Posted by Perry on August 11, 2002 at 08:13:20:

In Reply to: Perry: Asthma question posted by Peter on August 09, 2002 at 06:47:29:

Peter:

Astham/allergy treatment is somewhat personal as it seems that each person needs something different.

However, Asthma drugs can be broken into 3 general classes: Steroids, Mast Cell Inhibitors, Bronchiodialtors (spelling).

Each of these three classes of drugs work differently on the lung and in most cases a person should be on at least 2 of the classes.

Steriods due two things. First they prevent tissue from swelling. Asthma is an allergic reaction of the lung - where the lung swells up. Thus - steriods reduce the swelling.

The second things steroids do is turn off - to some extent - the allergic immune response system. Thus you can reduce the allergic reaction from the start.

The ability to "Partially" turn off the immune response system can have horible side effects if you "overdose" on steroids to the point of turning off this portion of the immune system.... Like in the extreem you can get sick and die from something else while your immune system is turned off... Dr's do use steroids at time to turn off this portion of the immune system, however they do in only in significant situations and for only a short time under relatively controled situations. Please do not take more steroid than you need...

Cortisone is the steroid of choice for treating allergy response problems.

Individual people have different levels of allergy problems, and thus different levels of needs for steroid treatment. The steroid can also be taken as pure cortisone, but in most cases some close relative that breaks down to cortisone. Thus you will find about a half dozen different named products - all who break down into cortisone in the body.

There is also a range of treatment levels available from very low dose to very high dose inhalers (and pills). Azmacort (which contains "triamcinolone acetonide") is one of the low dose ones in the US. This does not mean that all "triamcinolone acetonide" inhalers are necessarily low dose. For example Flovent another inhaler in the US contains "fluticasone propionate" and comes in several different strengths.

Typically people should start with a low dose steroid inhaler, then move up to a higher dose inhaler if needed.

The first time I wanted to try Flovent as it has less "body absorption" side effects than azmacort my insurance Co would not approve it - then the Dr changed me to somthine else (I don't remember what). Unbeknown to me that something else was a high dose inhaler and I immediately OD'd on steroids and messed myself up it turned out to be 3-4 times as potent as Azmacort). I quickly switched back to the azmacort. Later on I did get to try Flovent (in the low dose form) and decided that the extra money was not worth the benifit, and I am now back on Azmacort.

Mast cell inhibitors are a great idea that are not 100% effective. The first one was I believe Cromolyn Sodium and went under the name of Intal (or something similar) in the US. Tilade (Nedocromil sodium) is more effective but also rates as one of the worst tasting stuff out there (you get used to it).

Mast cell inhibitors work by turning off the mast cells and leaving the rest of the immune response system in place. It is the mast cell that triggers the allergic response (and the mast cell dumps 26 or 27 chemicals into the body when it triggers, with the biggest quantity being "histamine" -which is why you take "anti-histimines" to block some of the common allergy symptoms). If the mast cell does not trigger, then it does not dump all the chemicalls and your body does not respond. If you only turn off the mast cells in the lungs (or nose / throat) you eliminate asthma and nasal allergy problems Nasal mast cell inhibitors mixtrures are available).

Mast cell inhibitors take a while to work. It usually takes 3 to 5 days before you notice any significant reduction in symptoms - and may take up to 2 weeks to saturate your mast cells with the inhibitor. Mast cell inhibitors are not 100% effective even under the best conditions as they just cannot seem to turn off all the mast cells. Thus you typically need to be using the other drug clases with them to counter-react the mast cells that are reacting.

For some strange reason known only to the US Dr's both steriods and mast cell inhibitiors are classified as "Anti-Inflamitories" and the general instructions to Dr's is that an asthma patient needs to be on "a" inti-inflamitory and "a" bronchiodilator. While steroids reduce inflamation, mast cell inhibitors prevent inflamation. Also, while up to 70% of asthma / allergy patients report exhaustion as a common symptom - steroids do nothing for the exhaustion while mast cell inhibitors can significantly reduce the exhaustion component. The common Dr has not a clue about this...

The steroids do have minor side effects from having steroids floating arround your body (most people do not notice) while the mast cell inhibitores ara about as side effect free as any drug out there.

Bronchiodialtors work by short term reducing the swelling and getting your lung get back to normal. There are two basic ones on the market. Albuterol (that is the substance) which is a very fast acting bronchiodialtor, and in the US Serevent (salmeterol xinafoate) a long term one.

In my case I am currently taking 2 puffs Serevent, 2 puffs Azmacort, and 3 puffs Tilade - all twice a day (near bedtime, and before going to work). Once in a while then I need some albuterol (which is the one they tell you to carry with you).

I will note that this is a "heavy" use of the Tilade - but my lungs are larger than normal. The other thing is that I started on 2 puffs of Tilade 4 times a day for 2 weeks, then 2 puffs 3 times a day for a while, before getting to 2 times a day. Most people on Intal must stay at 3 or 4 times a day.

If you have astham you will probably end up on a similar routine - just the names and dosages of the specific drugs will change. Steroid, Bronchiodialtor are standard. I suggest you try a mast cell inhibitor as part of the mix, it allowed me to reduct the amount of steroid significantly. It may take some experimentation with the different drugs to find the ones that work best for you (this is typical).

There are examples of mixtures out there. For example, Servent and Flovent come combined in a single twice a day inhaler (a disc with some other name) with differnet streaghts of the Flovent available. I found that it did not work for me as somehow it seemed to interfear with my use of Tilade (but perhaps that was an individual thing. The thought of reducing my inhalers by one is a worhty goal).

It can also help what order you take them. For example, the best treatment comes when I use the bronchiodialtor first - and about 1/2 hour before I take the steroid and the mast cell inhibitor. Getting the lungs back to normal lets the other drugs get into the crack and crevaces of the lung.

It is also the Serevent that had the biggest effect on my AutoCPAP (lots of false events when not useing it - good AutoCPAP resonse when using Sevevent). However, you may find that the other drugs may do that for you.

Hope this helps.

Perry

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