Asthma inhalers can be too much of a good thing

ON CALL

March 22, 1994|By Dr. Simeon Margolis | Dr. Simeon Margolis,Special to The Sun

Q: I have had asthma for many years and have gotten considerable relief with an inhalant containing a bronchodilator. Recently, I have read that bronchodilator inhalers may be dangerous. Is that true?

A: Asthma symptoms are caused by exaggerated narrowing of the small airways (bronchioles) in the lungs after exposure to a variety of irritating stimuli such as dust, cigarette smoke and cold air. Sometimes asthma symptoms are a response to exercise. Periods free from symptoms are interrupted by acute attacks when constriction of the bronchioles obstructs air flow to the lungs and results in wheezing, shortness of breath and cough.

Once an attack begins, the symptoms often are relieved by using an inhaler that delivers a medication dispersed in fine droplets (aerosol) to the lungs.

Because the beta-agonist medications are extremely effective in relieving symptoms, people with asthma are tempted to use excessive amounts of these inhalers. Several studies reported over the past several years have found that excessive use of beta-agonists is associated with an increased risk of fatal and near-fatal asthma.

These findings do not mean that such inhalers cannot or should not be used. Rather, they should be used with carefully controlled frequency, and it is especially important to seek medical attention promptly when the symptoms are not relieved by the beta-agonist.

A component feature of asthma is inflammation of the bronchioles, which leads to their overreactivity. For many years, this component of asthma has been treated with the oral intake of corticosteroids, but chronic use of such medications can lead to many dangerous side effects and complications. It is now recognized that inhalers containing corticosteroids are quite effective in controlling bronchiolar inflammation.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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