Asthma in Women, Asthma in Pregnancy (cont.)

In summary, then, these anti-leukotrienes are a good choice for people with aspirin-induced asthma, and they can improve lung function in those with chronic asthma by decreasing: need for rescue medications, asthma symptoms, frequency of attacks needing oral steroid pills, and dose of inhaled steroids needed for long-term control. They are also useful for exercise-induced asthma.

In very severe asthma, daily oral corticosteroids (or steroids) may be necessary. These have many potential side effects, so that physicians generally explore every single other reasonable alternative before starting oral corticosteroids. They also try to use other medications to reduce the necessary dose of these steroid pills. These oral steroids are not the same medications used (abused) by body builders. They can be life-saving drugs for people with severe asthma, and they are used in the lowest dose possible in order to reduce possible side effects. When people are admitted to the hospital having an acute asthma attack that cannot be terminated with inhaled medications, they are often given corticosteroids in intravenous form (into the veins in their arms) for a short time to bring the attack under control, after which the medication is converted back to oral and inhaled forms. The most frequent use for oral steroids is a short course (5-10 days). This is the most effective way to control acute asthma attacks or poorly controlled chronic asthma which are not responding to inhaled medications.

The Office of Women's Health of the Federal Drug Administration has a section called Women's Health: Take Time to Care (7), the aim of which is to make women aware of safe medication use. Women are the principal users of medications and who often have to administer medication to family members.

D. Use of Medications: Optimizing Their Effects and Safety

Frequent review of the technique of using inhaled medications is very helpful. First, the cap should be removed. The inhaler should be shaken before use. Inhalation of the medication should be done with the head tilted back, with the mouth about 1 inch away from the inhaler. Before inhaling the medication, patients should exhale (breathe out) completely. The medication is inhaled slowly, over 3 to 5 seconds. Then breath should be held for 10 seconds so the medication will get to and stay in the lungs. When prescribed two puffs at one time, a few seconds should go by between puffs. People having difficulty using the inhaler with a spacer (see below) should discuss the problem with their physician. The inhaler and its cap should be cleaned in warm water each day. The mouthpiece should also be washed occasionally with mild dishwashing detergent and water. After being washed each time, the parts should be allowed to dry before storage.

Spacers are devices used to increase the amount of medicine actually reaching the lungs. They also help to avoid the thrush (see above) that can happen as a side effect of the inhaled corticosteroids. Rinsing out the mouth after each use of inhaled corticosteroids will also help minimize thrush. The spacer can minimize the amount of medication that just stays on the tongue, so that the medicine will go where it belongs, in the lungs. The spacer holds the medicine so it can be inhaled slowly, and helps to minimize cough that results occasionally from using an MDI.

If a woman uses her quick-relief (rescue) medication more than 3 times weekly, chances are she should be on a daily long-term therapy medication to decrease inflammation over the long-term. Using inhaled steroids early in asthma's course may not only control asthma better but also make lung function normal.

People who use both inhaled steroids and rescue inhaled bronchodilators should first use the bronchodilator to open the airways, to better allow the corticosteroid that they use next to reach the lungs.

All women with asthma need to have education regarding what to expect from their asthma as well as what to expect from their asthma medications. Education is critical, and every woman's plan is individualized so that a woman should be able to do her usual activities. Women should expect or request a written plan from a treating physician which includes expected length of treatment with each medication, when to expect each medication's effect to be felt, and what to do if a dose is missed.

To see how much medication is left in an MDI canister can be difficult. However, putting it in a sink full of water can give an idea of how empty the canister is. A canister floated in this way will float completely to the top when it is empty and sink all the way to the bottom when full. It will be floating vertically when half full, and sink vertically when mostly full.

The older form of the inhaled asthma medications is slowly being phased out. This is because the older MDI's have chlorofluorocarbons (CFC's). These CFC's decrease the amount of ozone in the ozone layer around the earth and are therefore thought to have a harmful effect on the environment. Therefore, the medications are gradually being put into forms that do not contain CFC's. Some of these forms are already available. New formulas, such as dry powder inhalers, are being substituted for the older CFC MDI medications, with the goal of one day having only non-CFC-containing inhalers.

Further information on how to use inhalers probably and regarding monitoring and treatment of asthma are available from the NHLBI (2).

E. Treatment & Monitoring Based on the Type of Asthma

Doctors usually give out a written set of instructions that describes the individual treatment plan. The partner in the treatment plan, the woman with asthma is expected to keep an accurate diary of her symptoms. She needs to go the doctor at least a few times a year, even if she feels okay and thinks her asthma is doing fine.

Also, if she has moderate or severe persistent asthma, or if she ever develops severe asthma attacks regardless of the type of asthma she has, she should monitor her peak expiratory flow, sometimes called simply peak flow. The highest of 3 trials using a peak flow meter is the person's peak flow. Peak flow monitoring helps both the woman and the physician know how her asthma is really doing, and may help the woman be more aware of how her symptoms relate to her lung function at any given time. The NIH has information on performing peak flow monitoring. (2)