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: Triamcinolone is a synthetic (man-made) steroid of
the glucocorticoid family used for treating
asthma. It is similar to
beclomethasone (Vanceril, QVAR) and
fluticasone (Flovent). The
naturally-occurring glucocorticoid hormone is cortisol or hydrocortisone
produced in the adrenal glands. Glucocorticoids have potent anti-inflammatory
actions. Some symptoms of asthma are caused by chronic inflammation in the
airways within the lungs that obstruct the flow of air into and out of the
lungs. Triamcinolone reduces inflammation in the lungs and airways and thereby
improves breathing in individuals with asthma. When used as an inhaler,
triamcinolone goes directly to the airways of the lungs, and very little is
absorbed into the body. The FDA approved the triamcinolone inhaler in April 1982.
STORAGE: Triamcinolone inhaler should be kept at room temperature, 20-25 C
(68-77 F) and protected from direct light. Exposure to temperatures above 38.8 C
(120 F)
may cause bursting of the canister. The canister should never be thrown into a
fire or incinerator.
PRESCRIBED FOR: The triamcinolone inhaler is used for preventing episodes of
asthma. It should not be used for acute attacks of asthma because it does not
work quickly enough. A triamcinolone inhaler may reduce or eliminate the need
for oral glucocorticoids to control asthma.
DOSING: The usual recommended dosage for adults is two inhalations (150 mcg)
given 3-4 times daily or 4 inhalations (300 mcg) given twice daily. The maximum
daily dose is 16 inhalations (1200 mcg) in adults. Higher initial doses (12 to
16 inhalations per day) may be considered in patients with more severe asthma.
The usual recommended dosage for children (6-12 years old) is 1 or 2
inhalations.
(75 to 150 mcg) given 3-4 times daily or 2-4 inhalations (150 to 300 mcg)
twice daily. The maximum daily dose is 12 inhalations (900 mcg).
DRUG INTERACTIONS: No drug interactions have been described with inhaled
triamcinolone.
PREGNANCY: There are no adequate studies of the triamcinolone inhaler in
pregnant women.
NURSING MOTHERS: It is not known if triamcinolone is secreted in
breast milk.
Other medications in its family are secreted into breast milk, but it is not
known whether the small amounts that may appear in milk affect the infant.
SIDE EFFECTS: Common side effects include headache,
pharyngitis (inflammation
of the throat), vomiting, dry mouth, and
cough. Mild cough or wheezing due to
chemical irritation may be minimized by using an inhaled bronchodilator, for
example, albuterol (Ventolin), prior to using the triamcinolone. Oral
candidiasis or thrush (a fungal infection) may occur in 1 in 20 to 1 in 10
persons who use triamcinolone, the risk being higher with higher doses. The risk
of thrush in children is lower than in adults. Hoarseness also may result from
the use of triamcinolone inhaler. Using a spacer (a device that is attached to
the inhaler) and washing the mouth out with water following each use reduces the
risk of thrush and hoarseness.
High doses of inhaled glucocorticoids may decrease the formation of bone and
increase the breakdown (resorption) of bone leading to weak bones and
fractures.
Very high doses may cause suppression of the body's ability to make its own
natural glucocorticoid in the adrenal glands. It is possible that patients with
suppression of their adrenal glands may need increased amounts of
glucocorticoids by the oral or intravenous route during periods of high physical stress such as illnesses when increased amounts of glucocorticoids are needed by
the body.
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.
Patients who have infrequent, mild bouts of asthma attacks may use over-the-counter (OTC) medications to treat their asthma symptoms. OTC asthma medicines are limited to epinephrine and ephedrine. These OTC drugs are best used with the guidance of a physician, as there may be side effects and the drugs may not be very effective.
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.
The cause of asthma is unknown. More is known about the abnormal conditions
that occur in asthma. These conditions include (1) hyper-responsiveness
(contraction) of the muscles of the breathing airways in response to many
stimuli such as exercise or allergies (for example, drugs, food additives, dust mites,
animal fur, and mold), (2) inflammation of the airways, (3) shedding of the
tissue lining the airways, (4) increased secretion of mucus in the airways, and
(5) swelling of the walls of the airways with fluid. All of these conditions
narrow the airways and make breathing difficult. Symptoms of asthma include
wheezing (the hallmark of asthma), coughing, difficulty breathing, and
tightness of the chest. Asthma is diagnosed by the presence of wheezing, but
it can be confirmed by breathing tests (spirometry) that evaluate the movement of air into
and out of the lungs.
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