Aging Begins at 30

Wheeze Free Asthma

Mary had labored harsh breathing and one could easily hear her wheeze. She would keep coughing but couldn't bring anything up. Her chest was expanded but she was trying to move her barrel-shaped chest further by the strap muscles in her neck. Her efforts were weakening. She had been doing this for several hours and, since she had had attacks that settled down before, she hoped it would improve. Death from asthma is uncommon, but this attack was not resolving and Mary began to feel that she might die. Fortunately, she had a physician who knew her well and responded quickly to her call

Not all that wheezes is asthma. But asthma is the most common cause of wheezing attacks.

The drugs that treat asthma either relax the bronchial spasm or reduce the inflammation that makes the bronchial tubes swollen and irritable to minor irritants. For example, cold air, perfume, cigarette smoke, air pollution, Christmas tree odors, as well as anything the patient is allergic to can cause spasm. The drugs that relax the bronchial tubes are mainly synthetic relatives of adrenaline that have the bronchial dilating effects without much speeding up of the heart. Adrenaline inhalers are the only ones you can buy without a prescription. They have been relatively safe because the side effects prevent you from taking an overdose. The prescription kinds are more comfortable and their effects last much longer, except when there is a lot of bronchial inflammation.

The inhaled drugs that treat the inflammation do not work quickly. These are the cortisone-like groups and a drug called cromolyn. They are most important.

Cortisone like drugs, particularly prednisone, are taken by mouth or beclomethazone by inhalation. Because prednisone takes about 6 hours to begin to have an obvious effect and asthma is at its worst between 2:00 and 4:00 AM, it is important, in severe asthma, to begin the prednisone before 8:00 PM. Prednisone pills are used to get asthma back under control. Afterwards the inhaled form is used for maintenance because the much smaller dose has fewer side effects.

Two other drugs have an effect on both the bronchial spasm and the inflammation. There are theophylline (or aminophylline) and cromolyn. They are both useful for maintenance. Theophylline is a relative of caffeine and can cause sleep problems. Cromolyn's main problems are cost and not working well for everyone.

It is important for the asthmatic to know that we are careful to use high dose prednisone for relatively short times only. Prednisone can also be used occasionally to make special events, like Christmas with cat owning grandchildren, possible. Talk to your doctor if there is something you especially want to do for a brief period.

Increased fluid intake at the time of the attack loosens up the tenacious mucus plugging some of the bronchioles.

Some asthma is allergic, even if it begins late in life, and every person with asthma should be allergy tested so that avoidable causes can be modified. A decision to try desensitization "allergy shots" should only be made and guided by a trained allergist. It must be done with great care in patients with asthma.

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See related Patient Topics Asthma, Breathing Problems, Immune System/AIDS, Lungs and Breathing or Symptoms and Manifestations.

See related Provider Topics Asthma, Breathing Problems, Immune System/AIDS, Lungs and Breathing or Symptoms and Manifestations.

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