Anxiolytic And Hypnotic Prescriptions
Our estimation of the frequency of prescription of anxiolytics or hypnotics in French asthmatic patients is consistent with observations from the available dispensing data . In Italy, we observed less frequent prescription of drugs in this category compared with France. A possible explanation for this finding is that patients must pay for all benzodiazepine prescriptions . Thus, a GP may preferentially prescribe other reimbursable drugs. The high prevalence of anxiety disorders and insomnia in France, especially in older people, may explain the high numbers of prescriptions for anxiolytics and hypnotics . More specifically, these prescriptions may be related to poor asthma control . This relationship could be interpreted in two ways: asthma exacerbation could induce anxiety or psychiatric disorders could be risk factors for asthma exacerbations .
In Europe and North America, women are generally prescribed twice as many psychotropic drugs as men . Psychiatric disorders and complaints are indeed more common in women than in men . Women are also exposed to specific situations such as pregnancy, which can both worsen asthma and generate anxiety . In addition, women have fewer opportunities than men to control symptoms of anxiety through social activities outside the home, including the use of alcohol .
How To Use A Metered
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A nebulizer can be used to deliver beta-adrenergic drugs directly to the lungs. A nebulizer uses pressurized air or ultrasonic sound waves to create a continuous mist of drug that is inhaled without having to coordinate dosing with breathing. Nebulizers are often portable, and some units can even be plugged into a power outlet in a car. Nebulizers and metered-dose inhalers often deliver different amounts of drug with a single dose, but both are capable of delivering sufficient amounts of drug to the lungs. Nebulizer therapy is less likely to reach the more distant airways in people who are breathing comfortably and not taking deep breaths, making nebulized therapy less effective than a correctly used metered-dose inhaler or a dry powder formulation.
What Are Oral And Intravenous Corticosteroids For Asthma
Methylprednisolone , prednisone , and prednisolone may need to be prescribed when inhaled medications fail to control asthma. Examples of such situations include after an acute asthma attack or when a respiratory infection or allergy aggravates asthma symptoms.
How corticosteroids work
Corticosteroids decrease the inflammation within the airway passages that contributes to asthma symptoms and acute attacks.
Who should not use these medications
- Individuals who are allergic to corticosteroids should not use these drugs.
- Individuals with systemic fungal infections or active tuberculosis should not use these drugs without medical supervision.
Use
Drug or food interactions
Use caution with other drugs that suppress the immune system, such as cyclosporine . Phenobarbital , phenytoin , or rifampin may decrease the effectiveness of corticosteroids. Some drugs, such as ketoconazole or erythromycin , may increase blood levels and toxicity of corticosteroids. An increased risk of stomach bleeding may occur when taken with high-dose aspirin or with blood thinners such as warfarin . Corticosteroids tend to increase blood glucose levels in individuals with diabetes, so diabetic therapy, such as insulin or oral medicines, may need to be adjusted. Talk to your doctor or pharmacist before taking other medications with oral corticosteroids.
Side effects
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What Are Methylxanthines For Asthma
Theophylline may be prescribed to take with other controller medications.
How methylxanthines work
Methylxanthines are related to caffeine. These drugs provide mild to moderate relaxation of muscles in the airway to decrease bronchospasm. Essentially, they work as long-acting bronchodilators. These medications may have a mild anti-inflammatory effect.
Who should not use these medications
- Individuals who are allergic to methylxanthines
- Individuals with active peptic ulcer disease
Use
Methylxanthines are administered orally as tablets, capsules, liquid preparations, or sprinkles . Some oral preparations are available in long-acting doses, allowing the dose to be taken once or twice each day. Your doctor will adjust the dose to maintain specific blood levels known to be effective to decrease bronchospasm.
Drug or food interactions
Ingesting large amounts of caffeine contained in coffee, tea, or soft drinks may increase theophylline side effects. Some drugs that may increase theophylline blood levels include cimetidine , erythromycin , and ciprofloxacin . Some drugs that may decrease theophylline blood levels include phenytoin and carbamazepine . Check with your doctor or pharmacist before taking or stopping other medications to know how your theophylline blood levels will be affected by the change.
Side effects
Can Allergy Shots Treat My Asthma
Children who get allergy shots are less likely to get asthma, recent studies show, but there are asthma shots specifically for adolescents and adults. Since allergies are an asthma trigger, it makes sense that if you control them, youâll have fewer asthma attacks.
Ask your doctor if allergy shots might work for you.
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Implications For Research Policy And Practice
The high prevalence of antibiotic prescription in asthmatic patients suggests a likely antibiotic over-prescription in France and Italy. While anxiety is frequent in asthmatic patients, the prescription of anxiolytics and hypnotics should be avoided and the use of non-pharmacological interventions should be considered in these patients. Apart from international guidelines, there is only one French guideline from 2004 on long-term asthma management. The French guideline does not mention the prescription of antibiotics and anxiolytics/hypnotics, and there are no specific Italian recommendations on asthma management.
Comparisons With Existing Literature
Our finding of high levels of antibiotic prescribing for ALRTI in primary care are consistent with the established literature . Results indicate that there is little difference in prescribing of antibiotics by asthma status, despite guidance that they should be avoided , and evidence that they are not effective in treating ALRTI . There has been little investigation of antibiotic prescribing for ALRTI in adults with asthma, although the available evidence indicates that antibiotics are still frequently prescribed for asthma exacerbations .
Antibiotic prescribing was associated with patients prior patterns of antibiotic prescribing, although when analysis was restricted to the first ALRTI episode, this association was attenuated in patients with asthma and reversed in those without. Results indicate that prior prescribing influences the likelihood of being prescribed an antibiotic for subsequent presentations, with infrequent prescribing in patients not prescribed antibiotics in the recent past. Prescribing practices are likely to be influenced by doctor and practice characteristics as well as patient expectations, as shown in other studies . Practice ALRTI prescribing was positively associated with antibiotic use, comparable to an earlier analysis of UK primary care data .
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Implications For Research And/or Practice
Our study provides evidence that general practices are continuing to frequently prescribe antibiotics for ALRTI, despite evidence of limited benefit, and in contradiction to national guidelines. Furthermore, practitioners frequently co-prescribe asthma medication and antibiotics, which may reflect uncertainty regarding the underlying aetiology. High quality research has been conducted to determine the lack of effectiveness of antibiotics in ALRTI in a non-asthmatic low-risk patient population and in reducing symptoms of asthma exacerbations , but research is now needed to address the clinical uncertainty in the optimum management of ALRTI in patients with asthma.
Talk To Your Asthma Specialist
If youâve been diagnosed with asthma but your treatment doesnât seem to work anymore, itâs time to see your doctor again. Likewise, if youâre having to use your rescue inhaler too often, see your doctor. You may need to change your asthma treatment for better control.
Though asthma is common, itâs a serious condition that needs a diagnosis and treatment. Talk to your doctor for asthma support, and find the medications that work best for you.
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Other Drugs Used To Prevent And Treat Asthma
Other drugs are occasionally used in asthma treatment. These drugs may be used in specific circumstances. Magnesium is often given by vein in the emergency department for acute attacks.
Other drugs that may be given for chronic asthma include lidocaine or heparin given with a nebulizer, colchicine, and intravenous immune globulin. Evidence supporting the use of any of these therapies is limited, so these drugs are used much less often.
, such as older age, family members with osteoporosis, a diet that is low in calcium and vitamin D, or thin build, may need to take calcium and vitamin D supplements and bisphosphonates to try to preserve bone density.
Drugs For Preventing And Treating Asthma
, DO, Wake Forest Baptist Health
Drugs allow most people with asthma to lead relatively normal lives. Most of the drugs used to treat an asthma attack can be used to prevent attacks.
