Guest Author - Amy Anaruk

Maintenance is one of the most important words you�ll encounter in the battle to gain control of asthma. Developing a maintenance plan involves reducing lung inflammation, avoiding triggers, working with a general practictioner and/or specialist to figure out the best treatment meds, and composing an Asthma Action Plan. This article is part one of the series Asthma Maintenance 101.

The most widely recognized symbol of asthma is, of course, the rescue inhaler. TV and movie directors love to portray asthmatic characters sucking down the medicine from their inhalers every hour or so�the character Mikey in The Goonies is a great example�but most people with mild to moderate asthma who practice good maintenance don�t need their rescue medications nearly that often. In fact, an individual who needs an inhaler as frequently as Mikey does would be in much poorer health. Inaccurate portrayals like this one obscure the larger picture of asthma as a complex disease with widely varying symptoms and no quick-and-easy fix. The rescue inhaler is, however, the one form of medication every asthmatic uses as the easiest, fastest, and most effective way to treat a flare.

Although asthma symptoms are wildly different for each person, results of a flare are the same across the board: bronchioles constrict and breathing deteriorates. All rescue medications therefore need to accomplish the same goal of creating a clear passage for the carbon dioxide to exit and leave behind empty, open lungs to take air in.

Short-acting beta-agonists, or bronchodilators, like Albuterol ( salbutamol sulfate) are the main rescue medications because they start working immediately and last four to six hours. Also sold under the brand names Proventil or Ventolin, they relax the bronchioles� smooth muscle fibers to help widen the airways and are available in an inhaler or for a nebulizer. Side effects include dry mouth and/or throat, headache, restlessness, anxiety, and heart palpitations, all of which sound scary but usually subside over time. I can vividly remember when my daughter started using Albuterol in a nebulizer at age two. Every single treatment turned her into a hyperactive ball of frenzied disobedience, and it was a little alarming to watch. After a month or two, her body adjusted and her behavior returned to normal.

Doctors sometimes add Atrovent (ipratropium bromide), an anticholinergic, for severe asthma cases that don�t respond well to bronchodilators alone. Anticholinergics work by suppressing the neurotransmitter that causes smooth muscle spasms. Although technically in the reliever class of medications, Atrovent does not work right away so doctors prescribe it for controller purposes. Its side effects are similar to bronchodilators�.

Occasionally, controller meds and a rescue inhaler are not enough during a severe flare, and doctors will turn to oral, or systemic, corticosteroids like prednisone. This third type of rescue medication is possibly the most critical for life-threatening, severe flares. No other intervention short of a hospital stay works as quickly or as well to calm pulmonary irritation. Systemic corticosteroids are a miracle drug of sorts for asthmatics.

Unfortunately, powerful drugs usually come with a price. As mentioned in this series� article about controller meds, synthetic corticosteroids mimic the natural hormone cortisol that blocks the substances responsible for inflammation. Synthetic oral corticosteroids work in the same way, so taking prednisone in tablet form during a flare will calm the pulmonary irritation and allow bronchodilators to work better.

The catch-22 here is that reducing inflammation helps asthma but can seriously affect health. Remember that an ordinary amount of inflammation is part of a healthy immune response because it increases circulation and healing. When oral corticosteroids reduce inflammation they suppress the entire immune system, making patients more prone to infection. (Inhaled maintenance corticosteroids like Flovent carry a much smaller risk of infection than oral ones because very little of the inhaled medication reaches the bloodstream.)

The long-term side effects are even more serious and include the risks of osteoporosis, skin-thinning, aggravation of diabetes, high blood pressure, eye problems like glaucoma and cataracts, and growth inhibition.

No one likes taking corticosteroids, but they save lives everyday. Used infrequently and under close medical supervision, they can stop a severe flare and prevent a hospital stay like nothing else in an asthmatics� arsenal. Doctors generally prescribe the lowest possible dose of oral steroids in what they call �short bursts� of five to ten days and only for flares that don�t respond to reliever medications.

By all accounts, faithfully following a good maintenance plan from the very beginning can reduce the need for all rescue medications, especially oral corticosteroids.


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"Smile, breathe and go slowly." -Thich Nhat Hanh



This article is not written by a medical professional, and information on this page should never be substituted for your physcian�s advice. If you have any questions about your asthma and/or allergies, you should always contact your physician first.