Category: asthma

Asthma is a chronic inflammatory lung disease caused due to the airway’s hypersensitive response to allergic stimuli. Severe asthma or status asthmaticus is defined as asthma that is uncontrolled, despite adherence with maximal optimized therapy and treatment of contributory factors or asthma that worsens when high dose treatment is decreased.

Asthma is a chronic inflammatory lung disease caused due to the airway’s hypersensitive response to allergic stimuli (dust, pollen, pollution, smoke or unhygienic conditions). The allergens cause the narrowing of airway passages making it hard to breathe. Asthma is often passed down in families and precipitated during childhood, but it can also be caused by other things. Not all individuals who possess the altered genes develop asthma. It depends on their exposure to environmental triggers that are capable of provoking airway irritation. Asthma has become a growing problem in today’s generation. 

Asthma can be very mild and need little to no medical treatment.  In other cases, it may be severe and life-threatening. The National Asthma Education and Prevention Program has classified asthma into mild intermittent asthma, mild persistent asthma, moderate persistent asthma and severe persistent asthma. Severe asthma or status asthmaticus is defined as asthma that is uncontrolled, despite adherence with maximal optimized therapy and treatment of contributory factors or asthma that worsens when high dose treatment is decreased. It is the most serious and life-threatening form of asthma. 

What happens in severe asthma?

The classification of “severe asthma” refers to patients who require high-dose inhaled glucocorticoid (GC) to maintain asthma control or who never achieve control despite that treatment.

People with severe asthma struggle to manage their day-to-day activities. They experience a heavy burden of symptoms, exacerbations and medication side effects. The symptoms can be unpredictable and occur during the day and night. If severe asthma symptoms aren’t controlled effectively, it can be very debilitating. Frequent shortness of breath, wheezing, chest tightness and cough interfere with day-to-day living, sleeping and physical activity. Patients often have frightening and unpredictable exacerbations also called asthma attacks or severe flare-ups.

Features of severe asthma

According to NIH guidelines, severe asthma includes the following features

• Symptoms that occur throughout the day
• Being woken up by symptoms, often seven nights per week (in those five years of age and older)
• For children four years of age and younger, being woken up by symptoms on more than one night per week
• Symptoms that require short-acting beta 2-agonist therapy several times per day
• Symptoms that significantly limit a person’s regular activities
• A forced expiratory volume 1 (FEV 1) measurement of less than 60 percent of usual (in those five years of age and older)

What are the signs and symptoms of a severe asthma attack?

The symptoms associated with a severe asthma attack include

• A bluish tint to the lips, face or fingernails
• Feeling the need to stand up or sit to try and breathe more easily
• Feeling confused or agitated
• Being unable to speak in full sentences
• Feeling very short of breath and unable to inhale or exhale fully
• Rapid breathing
• Symptoms that don’t get better even after using a rescue inhaler

How is severe asthma treated?

There is no single treatment or solution as everyone is affected differently. The prescribed medications may be the same for someone who has milder asthma, but the medications may be used at a much higher dose. Treatment of severe asthma focuses on trying to control the symptoms. The patient receives prescribed medication and treatment to manage airway inflammation and to prevent lung damage. They will also be advised to reduce the risk of coming into contact with asthma triggers.

In addition to inhalers to treat and prevent asthma attacks, those who have severe asthma may be prescribed other treatments. Treatment options include the following

• Long-acting bronchodilators (LBAs): These can be added to a preventer inhaler and help keep the airways open for at least 12 hours.
• Leukotriene receptor antagonists (LTRAs): A nonsteroid tablet that helps calm inflamed airways, blocks the effects of leukotrienes (inflammatory molecules) and helps with allergies.
• Long-acting muscarinic receptor antagonists (LAMAs): A form of long-acting bronchodilator that can work for 12 to 24 hours.
• Long-acting beta-agonists (LABAs): Another form of long-acting bronchodilator that is used to relax the muscles in the airways.
• Slow-release theophylline: A nonsteroid tablet that helps to relax the smooth muscles in the airways, enabling air to more easily flow through.
• Short-acting beta 2-agonists: A form of quick relief medication that can be used when asthma symptoms occur.
• Daily steroids: These are prescribed in tablet or liquid form and are a type of anti-inflammatory medicine. They work by helping to reduce sensitivity in the airways.
• Monoclonal antibodies (also called mAbs or biologics): A newer form of medication for severe uncontrolled asthma. They work by blocking the activity of immune system chemicals that trigger airway inflammation.
• Bronchial thermoplasty: In some cases, bronchial thermoplasty might be recommended. Bronchial thermoplasty is delivery of controlled, therapeutic radiofrequency energy to the airway wall. This heats the tissue, reducing the amount of smooth muscle present in the airway wall, and it widens the airways.

Properly diagnosing and managing asthma in babies and young children can be challenging. However, be on the lookout for these signs and symptoms.

Diagnosing and managing asthma in children younger than five years old can be challenging. However, especially lookout for the condition in children whose families have a history of it, as well as other allergies. Additionally, children are also at risk of the condition if their mother smoked during the pregnancy. 

