DRUG CLASS AND MECHANISM: Flunisolide is a synthetic (man-made) corticosteroid. It is

administered either as an oral metered-dose inhaler for the treatment of asthma (Aerobid) or as a
nasal spray for treating allergic rhinitis. Corticosteroids are naturally- occurring hormones that
prevent or suppress inflammation and immune responses. When given as an intranasal spray,
flunisolide reduces watery nasal discharge (rhinorrhea), nasal congestion, postnasal drip, sneezing,
and itching oat the back of the throat that are common allergic symptoms. Eye symptoms such as
itching and tearing that may be associated with allergy sometimes also are relieved. A beneficial
response usually is noted within a few days but can take as long as 4 weeks. Approximately 50% of
flunisolide is absorbed into the blood.

GENERIC AVAILABLE: No

PRESCRIPTION: Yes

PREPARATIONS: Flunisolide nasal spray is available in a 25 ml bottle. The bottle contains about 200
sprays. Each actuation delivers about 25 µg of flunisolide.

STORAGE: Store at room temperature between 15 and 30°C (59 and 86°F). Protect from heat, and
direct light.

PRESCRIBED FOR: Flunisolide nasal spray is used for relieving symptoms associated with seasonal or
perennial rhinitis due to allergies. (Rhinitis is an inflammation of the soft, wet tissue lining the inside
of the nose.)

DOSING: The canister should be shaken before each use. In adults, the usual starting dose is two
sprays in each nostril twice daily. The physician may increase the dose to three times per day. In
children ages 6-14 years, the usual starting dose is one spray in each nostril three times per day or
two sprays in each nostril twice daily.

DRUG INTERACTIONS: No drug interactions have been described with nasal flunisolide

PREGNANCY: Well-controlled studies on the use of flunisolide during pregnancy have not been
done. Studies in animals have shown flunisolide to have damaging effects on the fetus. During
pregnancy flunisolide should be avoided unless the physician feels that the potential therapeutic
benefit justifies the added risk to the fetus.

NURSING MOTHERS: It is unknown whether flunisolide accumulates in breast milk; however, it is

known that other corticosteroids are excreted in breast milk. The effects on the child, if any, are
unknown.

SIDE EFFECTS: The most common side effects following nasal inhalation of flunisolide are nasal
irritation and itching, increased cough, nausea or vomiting, sore throat, nasal congestion, sneezing,
nasal burning, bloody nasal discharge, and nasal dryness. Other adverse effects reported with
intranasal flunisolide include headache, dizziness, watery eyes, and abdominal bloating. All of these
effects are either mild or uncommon.

GENERIC NAME: FLUNISOLIDE - NASAL (flew-NISS-oh-lide)

BRAND NAME(S): Nasalide, Nasarel

Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes |
Missed Dose | Storage | Medical Alert

USES: This medication is a corticosteroid that works directly on nasal tissue to reduce swelling.
Flunisolide nasal is used to treat symptoms associated with allergic rhinitis, such as nasal congestion
and runny nose.
HOW TO USE: To get the most benefit from this medication, make sure you understand how to use
the nasal inhaler properly. Ask your doctor or pharmacist to show you how to use the aerosol or
spray. The medication must reach the nasal tissue to be effective. Therefore, blow your nose to clear
the nasal passage before using the medication. If passages are blocked, a nasal decongestant may be
used first (for a maximum of 3 to 5 days) to open the passages allowing proper penetration of the
medication. Use this medication exactly as prescribed. Do not use it more frequently without your
doctor's approval. It may take a few days before the benefits of the medication are noticed. Use this
medication with caution if sores or injuries are present in the nasal passages.

SIDE EFFECTS: This medication may cause irritation, stinging, burning, or dryness of the nasal
passages. Sneezing, nosebleed, headache, lightheadedness or nausea may also occur. If these effects
continue or become bothersome, inform your doctor. Notify your doctor if you experience: skin
rash, itching. Long-term use of nasal steroids may cause fungal infections of the nose or throat.
Inform your doctor if you develop an infection. The medication may be discontinued while the
infection is treated. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: This medication should be used with caution if the following medical conditions
exist: glaucoma, herpes-type eye infection, other infections, recent nasal surgery, existing nasal
sores, liver disease, tuberculosis, underactive thyroid. Though very unlikely, it is possible this
medication will be absorbed into your bloodstream. This may have undesirable consequences that
may require additional corticosteroid treatment. This is especially true for children and for those
who have used this for an extended period of time and if they also have serious medical problems
such as serious infections, injuries or surgeries. This precaution applies for up to one year after
stopping use of this drug. Tell your doctor immediately if any of the following side effects occur:
vision problems, persistent headache, increased thirst or urination, unusual weakness or weight loss,
dizziness. Consult your doctor or pharmacist for more details, and inform them that you use (or have
used) this medication. Caution is advised when using this drug in the elderly because they may be
more sensitive to the effects of the drug. Caution is advised when using this drug in children. Though
it is unlikely to occur with intranasal steroids (flunisolide), this medication may temporarily slow
down a child's rate of growth, but it will probably not affect final adult height. Monitor your child's
height periodically. This medication should be used during pregnancy only if clearly needed. Discuss
the benefits and risks with your doctor. This medication appears in breast milk. Breast-feeding is not
recommended while using this medication. Children under six years of age should not use this
medication

DRUG INTERACTIONS: Tell your doctor of all prescription and nonprescription drugs you may use,
especially of: antibiotics, oral corticosteroids (e.g., prednisone), other nasal products. Do not start or
stop any medicine without doctor or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room
immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian
residents should call their local poison control center directly.

NOTES: If no improvement in your symptoms is noted after 3 weeks of using this medication, notify
your doctor. Another medication may be needed or the dose may need adjusting. Watering or
itching eyes often associated with allergies are not significantly relieved by this medication. Inform
all your doctors you use (or have used) this medication.
MISSED DOSE: Use the missed dose if remembered within an hour or so. If you remember later, skip
the missed dose and resume your regular schedule. Do not "double-up" the dose.

STORAGE: Store at room temperature and keep away from moisture and sunlight.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment
information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada)