Male: We look at two different types of medicine. Things that you detect relieve the attack and things to prevent the attack and controlled.- and what kind of medicines were used to do this?
Dr. Marcus: There are two groups of medications that we use to treat asthma. It is a group of medications that we call rapid acting believer medications. These are the emergency medications that immediately relieve the spasm and the blockage in the lungs to make breathing easier. Some of these medications are Xopenex, Albuterol, Atrovent, Preventil, Ventolin, these types of medications relieve the spasm to make breathing easier but the problem with these medications is that even though they relieve the spasm, they don’t make the lungs stronger. They do not decrease the inflammation and so they don’t decrease the risk of frequent or recurrent episodes. You will relieve the spasm but the condition that lead to the spasm is still as severe and so as those medications were off the blockage in the lungs returns and the child is sick all over again. The second group of medications we use are the controller medications. These medications decrease the inflammation in the lungs thereby making the children healthier. I like to use the phrase – these medications help make the lungs stronger, because what they do in fact is they bring the lungs back to a normal level, thereby preventing future attacks and so we are actually helping treat the disease rather than just the symptoms of the disease. These controller medications then are used more chronically. Once the child falls into the category of either partly controlled or uncontrolled, it is recommended that they be placed on a controller medication and this controller medication is continued even when the child is feeling well in order to prevent future episodes and further deterioration of their disease.
Male: These controller type medicines, a very common one is inhaled steroids and how long will you use that in a child, a week, a month, a year?
Dr. Marcus: There are a number of controller medications that we commonly use. Inhaled corticosteroids such as Pulmicort, Flovent are medications which are considered the first line controller for our patients who have persistent asthma. Once these medications are started, the plan is to continue using them for long periods of time, many months, to even years, depending on the patient’s condition. The reason we need to use these medications in long term is that it clearly improved the condition of the lung preventing future attacks but, if we stop these medications, the studies have shown that within a two-month period, the lung function begins to deteriorate again and we are right back where we started from. Other controller medications we can use are pills such as Singulair as well as inhaler, long acting beta agonists such as Foradil, these medications also control the disease, but have the same limitation that the inhaled steroids have. And that is once these medications are stopped the disease begins to get sicker all over again.
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