Primary symptoms of asthma in infants and toddlers result in wheezing and cough, but can also include the following:

• Shortness of breath
• Fast breathing
• Working harder to breathe
• Persistent coughing
• Coughing spells that often happen during play or exercise, at night, in cold air or while laughing and crying
• Lack of energy during play and pausing to catch their breath during activities
• Chest retractions (seesaw motions in their chest)
• Difficulty in sleeping because of coughing or breathing problems
• Tight neck and chest muscles
• Difficulty sucking or eating
• Feeling tired or weak
• Cyanosis (tissue color changes on lips)
• Trouble eating or grunting while eating (in infants)
• Failure to gain weight

What factors can trigger or worsen asthma symptoms in babies?

Similar to other asthma sufferers, symptoms in infants can be triggered or worsened by certain factors. Identifying these triggers can help your child better control their condition.

Asthma symptoms in babies can be triggered or worsened by these factors:

• Colds or other respiratory infections
• Allergens, such as dust, pet dander or pollen
• Mold infestation in the house
• Physical activity or exercise
• Feeding (in infants)
• Change in the seasons
• Exposure to cigarette smoke or other airborne irritants
• Strong emotional reactions, such as crying or laughing
• Gastrointestinal reflux
• Changes or extremes in weather
• Viral infection in the lungs

What are the patterns of asthma symptoms in babies?

The severity and patterns of asthma symptoms may vary by the child; however, the most common patterns resemble the following:

• Exacerbation of symptoms at night
• Short episodes of coughing and wheezing between a symptomless period
• Repeated or chronic symptoms with episodes of worse wheezing and coughing
• Seasonal changes based on prevalent infections or allergy triggers

When should you consult a doctor?

In most cases, symptoms of severe asthma require immediate medical assistance, so be on the lookout for the following signs:

• Stopping in the middle of a sentence to catch a breath
• Using abdominal or neck muscles to breathe
• The abdomen sinks under their ribs when they try to get air
• Chest and sides that pull in as they breathe
• Severe wheezing
• Severe coughing
• Trouble walking or talking
• Blue lips or fingernails
• Increasing shortness of breath with decreased wheezing
• Enlarged nostrils
• Fast heartbeat
• Sweating more than usual

Is it asthma or something else?

Asthma symptoms may be similar to the symptoms of other illnesses or diseases. If you are unsure whether your child has asthma or another condition, consult your doctor.

Some of the diseases that have symptoms similar to asthma include:

• Bronchiolitis (an inflammatory bronchial reaction in young children and infants)
• Croup (upper airway infection that blocks breathing)
• Acid reflux
• Pneumonia
• Upper respiratory viruses
• Aspiration
• Inhaled object
• Epiglottitis (a potentially life-threatening condition that occurs when the epiglottis is inflamed)
• Cystic fibrosis (an inherited life-threatening disorder that damages the lungs and digestive system)
• Conditions leading to weaker lung development, such as prematurity

What is the difference between childhood asthma and adult asthma?

The main difference between childhood and adult asthma is the severity. As infants have a much smaller airway than adults, even a mild bronchial swelling can lead to a severe reaction. Tightened, inflamed airways and extreme mucus can easily block the flow of air, which makes it extremely hard for the baby to breathe.

Respiratory infections are often the first trigger to cause an asthma attack in a child. The child will continue to experience symptoms even after the infection has been treated. Hence, parents should closely monitor their child suffering from a respiratory infection for symptoms of asthma.

Depending on the severity of your asthma, treatment may include quick-relief or controller medicines, a combination of both or the use of biologics.

Though there is no cure for asthma, the good news is that symptoms get less severe with age. Additionally, symptoms can also be controlled with effective treatment and management.

Medication is always the first choice and most ideal option for managing asthma. The four types of asthma medicines and treatments are:

• Quick-relief medicines – medicines that work rapidly to relieve abrupt symptoms. These are taken as needed, usually at the first appearance of signs. Commonly used drug classes include:
  • Short-acting beta-agonists
  • Anticholinergics
  • Oral corticosteroids
  • Anticholinergic and a short-acting beta-agonist
• Controller medicines – medicines that help manage asthma by correcting the changes in the airways, such as swelling and excessive mucus. These can be one type or a combination of medicines. Some of the common drug and drug classes include:
  • Inhaled corticosteroids
  • Inhaled long-acting beta-agonists
  • Theophylline
  • Cromolyn
  • Leukotriene modifiers
• Combinations of quick-relief and controller medicines – medicines that are used for both short-term relief and maintenance. These are the most common drugs prescribed for asthma management.
• Biologics – this type of treatment aims at a cell or protein to prevent swelling inside the airways. They are specially indicated for people with certain types of persistent asthma and are mainly given by injection or infusion. Some of the drugs include:
  • Benralizumab
  • Omalizumab
  • Mepolizumab
  • Reslizumab

Biologics and surgical intervention are often reserved for asthma not responding to the first three classes of drugs.