Therapy is based on two classes of drugs:
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Anti-inflammatory drugs
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Bronchodilators
Anti-inflammatory drugs suppress the inflammation that narrows the airways. Anti-inflammatory drugs include corticosteroids , leukotriene modifiers, and mast cell stabilizers.
Bronchodilators help to relax and widen the airways. Bronchodilators include beta-adrenergic drugs , anticholinergics, and methylxanthines.
Other types of drugs that directly alter the immune system are sometimes used for people with severe asthma, but most people do not need immunomodulators.
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How Do You Take Asthma Medications
Asthma inhalers
Asthma inhalers are the most common and effective way to deliver asthma medicine to your lungs. Theyâre available in several types that work in different ways. Some deliver one medication. Others contain two medications. Your doctor might give you:
- A metered-dose inhaler, which uses a small aerosol canister to push out a short burst of medication through a plastic mouthpiece
- A dry powder inhaler, which releases the medicine only when you take a deep breath
Asthma nebulizer
If youâre having trouble using small inhalers, your doctor may recommend a nebulizer. This machine changes asthma medications from a liquid to a mist so itâs easier to get the medicine into your lungs. It also has a mouthpiece or mask that makes it a good option for infants, small children, older adults, or anyone who has trouble using inhalers with spacers. It takes a few more minutes to use than an inhaler.
Can Asthma Kill You
Asthma causes symptoms like wheezing, breathing difficulties, chest pain or tightness, and spasmodic coughing that often worsens at night. Asthma may impair individuals’ ability to exercise, to engage in outdoor activities, to have pets, or to tolerate environments with smoke, dust, or mold. Although asthma can be controlled with medications, asthma attacks vary in intensity from mild to life-threatening. Over the past several decades, the number of asthma attacks that result in death has increased dramatically.
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How Do Labas Work For Asthma
LABAs are an add-on treatment, which means they are never prescribed to prevent asthma on their own.
Inhaled corticosteroids are the main preventive drug for asthma. For people with moderate to severe asthma, combining inhaled corticosteroids with a LABA may help to further reduce symptoms.
LABAs act on the beta-2 receptors of the adrenergic system. They mimic the effects of neurotransmitters like epinephrine and norepinephrine to relax the smooth muscle in the airways.
This action is complementary to the effects of inhaled corticosteroids. In addition, LABAs also help inhaled corticosteroids work better.
- tricyclic antidepressants
- xanthine derivatives
Be sure to provide your doctor with an up-to-date list of medications, as well as any other vitamins or supplements you take.
What Are Leukotriene Inhibitors For Asthma
Montelukast , zafirlukast , and zileuton are used to control asthma symptoms. They are often used in addition to inhaled corticosteroids to avoid the use of oral corticosteroid.
How leukotrienes work
Leukotrienes are powerful chemical substances produced by the body. They promote the inflammatory response caused by exposure to allergens. Leukotriene inhibitors block the action or production of these chemicals, thereby reducing inflammation.
Who should not use these medications
- Individuals who are allergic to leukotriene inhibitors should not take these drugs.
- Individuals with phenylketonuria should not take the chewable tablets that contain aspartame because this artificial sweetener contains phenylalanine
Use
- Leukotrienes are available with a prescription as tablets, chewable tablets, and oral granules.
- Granules may be taken directly in the mouth, or they may be mixed in soft foods like pudding or applesauce.
- The drug is administered as a once-daily dose.
Drug or food interactions
No drug or food interactions have been reported.
Side effects
Leukotrienes are typically well tolerated, and side effects are similar to those of patients taking a placebo . Reports of headache, earache, sore throat, and respiratory infections have been noted.
Inhaled anticholinergic medications, such as ipratropium , enhance beta-agonists’ effectiveness.
