Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Monitoring of Asthma Inhalers

Category: Asthma and Allergy


The National Asthma Education Program recently recommended that pharmacists help physicians monitor use of asthma inhalers. An average asthmatic will go through one bronchodilator inhaler per month. Many patients, however are going through inhalers at a rate of one or more per week. Since these are frequently unlimited refill type prescriptions, only pharmacists can pick up this misuse. It is felt that by pharmacists contacting physicians and getting patients in for proper review of the treatment of their condition, asthma mortality might be lowered by as much as 50%.

Proper use of medicines is certainly a critical arm of overall medical care. I am glad to see pharmacists being encouraged to be more active in the medical treatment plan. We are blessed in our community of Opelousas in having many fine pharmacists who do this already and who back-up all of the medical care givers in our community with an extra safety-net of professionalism.

Last year a study in the New England Journal of Medicine scared all of us by suggesting that a bronchodilator inhaler called Fenoterol was associated with increasing asthma deaths. This particular bronchodilator which is not available in the United States is twice as strong as any we have available and was over used in patients who died from asthma. Whether the over use was due to their bad asthma or whether the drug actually caused the death is still undetermined. Nevertheless, the message we took from that article was to be cautious about potential over use of bronchodilators and to use other asthma medicines more aggressively such as anti-inflammatory medicines. These anti-inflammatory medicines include cromalyn sodium or Intal and inhaled bronchodilators such as Vanceril, Beclovent, Azmacort and Aerobid. Check with your physician if you or your children are presently using these medicines and you feel that you may need to use them more so that you can use your bronchodilators a little less.

Some of the studies reviewed by the National Asthma Education Program indicated that 90% of asthma deaths were under using their inhaled corticosteroid sprays. I believe this is probably accurate and try to encourage pediatricians and family doctors to use inhaled corticosteroids much more aggressively in moderate to severe asthmatic children. Fortunately, we have enough data now from studies over the past 15 years convincing us of the safe use of these inhaled corticosteroids in children. Finally, I recommend all asthmatic children have a written plan on a card posted on their refrigerator and carried in the mother's purse and perhaps even in the child's pocket with a 1,2,3, step by step plan of treatment for daily medicine use as well as aggressive emergency medicine use in cases of asthma flare-ups and severe shortness of breath. Ask your physician to help you write up such a plan.