What are different ways to take asthma medications?

The different ways in which asthma medication is administered include:

• Inhalers: the most common and effective way to deliver asthma medication. They are a medical device that delivers medicine straight to your lungs. This medication is mostly in the form of a mist or spray that the person breathes in. Unlike a tablet or syrup, inhalers deliver the medicine straight to the lungs. Devices come in the following three forms:
  • Metered-dose inhalers
  • Dry powder inhalers
  • Soft mist inhalers
• Nebulizers: prescribed for patients having difficulty using small inhalers. Nebulizers are an ideal option for infants, young children and older adults as it has a mouthpiece and masks.
• Injectables: Biologics are usually given via shots or infusions every few weeks. Shots are given via an auto-injector device and may be administered at the doctor’s office or at home, while infusions are only given at the doctor’s office.
• Oral: some drugs may need to be administered orally for better control of the condition.

What are the side effects of asthma medications?

Like every medication, asthma medicine may cause some side effects, which includes:

• Palpitations
• Fine tremors in hand
• Headache
• Nausea
• Vomiting
• Insomnia
• Irritability
• Dizziness
• Diarrhea
• Cough
• Bronchitis
• Pharyngitis
• Mood swings
• Weight gain
• High blood pressure
• Fungal infection of the airways if the patient does not rinse after using steroid inhalers

What are other ways of controlling asthma?

Medicine alone cannot completely manage asthma. Hence, it is important to try alternative ways to control your condition effectively, which may include:

• Avoiding asthma triggers to prevent exacerbations (You must find your triggers – cold air, stress, exercise, pollen, etc.).
• Improving indoor air quality to reduce your exposure to allergens (pollen, pet dander, mold, cockroach droppings, etc.) and irritants (particulate matter, exhaust from heaters, etc.).
• Making lifestyle modifications to manage your condition effectively (weight management, stress management, etc.)
• Undergoing an alternative therapy called bronchial thermoplasty will be suggested by your physician if medication is not enough to control your symptoms.

Eosinophilic asthma is a type of asthma that is hard to manage and quite severe. Here are the symptoms of this respiratory condition.

Patients with eosinophilic asthma may exhibit poor asthma control, experiencing more frequent and life-threatening asthma attacks. Unlike other forms of asthma, this form may affect the entire respiratory system, not just the lungs.

The symptoms of eosinophilic asthma are similar to those of other kinds of asthma, although they are often too severe and difficult to control with conventional treatments, such as using inhalers. Symptoms can include:

• Difficulty breathing or shortness of breath
• Coughing
• Wheezing
• Airflow obstruction
• Chest tightness

Additionally, these symptoms are often only associated with eosinophilic asthma (and not other types):

• Chronic rhinosinusitis (sinus infection)
• Congestion and nasal drainage
• Nasal polyps (growths of skin in the sinuses)
• Anosmia (loss of ability to smell)

Some patients with eosinophilic asthma may also develop fatigue, rashes, mouth sores and cognitive symptoms, such as confusion and memory loss (hypereosinophilic syndrome).

What is eosinophilic asthma?

Eosinophilic asthma is a type of asthma caused by the inflammation of the respiratory system. Blood cells called eosinophils are responsible for this swelling.

This type of asthma often starts in adulthood and is difficult to manage. Eosinophils usually help the body fight off parasitic illnesses. However, too many of these blood cells in the bloodstream can result in the secretion of toxic chemicals that inflame the body’s airways and obstruct them with mucus. While other types of asthma only cause swelling in the lungs, eosinophilic asthma affects the entire respiratory system.

Eosinophilic asthma is quite rare. Though experts don’t know the exact prevalence of the condition, estimates say about only 5 percent of asthma sufferers have it. Unfortunately, the cause remains unknown. However, those with eosinophilic asthma do not usually have any disease-related allergies that provoke their symptoms. Many ongoing clinical trials aim to investigate the potential causes of the condition.

What are the treatment options available for eosinophilic asthma?

Eosinophilic asthma has no cure and the effects can be severe. However, several treatment options can help control it, making working with your doctor a vital step in finding a plan that works best for you.

Treatment for eosinophilic asthma can come in the following forms:

Corticosteroids:

• Treatment can come in the form of an inhaler or pill and is usually taken daily for asthma maintenance. 
• Because eosinophilic asthma can be resistant to inhalers, corticosteroid pills are more likely to be diagnosed for this condition.

Bronchodilators:

• These rescue medicines are fast-acting inhalers that open your airways quickly if they are swollen and causing trouble breathing.

Leukotriene modifiers:

• Leukotrienes are chemicals in the body that contribute to causing inflammation. These modifiers lessen the effects of leukotrienes and minimize the production of the chemical to prevent asthma attacks and manage symptoms. 
• Like corticosteroids, these medications are for asthma maintenance, not for immediate relief during an asthma attack.

