Michael S. Fontenot, M.D.
Patient Information Sheet
Asthma is a medical condition in which the person wheezes and coughs repetitively in response toinfections, allergies or other respiratory irritants (like smoking). There are three factors that areresponsible for this process: bronchospasm, inflammation, and mucous plugging. Understandingthese three processes will shed light on the medications that we use to treat asthma.
BRONCHOSPASMThere is muscle surrounding the normal airways in the lungs. This muscle controls the flow of air tothe lung. In asthma, these muscles go into spasm which narrows the size of these airways. This iswhat results in wheezing (a whistling sound made as air moves through the narrowed airways) andcough. The medicines we use to counteract this wheezing are called bronchodilators. The mostcommon one used is albuterol (Proventil and Ventolin). This medicine can be given as a syrup or asan inhaler. Albuterol works very quickly (especially in the inhaler form) and its effects last for 4-6hours. This fast onset of action is what makes it the best choice for people who are having an asthmaattack. Another bronchodilator that is available is called Serevent. Serevent takes 20 minutes or so tostart working but last for 12 hours. It is a great medication for people having symptoms in the middleof the night but it is not a great medication for emergency use because its onset of action is so slow.
INFLAMMATIONThe importance of inflammation in the process of asthma has recently revolutionized our treatment ofthis disorder. There are many medications which can be used to counteract this swelling in the lungs.
In people having a difficult time breathing, oral steroids (prednisone) can make a world of differencewithin 12 or 24 hours. This treatment used in short courses (five days) has been shown to be a safeand effective way to avoid hospitalization. Steroids can also be taking in an inhaled form (Flovent 44,Azmacort, Pulmicort) and these are safe to take for long periods of time (even months or years).
These steroid inhalers are effective ways of preventing asthma attacks from occurring but often takeseveral days to become active. Therefore these medications are best used as preventive medicinesand should be taken even when the patient is feeling good. Other medicines that can be used to treatthe inflammation are Intal, Tilade, and Singulair. Keep taking these inhalers or medications until youare instructed to stop.
MUCUS PLUGGINGAn asthmatic cough is typically a tight hacking cough. This occurs because the mucus in the airwayscannot be coughed up because the airways are too narrow. When patients are begun onbronchodilators, the airways open up and typically the cough changes in character to a "productivecough." For the next two days or so, the patient may be coughing in order to clear this phlegm. Afterthat the cough should subside nicely. The best medication for this mucus plugging is Robitussin DM(guaifenesin plus dextromethorphan) or one of its generic equivalents.
Patient Information Sheet
_____ tsp, puffs _____ times a day for _____ weeks ANTI- INFLAMMATORIES: SLOW ACTING PREVENTIVE MEDICINES.
() Flovent 44 110 / Asmanex/Azmacort / Pulmicort : _____ puffs ______ times a day for _____ months() Prednisone tablets ______ inhalation _____ times a day for ______ months COMBINATION MEDICINES: TREAT BOTH INFLAMMATION AND BRONCHOSPASM: SLOWACTING!!!!() Advair inhaler: _____ puff twice daily for ______________ months COUGH SUPPRESSANT, EXPECTORANT() Robitussin DM _____ tsp _____ times daily as needed for cough IF YOU CHILD IS HAVING DIFFICULTY BREATHING, YOU SHOULD GIVE ALBUTEROL ORXOPENEX AS A RESCUE MEDICINE.
ADVAIR, while helpful, may take too long to become effective

Source: http://www.michaelfontenot.net/education/asthma.pdf


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