Asthma Management There are two main ways to pharmacologically manage this chronic inflammatory disease of the airways Medication Overview Rescue Meds Bronchoconstriction and acute airflow obstruction are typically treated with “rescue medication,” which primarily includes short-acting beta2-agonists, but also includes anticholinergics and systemic corticosteroids Rescue medications are an important part of appropriate asthma management, and everyone with asthma should have rescue medication on hand. Controller Meds People with persistent asthma, should be on controller medication, which is taken on a daily, long-term basis. They are primarily corticosteroids, but also include cromolyn, nedocromil, leukotriene modifiers, and long-acting Beta2-agonists.
Vertical Growth – The NEAPP Recommendations: Despite the reassuring findings from studies examining long-term effects of inhaled corticosteroids, it may still be prudent that providers: Weigh the benefits of asthma control against the possibility of growth suppression or delay. Keep in mind that growth rates in children are highly variable. Understand that children with asthma tend to have longer periods of reduced growth rates prior to puberty (males &gt; females). Monitor the growth of children and adolescents taking corticosteroids. Use the lowest dose of corticosteroids necessary to maintain control. Administer medications with age-appropriate devices, such as spacers/holding chambers. Advise patients to rinse and spit following inhalation.
Spacers come in many shapes and sizes. The only bad spacer is the one that isn’t used. All people with asthma, adults and children, should be using spacers.
Steroid Phobia Background Many patients and parents of children with asthma have heard about potential growth-stunting effects or other adverse events associated with corticosteroids and are therefore reluctant to agree to treatment with corticosteroids. In a recent Canadian survey of 603 patients with asthma, more than 50% of the patients reported they were ‘very’ or ‘somewhat’ concerned about using inhaled corticosteroids on a regular basis. Despite their concerns, two-thirds of these patients had never discussed their apprehensions with their physician. The most common concerns are those of vertical growth, bone mineral density, cataracts and glaucoma, skin problems, and glucose metabolism