Biologic therapies:

• Drugs that are chemically engineered to behave like human antibodies (immune proteins). They are typically used in conjunction with other asthma medications, and are administered by injection or intravenously. 
• Biologics that treat eosinophilic asthma block the immune system protein interleukin-5 (IL-5) and lessen the body’s production of eosinophils. 
• Biologics that are currently approved for use in the United States include the following:
  • Benralizumab: Antibody that binds IL-5 receptors. Recommended for people 12 years and older
  • Dupilumab: Interleukin-4 (IL-4) and Interleukin-13 (IL-13) inhibitor and binds to the IL-4 alpha receptor. Recommended for people 12 years and older
  • Mepolizumab: An antibody that recognizes and blocks IL-5. Recommended for people six years and older
  • Reslizumab: An antibody that recognizes and blocks IL-5. Recommended for people 18 years and older

Although it can be a severe condition, advances in asthma treatment make it possible to manage your eosinophilic asthma. If you have symptoms of this condition, talk to your doctor and keep track of what you think your asthma triggers are so you can find a treatment plan that works best for you. Many treatments and therapies are already underway to improve the lives of eosinophilic asthma sufferers.

Understand the five symptoms of an asthma attack to better get the treatment you need during an episode.

Asthma is a chronic respiratory disease characterized by episodic swelling and narrowing of the airways. While it often starts in childhood, adult-onset asthma is also possible.

Asthma attack symptoms arise due to inflammation in the airways, stress or seasonal changes. These symptoms may or may not occur suddenly. In fact, they often develop slowly over a few hours or days. Identifying when an asthma attack is about to occur can better help you manage your symptoms.

Here are five ways to identify an asthma attack:

1. The hallmark of asthma is wheezing, which is a whistle-like noise emerging from the airways when patients exhale. Some patients, however, may not have any wheezing.
2. Chest tightness or discomfort when breathing.
3. Cough variant asthma may be present with dry (nonproductive) coughing that does not respond to antihistamines and worsens at night or in the early hours of the morning.
4. Patients experience breathing issues where they feel like their breathing is getting faster, they cannot catch their breath and the skin on their chest or neck sinks or moves inward as they breathe.
5. Nonspecific symptoms such as a pale or sweaty face during an attack, irritability and feeling low.

What are the three types of asthma?

Understanding the different types of asthma can help patients seek the most effective treatment during an asthma attack. The three most common types of asthma are:

Exercise-induced asthma or exercise-induced bronchoconstriction

• Exercise does not directly cause asthma, but physical exertion during exercise can trigger the condition.
• Coughing and wheezing are the most common symptoms of exercise-induced asthma.
• With exercise-induced asthma, airway narrowings peak 5 to 20 minutes after exercise begins, making it difficult to catch a breath.
• Symptoms begin within a few minutes of exercise and peak or worsen a few minutes after exercise ends.
• Usually, doctors recommend a bronchodilator (an asthma inhaler) for this type of asthma.

Allergic asthma or occupational/seasonal asthma:

• Inhaling allergens is the most common trigger for inducing allergic asthma, which includes: 
  • Dust mites
  • Pet dander
  • Pollen
  • Mold
• Sometimes, allergic asthma may be due to a patients’ occupation (paint, metal or gas); hence, patients must determine the exact trigger and consult an allergist or immunologist.
• Few patients may develop asthma only during the winter season because the cold can trigger asthma attacks.
• Anyone who has an allergy due to allergens, the season or their occupation may require an immunologist or allergist intervention.
• Doctors recommend preventive and reliever inhalers for this type of asthma.

Nocturnal asthma:

• Patients may develop nocturnal asthma along with another type of the condition, including all those mentioned above.
• Usually, patients wake up coughing, wheezing or with chest pain; hence, more effective and long-term treatment is required for this type of asthma.
• Studies show that most deaths related to asthma occur at night due to these potential reasons:
  • Increased exposure to allergens (asthma triggers)
  • Cooling of the airways
  • A reclining position
  • Hormone secretions
• Sometimes, normal heartburn can trigger asthma symptoms at night.
• Doctors may recommend diet changes, eye drops, nasal decongestants and regular saline nasal rinse to wash out allergens.

What are the common treatment options for an asthma attack?

Long-term control and prevention are the key methods to stop asthma attacks before they start. Treatment usually involves recognizing triggers and avoiding them as much as possible.

There's currently no cure for asthma, but treatment can help control the symptoms so that patients may be able to live a normal, active life. Treatment may include:

Inhalers:

• These may relieve symptoms when they occur (reliever inhalers) and stop symptoms from developing (preventer inhalers). Some patients need an inhaler that does both (combination inhalers).

Tablets: Patients may need to take tablets if using inhalers alone is not helping to control their symptoms.

• Leukotriene receptor antagonists (LTRAs): LTRAs are the main tablets used for asthma. They also come in syrup and powder form.
• Theophylline: Doctors may recommend theophylline if other treatments do not help control the patient’s symptoms.
• Steroid tablets: Doctors may recommend steroid tablets if patients are unable to take any of the above medications to control their symptoms. They may give these tablets as an immediate treatment or every day for long-term treatment to prevent the symptoms.

