Byron stopped, too. “Bad asthma attack?”
Chad wheezed and nodded, then pointed down the hall.
“We won’t be late. Got your inhaler yet?”
Chad pulled out a small plastic tube, shook it, and inhaled from it. He inhaled again and took several gulps of air. “I can breathe again. Let’s get going,” Chad said.
But before long, Chad was wheezing and coughing badly.
When the two friends reached the nurse’s office, Ms. Jassen hurried to Chad’s side. “What’s wrong?” she asked. Ms. Jassen discovered that Chad had only been using his inhaler the last couple of days to treat his symptoms, instead of also using an anti-inflammatory medication. Most asthma requires two types of medication: one to open the airway for quick relief and one to reduce inflammation.
Why the Wheezing?
Experts are finding that a lot of teens have problems using their asthma medications properly. Some don’t know how to use their inhalers correctly.
Medication is an important part of dealing with asthma, a chronic lung disease. Ten million people in the United States have asthma, and one-third–more than 3.7 million–are under age 18. So, in a classroom of 30 kids, two are likely to have some form of asthma.
Chad’s asthma symptoms are typical: wheezing, gasping for air, coughing, and chest pains. That’s because when a person has an asthma attack, it causes the small air tubes, called bronchioles, to become narrow or blocked when they react to something in the environment. Bronchioles branch off of the two large air tubes (bronchi) which go to the lungs.
During an asthma attack, the smooth muscles around the bronchi and bronchioles tighten. The airway linings thicken, which further restricts the airways. Finally, the cells in the airways secrete more mucus that forms a thick, heavy, sticky coating. The narrowed airways and extra mucus make it harder for air to flow in and out of the lungs, so breathing is difficult.
Most teens with mild asthma take their medicines as they need them. However, teens with moderate or severe asthma need to take their medicines on a regular basis, even when they feel fine. Because asthma medications are strong and can cause serious side effects, teens need to carefully follow the dosage instructions–when, how much, and how often.
Doctors generally prescribe two major kinds of asthma medications for teens:
* Preventive medicines–These anti-inflammatory medications keep asthma attacks from starting.
Cromolyn, which is inhaled, blocks the swelling in the airways, keeps the surrounding muscles from tightening, and makes the airways less sensitive to asthma triggers. Some people take cromolyn every day to prevent asthma attacks. Others use it when needed, to head off attacks that occur after exposure to asthma triggers, such as exercise. Under those circumstances, cromolyn should be taken five minutes to one hour prior to exercise. A dosage lasts three to four hours. Cromolyn has few side effects, says Dr. Tunde Otulana of the U.S. Food and Drug Administration.
Inhaled corticosteroids, sometimes called steroids, are targeted directly at the lungs, so other parts of the body absorb just a little. Doctors usually prescribe these drugs for people with moderate to severe chronic asthma. The dosage for inhaled corticosteroids varies, as does how often the dosage is taken. Long-term use of very high doses increases the risk of developing high blood pressure, diabetes, and softening of the bones.
Oral corticosteriods, usually in tablet form, include prednisone, hydrocortisone, and others; they are taken for three to seven days to control severe asthma attacks. Oral corticosteroids reduqe the swelling in the airways, relax the surrounding muscles, and decrease the amount of mucus. These powerful drugs can cause many severe long-term side effects, especially in children and teens.
* Bronchodilators–These medications, which are often inhaled, open the airways by relaxing the tightened smooth muscles. Bronchodilators work quickly, giving relief within a few minutes. Possible side effects include feeling shaky or jittery, or a rapid heartbeat. Theophyllines are used for long-term control, along with an anti-inflammatory medication. It’s important for teens to tell their doctor if they are taking other medicines such as erythromycin or tetracycline (both are antibiotics), Retin-A, or birth control pills, because these medicines can increase theophylline levels in the body and cause serious problems. Theophylline’s side effects include upset stomach and headaches.
Teens usually take one or more medications to manage their asthma. They might think that because they feel better, it’s OK to skip or stop taking asthma medications. Don’t! Taking medication to control mild asthma attacks may prevent a more serious one. More is not better, however, because increasing medication, without a doctor’s knowledge, could be dangerous and lead to serious health problems.
People with asthma should let their doctor know of any other drugs they use, whether they’re prescription or over-the-counter (OTC). Drug interactions can add up to trouble. For example, tranquilizers can mask or hide important signs of breathing problems. Diuretics increase the discharge of urine. They also cause mucus to dry out, which is the opposite of what people with asthma want.
Potentially damaging combinations are asthma medicines taken with diet pills or with OTC drugs that keep people awake. Both types of drugs tend to speed up the heart rate. Alcohol and many asthma medicines spell trouble, too. Asthma medications make the person less tolerant of alcohol. This means the effects of alcohol will be felt faster.
Illegal drugs tend to make asthma worse, and they can also interact with asthma medication. “Downers” or depressants slow down breathing, which could be dangerous for people with asthma. “Uppers” or stimulants increase the heart rate, and so do many asthma medications.
The safest route for a person with asthma is to follow the doctor’s orders. Ask your doctor if you aren’t sure about the dosage or when to take your medication. Also, tell your doctor of any side effects or problems you’re having with your medications.
Using an Inhaler
Pocket-sized inhalers come in many shapes, usually square or round. A canister fits into the top of the inhaler. Canisters, which range in size from 1.5 inches to 3 inches, contain liquid asthma medicine. When you press the inhaler, it delivers a dose of the medicine as an aerosol, which you inhale directly into your lungs.
Since each inhaler differs, follow your doctor’s instructions exactly so that you use yours correctly. Here are the basic steps to use a metered dose inhaler.
1 Shake the inhaler and remove the cap.
2 Hold the inhaler upright or at a slight angle near your mouth, so that the mouthpiece is level with your mouth.
3 If you’re using a spacer, place it between the mouthpiece and your mouth.
4 Breathe out.
5 While pressing down on the canister, inhale slowly and deeply through your open mouth. You’ll inhale the aerosol containing the medication.
6 Close your mouth and hold your breath for 5 to 10 seconds. If your doctor prescribes more puffs, wait 1 minute and repeat steps 1 to 6.
7 If you are inhaling corticosteroids, rinse your mouth with water after each dosage.