Is It Better To Treat Adult Asthma With Pills Or Inhalers?

Two years ago I developed pneumonia and was hospitalized for eight days. It took three months until I had the strength to move at half my usual speed. I was then diagnosed as having developed adult asthma. A year and a half later, I was again hospitalized with pneumonia. My lungs are so sore, I am continually out of breath and am feeling completed exhausted.

What do you think about using inhalers (I use three kinds, twice a day) as opposed to pills? Or is there something else you have found that works best. I am 45 years old and also about 40 pounds overweight. I am watching my eating habits, but my lungs “don’t work” much for exercise. What should I do?

Asthma is a condition in which inflammation in the bronchi — the small tubes channeling air to the lungs — causes them to constrict, preventing the smooth flow of air. The constriction is usually worse during exhalation, causing a characteristic wheezing sound. Cough and mucus production accompany many attacks.

Over the years many treatments, including inhalers and oral medications, have been used for asthma. Prednisone, a steroid drug, is commonly used to break up very severe attacks, but we try to minimize its use because of the severe side effects.

Modern treatment of asthma relies primarily on inhalers and a new class of oral medication called leukotriene receptor antagonists (Singulair, Accolate). Mild asthmatics may get by using only an inhaler like albuterol, (Proventil, Ventolin). These are invaluable in quickly stopping an attack and can also be used before an attack if one gets asthma with exercise or during exposure to cold. Take one to two puffs before exercising or going out in cold weather to prevent wheezing from developing. There is also a long-acting inhaled drug of the same class as albuterol called salmeterol (Serevent). It can be helpful for someone whose asthma requires frequent use of the albuterol inhaler.

Most experts will add an anti-inflammatory type of medicine, also given by inhaler, to anyone whose asthma is more than mild. Such inhalers can either contain a cortisone-like drug, a steroid (Azmacort, Vanceril), or a non steroidal anti-inflammatory agent, such as cromolyn (Intal). Steroids taken by inhalation almost never produce the type of side effects that prednisone by mouth produces. These inhalers must be taken regularly as prescribed to reduce inflammation and prevent attacks. None of the anti-inflammatory drugs are helpful in stopping an attack once it has started. One of the leukotriene antagonists might also be used at this stage.

It sounds as though you should be on inhaled steroids regularly, with albuterol added either regularly or at the first tightening that precedes an asthma attack. You should be on an exercise program to try to lose the extra weight. If exercise causes wheezing, take the albuterol before starting.

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