(This post is Part 2 in a series on Asthma for Writers.)
In Part 1 we covered [the fundamentals of asthma] — what it is, and why it’s so devastating for so many people.
Today we’re going to go through some of the more common, run-of-the-mill or home treatments for asthma. (Next time we’ll go into the prehospital, emergency department, and ICU care of severe asthma attacks!)
There are four main fronts of battling asthma, each of which may be an extremely important aspect of asthma care for your characters. So let’s dig in!
The best asthma attack is the one that never happens. Asthmatics who have specific triggers are best off avoiding those triggers in the first place.
While this isn’t so sexy from a writer’s perspective, it’s an important part of the way asthmatics might think in their lives. For example, asthmatics who love animals may stay away from animals; they may force friends or family who smoke to do it outside and may constantly be shifting to be upwind of the smoker if they’re out with them; they may stay indoors to avoid pollen and ragweed.
Frequent cleaning may be important, particularly if the character is triggered by dust or pet dander. HEPA filters help clear the air for the asthmatic character and prevent particle-triggered attacks.
There are a number of preventative medications, too, which fall into the categories below.
Steroids, particularly glucocorticoids, can be extremely helpful in preventing asthma. These include medications like fluticasone (Flovent), which comes as an inhaler. (The same medication is also a popular nasal spray for allergies.)
It’s important to realize that your character can’t reach for a steroid during an attack and think that it’s going to cure their exacerbation. Steroids take hours to kick in, even those given emergently by medical staff.
Leukotriene blockers, such as monteleukast (Singulair), are important adjunctive medications, and many asthmatics find that taking a leukotriene blocker is enough to control their asthma. Monteleukast is a tablet taken once a day.
Many asthmatics must also take daily doses of albuterol, or combination medications such as CombiVent or DuoNeb, which are both discussed below.
Oh, one last thing. Methyxanthines (methyl-zan-theenz) are a small, but helpful, class of medication — and a natural ingredient in coffee. Coffee helps asthma a little bit.
This PSA has been brought to you by Asthmatics Justifying Our Coffee Habits™
Attack Meds: Bronchodilators
Medications taken during an asthma exacerbation are helpful because they help stop the escalation of inflammation and relieve the bronchoconstriction.
Particularly, bronchodilators do a great job of directly opening up inflammation, with one major caveat that we’ll discuss in a moment.
The primary category of bronchodilators are a group of medications called beta agonists, which means that they affect the B1 and B2 receptors. (B1 increases heart rate; B2 causes bronchodilation.)
Far and away the most popular medication for this is albuterol (known as salbutamol in the UK and in some other countries). Albuterol is primarily a B2 agonist (meaning it activates the B2 receptors), but it does have some B1 properties, meaning that those taking it can feel their heart rates climb and have their hands begin to shake.
Levalbuterol, popularly known by a trade name Xopenex (Zoh-pen-ex), is another medication your asthmatic character might take, particularly if it’s the 90s. Xopenex is supposed to be more B2 selective, meaning it has less effects on the heart. But it’s also extremely expensive by comparison; albuterol might cost less than $20 for an inhaler, while Xopenex can be hundreds of dollars a month. They’re about equally effective, which is why Xopenex isn’t very popular.
Albuterol, which is also known by the trade names ProAir, Ventolin, and Proventil, is given one of two ways:
The character will purse their lips around the port of the inhaler, press the medication bottle, and the medication will puff out; they’ll inhale at the same time to get the medicine into their lungs. They’re encouraged to breathe deeply.
Some characters may have spacers with their inhalers; these are essentially a small accordion that the character can inhale through, which will mean that they don’t have to time their breath to the triggering of the medication. This is very helpful for kids. I personally dislike them, but that’s me.
By nebulizer. Scroll back up to the top of this post. You see the happy monkey with the mask on his face and the little medication chamber below? That’s a nebulizer mask setup. Monkey, or monkey’s parent/friend/nurse/hopscotch partner, will open a small packet of medication, squeeze the liquid into the medication chamber, and start a pump that will force air through the nebulizer. The liquid bubbles as the gas goes through it, and the medication disburses into the air, which the character breathes in.
The significant downside to inhaled asthma medication is this: it has to get through the constriction in order to help. The bronchioles are tight and air flow is reduced, but in order to help, the medication has to travel through the constricted passages into the alveolus of the lung, so that it can enter the bloodstream. The portion of the medication that simply sits on the surface of the airway is actually completely useless. So the character may be too constricted for these to help much. (Foreshadowing for the next post!)
Attack Meds: Anticholinergics
The other main category of medication for acute asthma attack is the anticholinergic. The typical medication for this is one called ipratropium bromide, better known as Atrovent. Atrovent helps dry up the secretions that asthma produces, which makes it easier for air to be exchanged.
Attack Meds in Harmony
So if you take the bronchodilator albuterol, and the anticholinergic ipratropium bromide, and you mix it up into one asthma-kicking bundle, you get a great one-two punch. One opens up the passages, the other dries them out, and the character can feel mighty better, mighty fast.
This pair of medications is known as CombiVent or DuoNeb, and is the go-to asthma treatment at the time of this writing for acute exacerbations.
But What If That’s Not Enough?
Next time on Asthma For Writers, we’re going to take a dive into the world of asthma from the acute care perspective: EMS and hospital admission. We’ll talk about injected medications, steroids will make a reprisal, and we’ll talk about the Bad Day version of asthma: status asthmaticus.
Thanks so much for reading! I know many of my readers are asthmatic. Did I do a good job describing your home care? Is there anything I didn’t think of? Drop a comment and let me know!