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Tuesday, March 1, 2011

Why You Need to Take Asthma Medicine, Even if You Feel Fine (2)

Why you may be on a symptom roller coaster
Even patients with the best of intentions may have a hard time taking medications day in and day out, sometimes several times a day, when they feel just dandy. The temptation is to think, “Why not just skip it today since I feel fine?”

“This is a chronic problem that I encounter with many asthmatics,” says Len Horovitz, MD, a pulmonary specialist with Lenox Hill Hospital, in New York City. “Once patients are well controlled on medications, a part of their psyche thinks they’ve been cured and they no longer need medication.”

As a result, patients end up on a “roller coaster,” says Mark H. Moss, MD, an associate professor of medicine and pediatrics at the University of Wisconsin School of Medicine and Public Health. “They have very few symptoms when they take their medicine, but then the symptoms reemerge when they stop taking it.”

But skipping medications, even when you don’t have any symptoms, could mean more flare-ups and worsened asthma down the line.

“It’s important to continue to use anti-inflammatory maintenance medications because there’s an inflammation process that’s occurring within your lungs,” says Amber Watts, PharmD, an assistant professor of pharmacy practice at Texas A&M Health Science Center Rangel College of Pharmacy, in Kingsville. “The steroids in these medications help prevent that inflammation and reduce the chances of an exacerbation. It’s not going to completely prevent an exacerbation, but it does decrease the risk.”

What’s a steroid?
Asthma is a chronic condition that is thought to be driven by inflammation in the airways. That inflammation is pretty much always there, only producing symptoms when a certain threshold is reached; that threshold, as well as individual triggers, is different for each person.

“It’s like having a charcoal fire burning all the time and more fuel comes along, like wind or oxygen, then you have a raging inferno and get symptomatic,” Dr. Kercsmar says.

Anti-inflammatory medications such as corticosteroids (commonly called steroids, but in a different class of drug from anabolic steroids, which are sometimes abused by athletes), leukotriene pathway modifier drugs, and IgE blockers dampen down this ever-burning “charcoal fire.”

When a person has an asthma attack, the lining of the airway swells, secretes more mucus, and, most dramatically, constricts the muscles in the airways. This calls for a different treatment: A person uses a rescue inhaler or nebulizer to administer bronchodilator drugs (such as albuterol) to open the tight airways.

“That works primarily to relax the muscles. It essentially has no effect on inflammation,” says Dr. Kercsmar. And it acts within minutes to provide relief.

Even without maintenance medications, some patients will go weeks or even months without a problem. But doctors can’t always tell which patients fall into this category.

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