Side effects
Combination therapy
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What Are Mast Cell Inhibitors For Asthma
Cromolyn sodium and nedocromil are used to prevent allergic symptoms like runny nose, itchy eyes, and asthma. The response is not as potent as that of corticosteroid inhalers.
How mast cell inhibitors work
These drugs prevent the release of histamine and other chemicals from mast cells that cause asthma symptoms when you come into contact with an allergen . The drug is not effective until four to seven days after you begin taking it.
Who should not use these medications
Individuals who are allergic to any components of the inhaled product should not take these drugs.
Use
Frequent dosing is necessary, since the effects last only six to eight hours. Mast cell inhibitors are available as a liquid to be used with a nebulizer, a capsule that is placed in a device that releases the capsule powder to inhale, and handheld inhalers.
Drug or food interactions
Since these drugs have little or no effect beyond the area applied, they are unlikely to interact with other drugs. Mast cell inhibitors may cause a cough, irritation or unpleasant taste.
Side effects
These drugs are only effective for prevention and are not to be used to treat an acute asthma attack.
Inhalers Nebulizers And Pills As Asthma Medicine
There are a few ways to take asthma medications. Some are inhaled, using a metered dose inhaler, dry powder inhaler, or a nebulizer . Others are taken by mouth, either in pill or liquid form. They can also be given by injection.
Some asthma drugs can be taken together. And some inhalers mix two different medications to get the drugs to your airways quicker.
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Biological Basis For The Involvement Of Atypical Pathogens In Asthma And Chronic Airway Inflammation
Serologic evidence for increased atypical bacterial infections in asthma has been increasing steadily for 15 years and has been more recently supported by increased detection of the organisms themselves, mostly with molecular methods. A biologic basis for increased susceptibility to atypical bacterial infections however, is only just beginning to emerge. Studies in mouse models of C. pneumoniae pneumonitis revealed dramatically increased pathology in IFN-R/ mice and more recently it has been shown that IFN- secretion by bone-marrow-derived macrophages controls infection and importantly, that this is IFN- dependent , . The recent discovery of the type III IFNs and the realisation that they have almost identical properties in innate immunity to the type I IFNs, coupled with the demonstration that individuals with asthma have deficient type III IFN production in macrophages in response to both viral and bacterial stimuli , provides an important likely explanation for increased susceptibility to atypical bacterial infection in asthma. Further study to determine whether macrophages from individuals with asthma also have deficient type I IFN production in response to bacterial stimuli, and to determine whether type III IFNs are also important in host defence against C. pneumoniae infections, and both type I and type III IFNs against M. pneumoniae, will be required to confirm this theory.
Availability Of Data And Materials
The data that support the findings of this study are available from CPRD but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. The data used in the final analysis are however available from the authors upon reasonable request and with permission of CPRD.
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What Are Monoclonal Antibodies For Asthma
Omalizumab is one of the newer asthma medications. It may be considered for individuals with persistent, moderate to severe asthma due to seasonal allergies that is not controlled by inhaled corticosteroids. The cost of omalizumab is estimated at $12,000-$15,000 per year.
Mepolizumab is another monoclonal antibody that is also used for moderate to severe asthma not controlled with standard care, including inhaled steroids.
How monoclonal antibodies work
Omalizumab binds to human immunoglobulin E on the surface of mast cells and basophils . By binding to IgE, omalizumab reduces the release of the allergy-inciting chemicals.
Mepolizumab binds to interleukin 5, which results in a decrease certain inflammatory cells . These eosinophils contribute to the development of asthma attacks.
Who should not use these medications
Individuals who are allergic to omalizumab or mepolizumab or its contents should not use it.
Use
For omalizumab, the dose depends on the IgE levels in the blood.
Adults and children older than 12 years of age are given an injection every two to four weeks.
For mepolizumab, adults and children older than 12 years of age who have elevated eosinophils receive 100 mg by injection every four weeks.
Drug or food interactions