Injections:

• For some patients with severe asthma, doctors may give an injection, such as Fasenra (benralizumab), every few weeks to control their symptoms.
• These medicines are not suitable for everyone and can only be prescribed by an asthma specialist.

Surgery: 

• Doctors may offer a procedure called bronchial thermoplasty as a treatment for patients with severe asthma. This procedure works well, and there are no serious concerns about its safety.
• Doctors may sedate patients using general anesthesia during bronchial thermoplasty. The procedure involves passing a thin, flexible tube down the throat and into the lungs.
• Heat is then used on the muscles around the airways to help stop them from narrowing and causing asthma symptoms.

Breathing exercise:

• There’s some evidence that breathing exercises can improve symptoms and reduce the need for reliever medicines in some patients, but they should not replace asthma medications.

Why is your asthma worse in the colder months? Learn about causes of winter asthma

If you’re like many people, you may find that your asthma symptoms are worse in the winter. Cold, dry air outdoors can irritate your respiratory passages, and even indoors, tons of factors could cause your asthma to flare up. 

So why does winter asthma occur, and what can you do to prevent it?

Why does winter make my asthma worse?

Asthma frequency and severity can vary with the seasons, and winter is no exception. Reasons why the colder months can trigger asthma flare-ups include: 

• Cold air: Cold air can irritate your airways, causing them to narrow or produce more mucus. Winter air tends to be dryer, as well, which adds to the problem.
• Central heating: Different types of heaters, from wood to gas, often release particles into the air that can trigger asthma. Some heaters also cause water condensation inside the house, inviting mold to form.
• Mold: When moisture pools inside the house, it can create mildew or mold in vents, over walls, and near bathrooms. Mold spores are potent asthma triggers.
• Indoor allergens: Dust mites and animal dander tend to collect more in the house when there is less ventilation. And since people are usually spending more time indoors, they are more likely to be affected by these allergens.
• Flu season: Cold and flu viruses occur more often in cold weather. These infections can aggravate the airways and result in an increased frequency of asthma attacks.

How to prevent winter asthma flare-ups

You can prevent winter asthma flare-ups by identifying your triggers and addressing them:

• Inhalers: Your doctor may prescribe beclometasone inhalers to lower airway swelling and sensitivity. Regular or daily use can reduce the frequency and severity of asthma symptoms. As many as 90% of people use their inhalers incorrectly, which means the medicine is not getting into their lungs the right way. Ask your doctor or pharmacist to check how you’re using your inhaler and correct your technique if necessary.
• Flu vaccine: In addition to treating minor colds and coughs right away with antihistamines, steam inhalation, and nasal drops, consider getting the flu shot. The flu vaccine is the best way to protect yourself from getting sick, especially if you have lung conditions like chronic obstructive pulmonary disease (COPD). Ideally, you should get vaccinated around mid-April so that your body has enough time to build up immunity by the peak flu period from June to September. 
• Indoor air quality: Have your flue and chimney professionally checked and cleaned before winter. Clean the dust and soot that accumulates in the chimneys. Burn only dry, unseasoned, untreated wood. Do not overload your wood heater. Never leave your fire to smolder overnight. 
• Dehumidifiers: Invest in a dehumidifier to maintain indoor air humidity between 30%-50%. If you find mold growing inside the house, treat it with hydrogen peroxide or bleach. Consider replacing carpets because they tend to grow mold more easily. Repair leaks in faucets and roofs as soon as possible. Use exhaust fans to keep your bathrooms and kitchen well ventilated.

When it comes to overcoming winter asthma, it’s important to plan ahead well before winter arrives. Talk with your doctor to develop an action plan, and make sure to stay on top of your prescribed medications.

What is fluticasone propionate oral inhaler, and how does it work (mechanism of action)?

Fluticasone propionate is a man-made steroid
of the glucocorticoid family which is related to the naturally-occurring steroid
hormone, cortisol or hydrocortisone, produced by the adrenal glands.
Glucocorticoid steroids have potent anti-inflammatory actions. When used as an
inhaler, fluticasone travels to the airways in the lung. In asthmatic patients,
the suppression of inflammation within the airways reduces the spasm of muscle
cells that surround the airways as well as the accumulation of fluid and cells
that accompanies the inflammation which lead to narrowing of the airways. The
narrowing makes it difficult to get air into and out of the lungs. When used in
lower doses, very little fluticasone is absorbed into the body. When higher
doses are used, fluticasone is absorbed and may cause side effects elsewhere in
the body. The FDA approved fluticasone in March 1996.

What brand names are available for fluticasone propionate oral inhaler?

Flovent Diskus, Flovent HFA

Is fluticasone propionate oral inhaler available as a generic drug?

GENERIC AVAILABLE: No

Do I need a prescription for fluticasone propionate oral inhaler?

Yes

What are the side effects of fluticasone propionate oral inhaler?

The most common side effects of fluticasone are:

• headache,
• upper respiratory infections,
• throat irritation,
• nasal congestion,
• nasal discharge, and
• hoarseness or difficulty speaking.

