Asthma: Over-the-Counter Treatment
George Schiffman, MD, FCCP
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
- What is asthma?
- What medications are used to treat asthma?
- How do over-the-counter (OTC) medicines for asthma work?
- What factors should be considered in choosing and using OTC epinephrine or ephedrine?
- What side effects and drug interactions are there with OTC asthma medicines?
- What are additional measures in the management of asthma?
- Find a local Asthma & Allergy Specialist in your town
Asthma is a disease in which there is a brief, temporary narrowing of the airways in the lungs, referred to as bronchospasm. This narrowing prevents air from moving in and out of the lungs easily. As a result, an asthmatic patient has episodes when breathing is difficult. An asthmatic episode can resolve spontaneously or may require treatment.
Asthmatic patients and their physicians may select from a wide variety of prescription medications. This is not true for over-the-counter (OTC) medicines, which are limited to epinephrine (adrenaline) and ephedrine. In addition, many asthmatic patients should not use epinephrine or ephedrine because of their relatively weak effectiveness or side effects.
To decide whether or not an OTC epinephrine or ephedrine product may be useful, viewers should understand
- the abnormal conditions that exist in the airways of asthmatics,
- the effects of epinephrine and ephedrine,
- the specific factors that should be considered when choosing and using epinephrine and ephedrine, and
- the side effects of these drugs.
The advantages of using OTC medications for asthma include their affordability and accessibility (lack of need for a prescription and/or health-insurance approval). Unfortunately, these medications are less effective at controlling asthma and sometimes can be more dangerous.
What is asthma?
The cause of asthma is unknown. More is known about the abnormal conditions that occur in asthma. These conditions include:
- hyper-responsiveness(contraction) of the muscles of the breathing airways in response to many stimuli such as exercise or allergies (for example, drugs, food additives, dust mites, animal fur, and mold),
- inflammation of the airways,
- shedding of the tissue lining the airways,
- increased secretion of mucus in the airways, and
- swelling of the walls of the airways with fluid.
All of these conditions narrow the airways and make breathing difficult. Symptoms of asthma include wheezing (the hallmark of asthma), coughing, difficulty breathing, and tightness of the chest. Asthma is diagnosed by the presence of wheezing, but it can be confirmed by breathing tests (spirometry) that evaluate the movement of air into and out of the lungs.
What medications are used to treat asthma?
Epinephrine and ephedrine once were the only effective medications for treating asthma. Beginning in the 1980s, newer medications were introduced that target more of the abnormal conditions in asthma and do so more effectively than epinephrine or ephedrine. For example, prescription-inhaler forms of beta2-agonists (albuterol and metaproterenol [Proventil and Alupent]), corticosteroids (beclomethasone and flunisolide [Beclovent and Aerobid]), anticholinergics (ipratropium bromide [Atrovent]), and other medicines are now widely used because of their greater effectiveness and fewer side effects. The use of inhaled antiinflammatory medications that include steroid agents such as fluticasone, budesonide, beclomethasone, and flunisolide have become the mainstay of initial asthma therapy. Unfortunately, none of these medications are available without a prescription.
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