Asthma Inhalers - Ventolin Inhaler Treatment of Bronchial Asthma
Disodium cromoglycate is effective in asthma and has been used clinically for the last 20 years in Japan. Children tend to respond better than adults and some Japanese pediatricians feel disodium cromoglycate is the first choice drug in childrens asthma. Perennial asthmatics without definable allergens may also respond. Exercise-induced asthma can often be prevented by therapy with disodium cromoglycate. Oral preparations of disodium eromoglycate-like drugs such as ketotifen (a Swiss product) and tranilast (from Japan) lead to a reduction in both the frequency and the intensity of asthma attacks. More money is spent on anti-allergic drugs than on any other preparation to treat asthma in Japan (Fig 2). Many similar drugs are coming into clinical use in Japan, including inhibitors of the lipoxygenase pathway and leukotriene antagonists.
In asthma, there is increased production of highly viscid mucus. If mucus flow and removal by ciliary action is impaired, additional airway obstruction may occur, and bronchial infection often is superimposed. Therefore, it is imperative to institute measures to keep the mucus liquefied and thin. Increased fluid intake and use of expectorants and mucolytic agents are used in conjunction with other antiasthmatic treatment. It is unwise to suppress the cough in asthmatic patients unless it is irritative, fatiguing, and nonproductive. In patients with yellow or green sputum and an exacerbation of asthma, a broad spectrum antibiotic such as tetracycline, ampicillin or oleoan-domycin may be of considerable value.
Tranquilizers and sedatives have in the past enjoyed some popularity in the treatment of asthma because the dyspneic patient is anxious. However, verbal reassurance and relief of bronchospasm using bron-chodilators is the treatment of choice for anxiety. The main preparation for asthma is asthma medications – ventolin which may become the integral part in asthma treatment.
Atropine is not approved for use in asthma because of drying effects on mucous membranes. However, anti-cholinergic aerosols such as ipratropium bromide (SCH 1000) block vagal irritant receptors in airways and have been used to some extent in Japan, since these new drugs have much less drying effect. Calcium transport antagonists such as nifedipine have some clinical value in the elderly asthmatic with hypertension or angina pectoris.
Histaglobin, the conjugate of 7-globulin and histamine, has been used in the treatment of asthma to some extent in Japan. After 10 to 15 weekly injections of 1 to 3 ampules of histaglobin, monthly injection is recommended as maintenance therapy for an extended period.
Immunotherapy has been used fairly widely in the last 30 years. In spite of good environmental control and use of proper medications, asthma sometimes cannot be well controlled. For such cases, immunotherapy is considered. Because of other effective drugs and methods, however, the number of cases under immunotherapy has decreased. Moreover, immunotherapy with molds, especially Candida albicans, occasionally causes a severe systemic reaction following an injection. In addition, the possibility of immune-complex diseases was raised with immunotherapy. Therefore, the use of molds has been largely deleted from therapy. Consequently, immunotherapy has been confined to house dust and pollens in many institutes in Japan. There is a trend, however, to use purified allergens in immunotherapy. This may change the current use of immunotherapy. Denatured allergen, polymerized allergen and conjugated allergen to innate materials have been tested in animal experiments with encouraging results. Oral hyposensitization is also under investigation. More studies are needed before clinical use can be recommended.
Gold has been used as a medicine off and on for the last several hundred years. Indications for gold therapy included chronic infection, rheumatoid arthritis and other chronic diseases. Because of its side effects, however, it has not been used widely except for rheumatoid arthritis. In the last 50 years, gold has been adopted in the ventolin inhalers treatment of intractable asthma in Japan, with beneficial effects. Gold has not been used to relieve acute symptoms of asthma, but rather for a slow amelioration of symptoms and to decrease the need for other medications, especially steroids. Gold therapy can cause some asthmatic patients to go into remission for months and even years. The typical regimen for asthma is a weekly intramuscular injection of 10 mg for ten weeks, followed by 25 mg per week for ten weeks, if no adverse reactions are noted. If needed, the dose is increased to 50 mg. In the past, doses of 100 mg or even 150 mg were used; however, recently 25 mg or 50 mg was considered the maximum dose. After 25 mg or 50 mg for ten injections, the same dose was given every two weeks for ten weeks or more, and then every four weeks for months or years. According to the clinical response, the dose is reduced to 25 mg, then 10 mg. Injection of 10 mg monthly will then be given for prolonged periods. As a result of such therapy, improvement in asthmatic symptoms will be seen after about 30 injections. A considerable anti-asthmatic effect was usually achieved when a total of1,000 mg had been administered after years of therapy. The effectiveness of gold was proved by a double-blind study. Because of side effects such as skin eruption, proteinuria, bone marrow suppression, and liver dysfunction, gold is only used in severe and intractable cases. Recently, oral gold (auranofin) has been used in the treatment of rheumatoid arthritis. The clinical effectiveness of auranofin in asthma is currently under investigation in Japan.
Nonspecific measures such as protection from mete-orologic factors, control of the internal environment in the home, and discouraging smoking, are important in the treatment of asthma. In the last 20 years, asthma has become much easier to treat as a result of the development of more effective drugs and forms of therapy.