By Brian Bizik

With COVID-19 taking most of the health headlines, other medical ailments have been pushed to the news cycle background. One of those conditions is asthma. But that cough you hear might not be the latest virus; it might be asthma, a disease that is frequently worse in the fall and winter months.

If you have a child with asthma you know just how scary the disease can be. Even mild asthma can cause wheezing and coughing, making activity or sleeping difficult. As of 2018, 7.7 percent of children in the U.S. had asthma and missed a total of 10.5 million days of school. The cost of asthma treatment and the missed school/work due to asthma is astounding, just under $60 billion dollars a year – over $3,000 for every person in the US. These costs make it the 7th most expensive disease.

When it comes to the treatment of asthma in the U.S., the National Institutes of Health has a division called the National Heart, Blood and Lung Institute that is in charge of providing updates on the medications and plans that are best at controlling this chronic disease. The last published update was in 2007, meaning no real change in treatment has been recommended since the year the very first iPhone was released by Apple. That all changed in late 2019.

Just before the medical world was turned upside-down with a virus migrating its way from Wuhan, China, the U.S. released a proposed update to the management of asthma. The changes recommended would dramatically alter how we manage asthma.

For almost 50 years the basis of asthma management was albuterol. If you have asthma, have a child with asthma, or have ever seen an inhaler, it was likely albuterol. This quick-relief inhaler provides an ultra-quick way to open up tight lungs, dissolve asthma cough and make wheezes a thing of the past. Just a couple puffs and asthma is gone. Right?

Wrong! The latest update made it clear that while albuterol (brand names include Proair, Proventil and Ventolin) is a rapid acting medication and is the clear choice when a swift remedy is needed, it does little to change the course of the asthma state. Specifically, it does nothing to help change the other aspects of asthma – lung swelling (inflammation) and increased mucous production. When the only medication given for asthma is albuterol, the lungs may feel open, but the base asthma problems are not affected.

The new recommendations seek to change this “severe over-reliance on albutero.” The updated guidelines also note that patients who over-use albuterol are more likely to end up in the emergency room and more often get admitted to the hospital.

The parental take home point: if you have a youngster with asthma who uses their rescue albuterol inhaler more than once a week, on average, they need a second inhaler. This new device is one with a medication that can reduce the inflammation and mucous production that accompanies asthma. The second inhaler is a corticosteroid medication. These inhaled anti-inflammatory medications are very safe, with little getting into the bloodstream yet are powerful treatments that get to the heart of asthma and change the disease process. In short, they are not an asthma band-aid.

Dr. Neetu Talreja, a board-certified allergist and pediatric asthma and allergy specialist with The Allergy Group in Boise notes, “We want children who have symptoms more than a few times a month to talk with their provider about the possibility of adding in an inhaled corticosteroid to help control their symptoms, not just treating the airway tightness.”

The additional inhaler does more than treat the immediate symptoms; it goes further to help stop the tissue swelling that often accompanies asthma flares. “The corticosteroid inhalers work much longer than albuterol and help maintain control of asthma,” added Dr. Talreja.

Most children and teens will just keep both inhalers with them at all times, carrying both in their backpack or when at a friend’s house. Like before, they will use their rescue albuterol inhaler when they have symptoms like a cough or wheeze. However, now after their albuterol, they will also take two puffs of the second inhaler. This way they can address all aspects of asthma and make additional problems (asthma flares) less likely to occur. If this as-needed use of both inhalers is not enough to control symptoms, your provider may want to increase use to once or twice daily.

Considering we are on iPhone 11 now, these new guidelines have been anticipated for some time and have started to change how we prescribe inhaler mediations. Thankfully most insurance plans and Medicaid cover these anti-inflammatory inhalers with minimal or no co-pays.

As we head into the latter part of the year when infection rates and asthma flares rise, it is a good time to talk with your health care provider or asthma specialist. Talk about how often inhalers are used and the asthma symptoms you see. Pay close attention to cough, especially at night, and to problems during activity or exercise as these may indicate asthma that is less well controlled than it should be.

A wonderful free resource for asthma information is the Asthma and Allergy Network (AAN) – a group started Nancy Sander. In 1985, Nancy was the mother of a young child with asthma. She was frustrated that she could not find patient friendly material on asthma so she started the AAN. It is now one of the most important sources of easy to understand asthma education and free material. You can see their material at allergyasthmanetwork.org.

Brian Bizik, MS, PA-C, is Asthma Care Coordinator at Terry Reilly Health Services, Boise and Nampa. He is a Boise area physician assistant with almost 20 years’ experience treating pediatric and adult asthma and may be reached at brianbizik@yahoo.com.

References

1 United States Environmental Protection Agency. Asthma Facts. March 2013: http://www.epa.gov/asthma/pdfs/asthma_fact_sheet_en.pdf

2 Asthma Surveillance Data: https://www.cdc.gov/asthma/asthmadata.htm

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