Drug Interactions

Asthma is often treated with a combination of medications. Before taking any new medication (prescription, over the counter or herbal) always check with your pharmacist or other health care provider to make sure the medication does not interact with the drugs you are presently taking and that it will not cause your asthma to become worse. Keep an updated list of the medicines you are taking readily available at all times.

Drug interactions may come in the form of drug-drug interactions or drug-disease state interactions.

Drug-drug interactions may result in:

• more side effects
• the blood level of one or both drugs increasing to toxic levels
• the blood level of one or both drugs decreasing and becoming less effective

Drug-disease state interactions may result in an increase in symptoms from a particular disease. Medications that may increase asthma symptoms include:

• aspirin, ibuprofen
• beta-blockers
• antibiotics-i.e. penicillin, sulfa
• allopurinol
• anaesthetics

Tips for preventing asthma symptoms

• Avoid asthma triggers when possible.
• Use only unscented personal and household products
• Do not use humidifiers if you are allergic to mold or dust mites
• Choose hardwood, laminate, ceramic or tile floors rather than carpets or rugs.
• Do not smoke and stay away from smoking areas
• Acid Reflux disease can trigger asthma. Avoid triggers for acid reflux disease including:
  • overeating
  • high fat, spicy or acidic foods
  • eating 2-3 hours before lying down
  • being overweight
  • wearing clothing that is tight around the waist

Asthma in special populations

Childhood asthma

An estimated 9 million American children have been diagnosed with asthma and the number of children affected continues to rise. Childhood asthma has risen by 75% over the past 15 years. Health care costs for asthma in children is approximately $10 billion dollars per year, with 50% of that cost for prescriptions.¹

Children may respond to medications differently than adults and some measurements of lung function are more difficult to monitor in younger children, hence treatment guidelines are divided into three age groups: 0-4 years, 5-11 years and 12 years and older.

Some differences between the three groups can be seen in the chart outlining Assessing Asthma Control. Differences include:

• In children ages 0-4 peak flow, FEV1, FEV6 or FVC measurements are not used to evaluate severity of asthma or asthma control. These measurements are used in the 5-11 and 12 and older age groups.
• Goals for fewer nighttime awakenings are set for younger children
• Exacerbation frequency for monitoring control vary between the age groups
• Questionnaires are accepted as valid monitoring tools for those ? 12 years of age but not for younger children.

Asthma in Pregnancy

The fetus requires a healthy blood oxygen level for optimum growth and development. It is safer for pregnant women with asthma to be treated with asthma medications than it is for them to have asthma symptoms and exacerbations. Inadequate control of asthma poses a greater risk to the developing fetus than asthma medications do. Proper control of asthma should enable a woman to maintain a normal pregnancy with little or no risk to her or her baby.

Tips for asthma in pregnancy

• Avoid asthma triggers when possible.
• Pay close attention to the unborn baby's activity level.
• Regular ultrasounds may be ordered in women whose asthma is poorly controlled and after exacerbation of symptoms.
• Use a peak flow meter regularly to track lung function. Spirometry tests are recommended at the time of initial assessment and are useful on follow up visits if they are available.
• Continue using your rescue asthma medications and long term control medications during pregnancy, labor and delivery.

Asthma in seniors

Asthma is frequently thought of as a childhood disease but occurs in approximately 6% of seniors. Many seniors who experience asthma experienced the condition during their childhood years. Extra cautions required when treating asthma in seniors include:

• watching for drug-drug interactions and drug-disease state interactions since seniors often have more than one medical condition
• ruling out other diseases with symptoms similar to asthma
• making sure they are able to use their inhalers properly. Seniors should use spacers with or without masks, depending on the level of difficulty they experience using an inhaler.

Conclusion

Asthma cannot be cured; however through education, healthy life style choices and medication it can be controlled. Treatment is approached in a step-wise manner with medications added or subtracted and dosages altered depending on the level of control. Patients should be encouraged to strive for maximum control to ensure minimal irreversible damage to the airways.