Asthma and Allergy Network

Asthma, Chronic Bronchitis and Emphysema

Asthma is a disease in which the smaller air passages in the lungs are hyperirritable. Attacks, which may be initiated by various influences, lead to narrowing of the airways and difficulty breathing. Wheezing, chest tightness, and an unproductive cough usually accompany the sensation of shortness of breath. Most asthmatics have only occasional trouble breathing.

Asthma attacks are commonly caused by exposure to specific allergens, air pollutants, industrial chemicals, or infection. They can be caused by exercise (especially in cold air). Asthma can be worsened by emotional factors, and the disease often runs in families. Other ailments common to many asthma sufferers, or their family members, are hay fever and an allergic skin condition called eczema.

Chronic bronchitis is a disease in which the cells lining the lungs secrete excess mucus, leading to a chronic cough, usually accompanied by phlegm.

Emphysema is due to destruction of the walls of lung air sacs and is characterized by shortness of breath, with or without a cough. There is a fair degree of overlap between chronic bronchitis and emphysema, and the two are sometimes lumped together into "chronic obstructive pulmonary disease", or COPD. Wheezing may occur with chronic bronchitis or emphysema.

Chronic bronchitis or emphysema is most commonly the end result of many years of cigarette smoking. Other causes include occupational or environmental air pollution, chronic lung infections, and hereditary factors.

Asthma, chronic bronchitis, and emphysema may be occupational illnesses (a problem related to the workplace). Asthma frequently occurs among meat wrappers, bakers, woodworkers, and farmers, and among workers exposed to specific chemicals. Chronic bronchitis frequently is the result of exposure to dusts and noxious gases.

Asthma, bronchitis, and emphysema may be mild. For some people, however, these diseases can become life-threatening or can cause restriction in lifestyle. For all people afflicted with these problems, the types of drugs prescribed to treat or prevent the attacks are quite strong. If used incorrectly, they may have an immediate and dangerous effect on the health of the user.

Do not try to diagnose or treat yourself. Asthma, chronic bronchitis, and emphysema must be diagnosed and treated by a doctor or other health professional. Two other common conditions that cause breathing difficulties, congestive heart failure and pneumonia, have similar symptoms, and many of the drugs used to treat asthma or COPD may worsen these conditions. Therefore, it is extremely important that you have your condition properly diagnosed before starting any medication.


Like its diagnosis, the treatment of asthma or COPD should be determined by a doctor. Attacks of asthma can be very frightening, and sufferers often overtreat themselves, especially when the desired relief has not been provided by the recommended dosage. Do not use more or less than the prescribed dose of any asthma or bronchitis medication without first consulting your doctor.

All medications for the treatment of these disorders, including those available without a prescription, should be chosen by you and your doctor together. A doctor is likely to prescribe one or more prescription drugs for the asthmatic. The currently available nonprescription (over-the-counter) drugs should not be used even for the treatment of minor or infrequent asthmatic episodes. The drug of choice for treatment of occasional acute symptoms of asthma is an inhaled short-acting beta2-agonist, such as albuterol (PROVENTIL, VENTOLIN), or pirbuterol (MAXAIR). These drugs are also commonly used for chronic bronchitis or emphysema.

Corticosteroids such as oral prednisone (DELTASONE, METICORTEN), or inhaled beclomethasone (BECLOVENT, VANCERIL), flunisolide (AEROBID), and triamcinolone (AZMACORT) are commonly used when severe acute symptoms of asthma do not improve after treatment with inhaled albuterol. These are not used in COPD unless there is a component of asthma on top of the COPD.

Theophylline and aminophylline are commonly used for suppressing the symptoms of chronic asthma, bronchitis, or emphysema. Aminophylline is identical to theophylline except that aminophylline contains a salt called ethylenediamine, which has caused rashes and hives in some people. Oxtriphylline (CHOLEDYL) is not recommended because it is no more effective than theophylline and costs more. These drugs must be taken exactly as prescribed, and the level of drug in the bloodstream must be monitored by a doctor. These measures will prevent adverse effects and ensure the optimal dose.

Montelukast (SINGULAIR) and zafirlukast (ACCOLATE) are members of a family of asthma drugs called leukotriene antagonists. Both of these drugs are approved only to prevent asthma attacks in people with chronic asthma, not to treat acute attacks of asthma. Montelukast is also approved for seasonal allergy. Montelukast is associated with liver toxicity. Production of the third leukotriene antagonist zileutin (ZYFLOW) was halted. The manufacturer cited poor sales as the reasons; however, zileutin was also associated with liver toxicity.

The National Institutes of Health's Guidelines for the Diagnosis and Management of Asthma said of the leukotriene inhibitors that further clinical experience and study are needed to establish their roles in therapy. At this time, the role of the leukotriene inhibitors in the management of asthma is still far from established.

The leukotriene inhibitors are promoted as useful in helping patients reduce their dosages of steroid drugs, for example triamcinolone (AZMACORT). The Cochrane Database of Systematic Reviews found, in comparing leukotriene inhibitors to placebo in people also using steroids, that the dosage of inhaled steroids can be safely reduced without requiring the use of leukotriene inhibitors. Furthermore, the dose of leukotriene inhibitors required to achieve a significant reduction in steroid dosage is several times the currently approved maximum dosage.

Proper Use of Inhalers

To receive the most benefit from your inhaler, follow the directions below, even though they may not agree with the directions on the drug manufacturer's packaging. Always shake well before taking each dose. Remove the plastic cap that covers the mouthpiece. Hold the inhaler upright, approximately 1 inches from your lips. Open your mouth widely. Breathe out as fully as you comfortably can. Breathe in deeply as you press down on the can with your index finger. When you have finished breathing in, hold your breath as long as you comfortably can (try to hold it for 10 seconds). This allows time for the medication to treat your lungs before you breathe it out. If you have difficulty with hand-breath coordination, as many people do, ask your doctor for an "add-on" device that attaches to your inhaler. It allows you to close your lips around the inhaler, yet still receive the full therapeutic benefit from that dose.

If your doctor has told you to take more than one puff at each treatment, wait one minute, shake the can again, and repeat. If you also take a bronchodilator in addition to the corticosteroids, you should inhale the bronchodilator first. Wait 15 minutes before inhaling the corticosteroids. This allows more corticosteroid to be absorbed into the lungs.

Your inhaler should be cleaned every day. To do this properly, remove the can from the plastic case. Rinse the plastic case and cap under warm running water. Dry thoroughly. Using a gentle, twisting motion, replace the metal can into the case. Put the cap on the mouthpiece.