Fluticasone may also
cause bronchospasms (wheezing). Bronchospasms should be treated with a rescue
inhaler.

Oral candidiasis or thrush (a fungal infection) may occur.

High doses
of inhaled fluticasone may decrease formation and increase break-down of bone
thereby weakening bones and promoting
fractures.

Higher doses of fluticasone
also may suppress the body's ability to make its own natural glucocorticoid in
the adrenal gland. People with suppression of their adrenal glands (which can be
diagnosed by a testing performed by doctors) need increased amounts of
glucocorticoids, probably by the oral or intravenous route, during periods of
high physical stress when glucocorticoids are particularly important.

Inhaled steroids may suppress growth, weaken the immune system, and may increase the
risk of glaucoma (increased eye pressure), and cataracts.

QUESTION

Asthma is a chronic respiratory disease.
See Answer

What is the dosage for fluticasone propionate oral inhaler?

Doses vary from patient to patient.

The recommended dose for
the aerosol is 88 to 440 mcg twice daily.

The recommended dose for the Diskhaler
is 100 to 1000 mcg twice daily. Following administration, the mouth should be
rinsed thoroughly with water or mouthwash to minimize dry mouth, irritation of
the throat, and hoarseness.

The aerosol inhaler must be cleaned at least once a
week.

If a bronchodilator aerosol spray (a spray that causes the airways to
expand), for example, albuterol (Proventil; Ventolin), is used, it should be
used first, and then 5-15 minutes later fluticasone should be used.

Which drugs or supplements interact with fluticasone propionate oral inhaler?

Ritonavir (Norvir), atazanavir (Reyataz),
clarithromycin (Biaxin), indinavir (Crixivan), itraconazole (Sporanox),
ketoconazole, nelfinavir (Viracept), and telithromycin (Ketek) may increase
levels of fluticasone in the body by reducing the breakdown of fluticasone by
liver enzymes. This may increase side effects of fluticasone.

Latest Asthma News

• People With Asthma Aren’t Seeing a Specialist
• Allergy Treatment Crucial If Your Child Has Asthma
• Could Certain Diabetes Drugs Fight Asthma, Too?
• Ultra-Fine Air Pollution Could Raise Asthma Risks
• Is Your Child at Risk for Asthma?
• Want More News? Sign Up for MedicineNet Newsletters!

Daily Health News

• H5N6 Bird Flu Infection in China
• COVID Vaccine Misinformation
• Antibiotic-Resistant Pneumonia
• Mask Mandate Returns to L.A.
• Fermented Foods Help Microbiome
• More Health News »

Trending on MedicineNet

• Guillain-Barre Syndrome
• What Triggers Shingles?
• Normal Blood Sugar Levels
• Identify Tick Bites
• Why Is Autism Increasing?

Is fluticasone propionate oral inhaler safe to take if I’m pregnant or breastfeeding?

Adequate studies of fluticasone during
pregnancy have not
been done. Fluticasone use during pregnancy should be avoided unless the
potential benefit justifies the potential but unknown risk to the fetus.

It is not known if fluticasone is secreted in
breast
milk. Other medications in the same class as fluticasone are secreted into
breast milk. It is not known whether the small amounts that may appear in the
milk affect the infant.

What else should I know about fluticasone propionate oral inhaler?

What preparations of fluticasone propionate oral inhaler are available?

Inhalation aerosol: 44, 110, and 220 mcg/inhalation.
Inhalation Powder (Diskhaler): 50, 100, and 250 mcg/inhalation

How should I keep fluticasone propionate oral inhaler stored?

Fluticasone should be kept at room temperature, 4 C – 30 C (39 F – 86 F), and the aerosol should be shaken well before each use.

Other important side effects include Allergic reactions such as:

• including swelling of face,
• throat swelling,
• tongue swellling,
• rash,
• hives, and
• breathing problems

What is hydrocortisone, oral, and how does it work (mechanism of action)?

Hydrocortisone is a naturally-occurring
corticosteroid produced by the adrenal glands. Corticosteroids have potent
anti-inflammatory properties and are used in a wide variety of inflammatory
conditions such as:

• arthritis,
• colitis,
• asthma,
• bronchitis,
• certain skin rashes, and
• allergic or inflammatory conditions of the nose and eyes.

There are numerous
preparations of corticosteroids including oral tablets, capsules, liquids,
topical creams and gels, inhalers and eye drops, and injectable and intravenous
solutions. Hydrocortisone that is prescribed in oral, tablet and liquid forms is
addressed in this article.

Dosage requirements of corticosteroids vary among
individuals and the diseases being treated. In general, the lowest possible
effective dose is used. Corticosteroids given in multiple doses throughout the
day are more effective but also more toxic than if the same total dose is given
once daily or every other day. The FDA approved hydrocortisone in December 1952.

What brand names are available for hydrocortisone, oral?

A-Hydrocort, Solu-CORTEE, Cortef

Is hydrocortisone, oral available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for hydrocortisone, oral?

Yes

What are the side effects of hydrocortisone, oral?

