Asthma : Common Triggers, Types of Medication

by Food and Drug Administration (FDA)

(Page 2 of 4)

Common Triggers

Brian Thomas, 41, a book distributor in New York City, has childhood memories of vaporizers by the side of his bed. "I remember wheezing the night away, often with my mother sitting with me," he says. He noticed some relief from asthma symptoms when he went off to college in Syracuse, N.Y. But the symptoms returned whenever he came home to his childhood bedroom. The culprits were dust mites, tiny bugs that are too small to see. They live on mattresses, bed linens, carpet, and stuffed animals. When Thomas' parents removed the carpet from his room, his asthma symptoms improved considerably.

He went about 10 years without problems, but after a bad cold in 1989, he began wheezing and using an inhaler as needed. In 1990, Thomas had the worst asthma attack of his life when his roommates began building an addition to their New York apartment. "They were doing a lot of woodwork, and I noticed some wheezing," Thomas says. "I thought I had it under control with my inhaler." Then his roommates painted, and that's when things got much worse.

"My chest felt tight and burned, and I just couldn't catch my breath," he says. Luckily, his landlord got a cab to take him to the emergency room at Beth Israel Hospital, and doctors were able to quickly get Thomas' asthma under control. But it was the longest cab ride of his life. "I thought I would die right there on the bridge" that connects the Williamsburg section of Brooklyn to the Lower East Side of Manhattan.

Common asthma triggers include dust, pollen, cockroaches, cold air, smoke, and other strong odors, such as paint, cleaning fluids, perfume, hair spray, and powder. For some people, the problem is animal dander, flakes of skin and dried saliva from furry or feathered animals. For others, asthma can be triggered by medication, such as aspirin, or sulfites, preservatives used in food.

Stress is thought to be a trigger of asthma. Stress can create strong physiologic reactions that lead to airway constriction. Stress can also alter the immune system, which can, in turn, increase the likelihood of an asthma attack in people with asthma. According to the Centers for Disease Control and Prevention (CDC), after the Sept. 11, 2001, attacks on the World Trade Center, some adults in Manhattan reported an increase in their asthma symptoms due to stress, as well as from smoke and debris.

It's not always possible to avoid triggers, but experts suggest that you can track what causes problems and limit exposure as much as possible. Also, talk with your doctor about preventive steps you can take. When Thomas cleans up, for example, he wears a dust mask, available at many hardware stores. To get rid of dust mites, you can encase pillows and mattresses in dust-proof covers and wash bed linens and stuffed animals in hot water each week.

The NHLBI recommends keeping furry and feathered pets out of the home, or at least out of bedrooms, if pets are known to trigger asthma symptoms. Recent research, however, suggests that children with high exposure to cat allergens early in life develop an immune response to cats, reducing the risk for asthma. In the study, published in the March 10, 2001, issue of The Lancet, Thomas Platts-Mills and colleagues at the University of Virginia found that exposure to cats may be protective for some kids but a risk factor for others. The research suggests you might not have to get rid of your cat when the baby comes, but if you or your child experience asthma symptoms because of the cat, the cat should go.

Consult with a doctor about when or how much to increase medications as a preventive measure, such as before allergy season starts or if you're traveling to a place where it may be impossible to know what you will encounter in the way of pollution or environmental allergens.

Types of Medication

There are two main categories of asthma drugs: short-term, quick-relief medications that relieve asthma symptoms, and long-term controller medications that are used every day by people with persistent asthma, even when they feel fine.

Wasserman, who works with The Dallas Asthma Consortium, says the organization advises consumers with "The Rules of Two": If you take your quick-relief inhaler more than two times a week, if you wake up with asthma more than two times a month, or if you refill your quick-relief inhaler more than two times a year, the group recommends that two medicines for asthma are needed and that you should talk with your doctor about a long-term controller.

Short-term reliever medication refers to short-acting inhaled beta-2 agonists such as albuterol and pirbuterol. Beta-2 agonists, also known as bronchodilators, relax the muscles surrounding the airways. In addition, systemic corticosteroids, such as prednisone and prednisolone, are drugs that help relieve the inflammation or swelling in the airway. Taken in tablet or syrup form, they are often used to treat severe asthma attacks.

As for long-term controller medication, inhaled corticosteroids are the most consistently effective. Other long-term controller medications include long-acting beta-agonists, which are used in addition to inhaled steroids. Examples of long-acting beta-agonists are salmeterol and formoterol. (For recent news about salmeterol, see "Safety Study on Serevent.") Cromolyn sodium, nedocromil, and methylxanthines are also in the controller anti-inflammatory category. Another class of long-term controller drugs is called anti-leukotriene medication, and examples include Singulair (montelukast) and Accolate (zafirlukast). These drugs block the action of chemicals called leukotrienes, which are involved in the development of asthma.

In June 2003, the FDA approved Xolair (omalizumab), the first biotechnology product to treat people 12 years and older who have moderate-to-severe allergy-related asthma. The product, which is given as an injection under the skin, is a second-line treatment, recommended only after first-line treatments have failed.

National guidelines on managing asthma now recommend that inhaled corticosteroids are the preferred first-line treatment for people of all ages with persistent asthma. (See "NIH Updates Asthma Guidelines.") Developed by an expert panel of the National Asthma Education and Prevention Program (NAEPP), the guidelines also recommend that if inhaled corticosteroids are not achieving optimal control, dual-control therapy should be used. "We're advising doctors that if inhaled corticosteroids are not proving effective, before increasing the dose, add a long-acting beta-2 agonist," says James Kiley, Ph.D., director of the Division of Lung Diseases at the NHLBI.

Badrul Chowdhury, M.D., Ph.D., acting director of the FDA's Division of Pulmonary and Allergy Drug Products, says significant advances in asthma drugs include the approval of Advair (fluticasone and salmeterol) in 2000. "This drug might improve adherence because you don't have to go between two drugs," Chowdhury says. It's the first drug approved by the FDA that combines an inhaled corticosteroid and a long-acting bronchodilator in one device, which has a built-in counter that tracks the number of doses. Chowdhury says also significant is the recent FDA approval of the inhaled corticosteroid Pulmicort (budesonide) for children as young as 1 and the approval of Xolair (omalizmab) in 2003.

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