Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
How do over-the-counter (OTC) medicines for asthma work?
Epinephrine acts by relaxing the muscles of the airways, thereby opening up
the airways and allowing air to flow in and out of the lungs more easily.
Ephedrine also relaxes the muscles of the airways.
What factors should be considered in choosing and using OTC epinephrine or ephedrine?
Despite the development of newer medications, epinephrine and ephedrine
remain available as OTC medications. The choice of epinephrine or ephedrine
should involve consideration of several factors. Most importantly, the asthma
should be mild and less frequent, defined as occurring less than once per week
and lasting from a few hours to a few days at most. OTC epinephrine or
ephedrine is best used under the guidance of a physician. A patient should seek
medical attention and prepare to switch to a prescription asthma medication if
(1) moderate to severe asthma develops, (2) frequent or regular doses of
epinephrine or ephedrine are needed to relieve symptoms, (3) episodes of asthma
occur once or more per week, or (4) asthmatic episodes develop at
night.
OTC epinephrine is available in various concentrations for oral inhalation
or as a solution in vaporized form (nebulization). Both forms may or may not
contain alcohol or sulfite as preservatives. For example, AsthmaHaler Mist does
not contain alcohol. Alcohol and sulfite preservatives may trigger an attack of
asthma, and therefore, patients whose asthma is sensitive to these
preservatives should read product labels carefully. The nebulized epinephrine
solutions may or may not require diluting with a separate saline (salt)
solution before use. Several saline solutions are available OTC in various
concentrations. Again, careful reading of the label will provide information
about combining an epinephrine solution for nebulization with a specific saline
solution. Oral epinephrine is unavailable because it is rapidly broken down in
the digestive system before it can reach the lungs. Once inhaled, epinephrine
should provide rapid relief of symptoms (within five to 10 minutes) and continue
working for one to three hours. Good inhaler and nebulizing techniques are critical in
the use of epinephrine. If epinephrine is used frequently, tolerance to its
effects occurs; that is, repeated inhalations provide progressively less and
less benefit. Some of these inhalers use a chlorofluorcarbon (CFC) propellant. These gases have been shown to damage the ozone layer. The FDA is likely to expand the ban on CFC propellants making these agents unavailable in the near future.
OTC ephedrine is available only as an oral medication in combination with
guaifenesin as caplets, tablets, or syrup. (Guaifenesin is an expectorant that
loosens mucus in the airways and facilitates its removal by coughing.) Caution
should be used when first starting these products since they occasionally
irritate the airways of some patients and may make the asthma worse. OTC
ephedrine should provide relief of symptoms within 15-60 minutes and may
continue to be effective for three to five hours. Continued use of ephedrine, like
frequent use of epinephrine, leads to tolerance.
Neither epinephrine or ephedrine should be continued if thick mucus or
sputum (colored mucus) develops and/or a persistent or chronic cough occurs
with the asthma. These may be signs of infection in the lungs and require
immediate medical attention. If OTC asthma drugs do not relieve an episode of
asthma within 10 (for epinephrine) or 60 minutes (for ephedrine) or the
symptoms worsen, medical attention should be sought immediately.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Asthma, the main cause of chronic illness in children, has signs and symptoms in children that include frequent coughing spells, low energy while playing, complaints of chest "hurting," wheezing while breathing, shortness of breath, and feelings of tiredness. Treatment will involve a doctor creating an asthma action plan which will describe the use of asthma medications and when to seek emergency care for the child.
There are many unusual symptoms of asthma, including sighing, difficulty sleeping, anxiety, chronic cough, recurrent walking pneumonia, and rapid breathing. These symptoms may vary from individual to individual. These asthma complexities make it difficult to accurately diagnose and treat asthma.
There are two types of asthma medications: long-term control with anti-inflammatory drugs and quick relief from bronchodilators. Asthma medicines may be inhaled using a metered dose inhaler or nebulizer or they may be taken orally. People with high blood pressure, diabetes, thyroid disease, or heart disease shouldn't take OTC drugs like Primatene Mist and Bronkaid.
Biologic rhythms, or biorhythms, are how our bodies respond to the regular phases of the sun, moon, and seasons. A medical chronobiologist studies how the "body clock" or biorhythms affect diseases and how the body clock responds to treatment of diseases and conditions at different times of the day.
Asthma RSS
Healthy Living Tips
This site complies with the