Hydrocortisone side effects depend on the dose, the
duration and the frequency of administration. Short courses of hydrocortisone
usually are well tolerated with few and mild side effects. Long term, high doses
of hydrocortisone usually will produce predictable, and potentially serious side
effects. Whenever possible, the lowest effective doses of hydrocortisone should
be used for the shortest possible length of time to minimize side effects.
Alternate day dosing also can help reduce side effects.

Side effects of
hydrocortisone and other corticosteroids range from mild to serious. Side
effects include:

• fluid retention,
• weight gain,
• high blood pressure,
• potassium loss,
• headache,
• muscle weakness,
• puffiness of and hair growth on the face,
• thinning and easy bruising of the skin,
• glaucoma,
• cataracts,
• peptic ulceration,
• worsening of diabetes,
• irregular menses,
• growth retardation in children,
• convulsions, and
• psychic disturbances.

Psychic disturbances can include:

• depression,
• euphoria,
• insomnia,
• mood swings,
• personality changes, and
• psychotic behavior.

Hydrocortisone and other corticosteroids can mask signs of
infection and impair the body’s natural immune response to infection. Patients
on corticosteroids are more susceptible to infections, and can develop more
serious infections than healthy individuals. For instance,
chickenpox and
measles viruses can produce serious and even fatal illnesses in patients on high
doses of hydrocortisone. Live virus vaccines, such as the small pox vaccine,
should be avoided in patients taking high doses of hydrocortisone, since even
vaccine viruses may cause disease in these patients.

Some infectious organisms,
such as tuberculosis (TB) and malaria, can remain dormant in a patient for
years. Hydrocortisone and other corticosteroids can reactivate dormant
infections in these patients and cause serious illness. Patients with dormant TB
may require anti-TB medications while undergoing prolonged corticosteroid
treatment. Prolonged use of hydrocortisone can depress the ability of body’s
adrenal glands to produce corticosteroids.

Abruptly stopping hydrocortisone in
these individuals can cause symptoms of corticosteroid insufficiency, with
accompanying nausea, vomiting, and even shock. Therefore, withdrawal of
hydrocortisone is usually accomplished by gradual tapering. Gradually tapering
hydrocortisone not only minimizes the symptoms of corticosteroid insufficiency,
it also reduces the risk of an abrupt flare of the disease under treatment. The
insufficient adrenal gland function may not recover fully for many months after
stopping hydrocortisone. These patients need additional hydrocortisone treatment
during periods of stress, such as surgery, to avoid symptoms of corticosteroid
insufficiency and shock, while the adrenal gland is not responding by producing
its own corticosteroid.

Hydrocortisone impairs calcium absorption and new bone
formation. Patients on prolonged treatment with hydrocortisone and other
corticosteroids can develop osteoporosis and an increased risk of bone
fractures. Supplemental calcium and vitamin D are encouraged to slow this
process of bone thinning.

In rare individuals, destruction of large joints
(aseptic necrosis) can occur while undergoing treatment with hydrocortisone or
other corticosteroids. These patients experience severe pain in the joints
involved, and can require joint replacements. The reason behind such destruction
is not clear.

What is the dosage for hydrocortisone, oral?

Hydrocortisone should be taken with food. The recommended
dosage range is 10 mg to 300 mg per day depending on the disease administered in
3 to 4 divided doses.

Which drugs or supplements interact with hydrocortisone, oral?

By interfering with the patient’s immune response,
hydrocortisone can impede the effectiveness of vaccinations. Hydrocortisone also
can interfere with the tuberculin skin test and cause false negative results in
patients with
tuberculosis infection.

Rifampin and phenytoin
(Dilantin, Dilantin-125) may increase the
elimination of hydrocortisone from the body, reducing its effectiveness. Troleandomycin and ketoconazole may reduce the elimination of hydrocortisone,
possibly leading to increased side effects.

Latest Asthma News

• People With Asthma Aren’t Seeing a Specialist
• Allergy Treatment Crucial If Your Child Has Asthma
• Could Certain Diabetes Drugs Fight Asthma, Too?
• Ultra-Fine Air Pollution Could Raise Asthma Risks
• Is Your Child at Risk for Asthma?
• Want More News? Sign Up for MedicineNet Newsletters!

Daily Health News

• H5N6 Bird Flu Infection in China
• COVID Vaccine Misinformation
• Antibiotic-Resistant Pneumonia
• Mask Mandate Returns to L.A.
• Fermented Foods Help Microbiome
• More Health News »

Trending on MedicineNet

• Guillain-Barre Syndrome
• What Triggers Shingles?
• Normal Blood Sugar Levels
• Identify Tick Bites
• Why Is Autism Increasing?

What Are Biologics
and Biosimilars?

Learn More on

Is hydrocortisone, oral safe to take if I’m pregnant or breastfeeding?

Hydrocortisone has not been adequately evaluated
during
pregnancy.

Hydrocortisone can appear in
breast milk, and can
have adverse effects on the baby. Therefore, mothers taking hydrocortisone
should discontinue nursing.

