Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: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.
PRESCRIPTION: yes
GENERIC AVAILABLE: no
PREPARATIONS: Canisters (13g with 120 inhalations and
6.5g with
60 inhalations).
STORAGE: Salmeterol should be stored between 36 and 86
F (2.2 to 30C). The canister should be kept away from heat or flame and not
punctured;
it should not be frozen or placed in direct sunlight .
PRESCRIBED FOR: Salmeterol is used twice daily (morning
and evening) for the maintenance treatment of asthma and in preventing spasm of
the airways (bronchospasm) in patients 12 years and older. Salmeterol is also
used for the prevention of exercise induced asthma. Salmeterol is a long-acting
beta-2 agonist, its action starts within 15 minutes and can last more than 12
hours. Therefore, salmeterol is useful in patients that require frequent
administration of short acting beta-2 agonists, such as
albuterol, for control
of their asthma symptoms. Salmeterol is generally not used in patients whose
asthma symptoms can be easily controlled with infrequent administration of short
acting inhalers. Some patients with chronic bronchitis and emphysema may also benefit from
salmeterol when
their symptoms are related to reversible airway narrowing.
DOSING: 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.
DRUG INTERACTIONS: 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.
COPD (chronic obstructive pulmonary disease) is a disorder that persistently obstructs bronchial airflow. COPD mainly involves three related conditions, chronic bronchitis, chronic asthma, and emphysema. Symptoms of COPD include chronic cough, shortness of breath, frequent respiratory infections, wheezing, morning headaches, and pulmonary hypertension. Treatment of COPD is focused on the related condition(s).
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.
Emphysema is a progressive disease of the lungs. The primary cause of emphysema is smoking. Alpha 1-antitrypsin deficiency is a rare disorder that has a genetic predisposition to emphysema. Aging, IV drug use, immune deficiencies, and connect tissue illnesses are also risk factors for emphysema. Emphysema is a subtype of COPD (chronic obstructive pulmonary disease, COLD). Symptoms include shortness of breath and wheezing. Management of symptoms may be achieved with medications, quitting smoking, pulmonary rehabilitation, or surgery.
Chronic bronchitis is a cough that occurs daily with production of sputum that lasts for at least three months, two years in a row. Causes of chronic bronchitis include cigarette smoking, inhaled irritants, and underlying disease processes (such as asthma, or congestive heart failure). Symptoms include cough, shortness of breath, and wheezing. Treatments include bronchodilators and steroids. Complications of chronic bronchitis include COPD and emphysema.
Exercise-induced asthma is asthma triggered by vigorous exercise. Symptoms include coughing, shortness of breath, chest tightness, wheezing, and fatigue while exercising. Preventing exercise-induced asthma attacks involves using inhaled medicines before exercising, performing warm-up exercises and cooling down afterward, avoiding exercising outdoors when pollen counts are high, restricting exercise when you have a viral infection, and wearing a mask over your nose and mouth when exercising in cold weather.
Before we present the typical symptoms of asthma, we should dispel some
common myths about this condition. This is best achieved by conducting a short
true or false quiz.
T or F - Asthma is "all in the mind."
T or F - You will "grow out of it."
T or F - Asthma can be cured, so it is not serious and nobody dies from it.
T or F - You are likely to develop asthma if someone in your family has it.
T or F - You can "catch" asthma from someone else who has it.
T or F - Moving to a different location, such as the desert, can cure
asthma.
T or F - People with asthma should not exercise.
T or F - Asthma is best controlled when one has an asthma management plan designed by your doctor. This should include the medications used for quick relief as well as maintenance therapy.
T or F - Medications used to treat asthma are habit...
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