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Breathe easy

Inhalers target the medicine directly to the lungs for asthmatic patients

HOLDING IT RIGHT A wrong technique in using the inhaler will not produce the desired benefit

Do you feel breathless and tired quite often? Do you cough frequently in your sleep? Have you heard whistling sounds from within your chest? If so, it is quite likely that you have asthma.

Asthma is not uncommon and about 10 per cent of the population suffer from this disease. It is seen more frequently in children and usually these kids recover from the disease as they become older. In the past, hospitalisation for asthma and asthma-related deaths were common.

Medical research in the past two decades has lead to an increased knowledge about asthma. This in turn has translated into the development of a host of new drugs to control asthma. Subsequently hospital admission rates for asthma have come down drastically and now asthma deaths are a rarity.

Inhaler therapy

The basis of the current treatment concept of asthma is the method of delivering the drug directly to the lungs - also referred to as inhaler therapy. This is with the use of inhalers, which target the medicine directly to the lungs, the only place where it is needed to act. This technology offers a lot of advantages.

Firstly, the drug acts only in the lungs. It is hardly absorbed into the blood stream and so does not reach anywhere else in the human body. This is similar to applying eye drops for eye diseases and ointments for skin problems.

Secondly, since it reaches the lungs directly, it starts acting within minutes. More importantly, the amount of medicine contained in a single puff is only in microgram doses.

In contrast, taking regular treatment for asthma in the form of tablets does more harm than good.

When the tablet reaches the stomach, it gets absorbed into the blood stream, and along with the blood it travels and reaches all parts of the body.

Disadvantages

As a result, it exerts its action in different parts of the body where it is not needed at all.

This results in development of side effects like palpitation, sleeplessness and heartburn, which all asthmatics who have taken oral medications would have experienced at some time or the other.

Also, the drug content in tablets comes to milligrams, which is almost hundred times more than what is present in a puff of the inhaler.

Yet another disadvantage of tablets is that it takes about four to five hours to start its action. Because of all these reasons, long-term regular treatment with oral drugs for asthma is not advisable.

However, one cannot avoid oral drugs altogether as they certainly have a role, when a sudden increase in symptoms occur for instance, following an infection.

Right inhaler

Inhalers come in different sizes and shapes and it is very important to choose the correct device and dose of the drug to get good control of asthma. But equally important is the correct method of using the inhaler as a wrong technique will result in the drug getting wasted and hence not producing the desired benefit.

There are two different classes of drugs contained in the inhalers - relievers which provide symptom relief and preventers, which help in control of asthma.

However, many asthmatics have poor control of asthma because they are reluctant to use inhalers. This is because there are a lot of misconcepts regarding the use of inhalers. These include impressions that inhalers are the last resort for asthma, they end up in addiction, need to be used life long and are associated with development of diabetes and kidney problems.

Needless to say, all these are totally wrong and do not have any scientific basis at all.

In fact, inhalers are the first choice treatment for asthma, and should be started the moment the diagnosis is confirmed. They do not have any addiction potential nor do they produce diabetes, renal diseases or cardiac problems.

They do not affect growth in children and can be used safely during pregnancy.

Also they are cheaper in the long run, compared to taking oral drugs for asthma, since they prevent frequent exacerbations, emergency room visits and even frequent hospitalisation.

The wrong notions about inhalers have to change and only then we will be able to achieve the current global standards of asthma care.

P. ARJUN

(The author is a consultant pulmonologist)

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