What else should I know about hydrocortisone, oral?

What preparations of hydrocortisone, oral are available?

Tablets: 5, 10 and 20 mg; Oral Suspension: 10 mg/5 ml.

How should I keep hydrocortisone, oral stored?

Hydrocortisone should be stored at room temperature at 20 C – 25
C (68 F – 77 F) in a sealed container.

What is salmeterol, and how does it work (mechanism of action)?

Asthma is a breathing problem
involving narrowing of the airways. Airways are breathing passages that allow
air to move in and out of the lungs. In patients with asthma, airways can be
narrowed by accumulation of mucus, spasm of the muscles that surround these
airways, or swelling of the lining of the airways. Airway narrowing lead to
symptoms of shortness of breath, wheezing, cough, and congestion. Medications
used in treating asthma open airways are called bronchodilators. Salmeterol is a
bronchodilator of the beta-2 agonist type. Beta-2 agonists are medications that
stimulate beta-2 receptors on the smooth muscle cells that line the airways,
causing these muscle cells to relax, thus, opening airways.

Certain
allergens (such as pollen) can cause airway narrowing by inducing release of
histamine by mast cells. Histamine is a natural chemical that causes tissue
swelling and other allergic reactions in the body when released into the tissue.
Mast cells belong to a class of immune
cells located around the airways. Salmeterol is an inhaled
medication that
blocks the release of histamine by the mast cells, thus
preventing airway
narrowing when exposed to allergens.

What brand names are available for salmeterol?

Serevent

Is salmeterol available as a generic drug?

No

Do I need a prescription for salmeterol?

Yes

What are the side effects of salmeterol?

Side effects include:

palpitations,
fast heart rate,
elevated blood pressure,
tremor,
nervousness, and
headache.

Throat and upper airway irritation can occur.

Use of long acting drugs like salmeterol may increase the risk of asthma-related death. Therefore, salmeterol should only be used in patients uncontrolled by other agents and who are using other long-term asthma-controlling medications such as an inhaled corticosteroid.

What is the dosage for salmeterol?

Salmeterol inhalations should not be used more
often than prescribed (twice per day) and proper techniques of inhalation
closely followed. Salmeterol is metabolized by the liver and should be used with
caution in patients with liver dysfunction. Salmeterol is not meant to be used
in treating acute asthma attacks; short acting inhaler medications are used for
acute attacks. When using salmeterol in preventing exercised induced asthma, the
medication is administered 30 to 60 minutes before exercise. Salmeterol does not
take the place of oral or
inhaled corticosteroids.

QUESTION

Asthma is a chronic respiratory disease.
See Answer

Which drugs or supplements interact with salmeterol?

Salmeterol can increase heart rate,
blood pressure, and cause chest pain and excitement, especially if used in
higher doses than recommended or used in those with coronary heart disease or
high blood pressure.
Tricyclic antidepressants and salmeterol should not be combined because of additive effect
on the vascular system. In rare instances, salmeterol can induce paradoxical
worsening of bronchospasm (which can be life-threatening). If this occurs,
salmeterol should be discontinued, and the doctor notified immediately. Rare
allergic reactions to salmeterol can cause
skin rash, hives, swelling, bronchospasm, and anaphylaxis. Worsening of diabetes
and lowering of potassium
have also been described.

Latest Asthma News

• People With Asthma Aren’t Seeing a Specialist
• Allergy Treatment Crucial If Your Child Has Asthma
• Could Certain Diabetes Drugs Fight Asthma, Too?
• Ultra-Fine Air Pollution Could Raise Asthma Risks
• Is Your Child at Risk for Asthma?
• Want More News? Sign Up for MedicineNet Newsletters!

Daily Health News

• H5N6 Bird Flu Infection in China
• COVID Vaccine Misinformation
• Antibiotic-Resistant Pneumonia
• Mask Mandate Returns to L.A.
• Fermented Foods Help Microbiome
• More Health News »

Trending on MedicineNet

• Guillain-Barre Syndrome
• What Triggers Shingles?
• Normal Blood Sugar Levels
• Identify Tick Bites
• Why Is Autism Increasing?

Is salmeterol safe to take if I’m pregnant or breastfeeding?

Adequate studies of salmeterol during pregnancy have not been done. In some, but not all, pregnant animal models
exposure to very high doses of oral salmeterol has led to offspring
with birth defects. The concentrations of salmeterol in the blood after these very high doses, however, were much higher than the concentrations observed after inhalation. Salmeterol inhalation should be used during pregnancy only if the potential benefit
justifies the potential risk to the fetus.

In rats, salmeterol is excreted in milk. Therefore, caution should be exercised when salmeterol is administered to
nursing women.

What else should I know about salmeterol?

What preparations of salmeterol are available?

Canisters (13g with 120 inhalations and
6.5g with
60 inhalations).

How should I keep salmeterol stored?

Salmeterol should be stored from 36 F to 86
F (2.2 C to 30 C). The canister should be kept away from heat or flame and not
punctured;
it should not be frozen or placed in direct sunlight .