If properly treated, patients with acute bronchial asthma should rarely need to be hospitalized. This is usually a nocturnal condition and patients often appear well during the day. For this reason, the doctor may simply think that the patient "just has a cold" and prescribe a non-curative over-the-counter (OTC) cold "remedy". Promethazine DM (Phenergan DM) is contraindicated in asthmatics, though it is often prescribed. If a doctor prescribes Promethazine (Phenergan®) DM for a cough or bronchial asthma, he may be endangering his patient's life. Wyeth® pharmaceuticals sent a letter on February 15, 2005 to all American medical providers which stated, "Phenergan (Promethazine) should not be used in pediatric patients because of the potential for fatal respiratory failure. Respiratory depression and apnea, sometimes associated with death, are strongly associated with Promethazine products."
The two most important drugs in Asthma are short acting bronchodilators (Albuterol) and cortisone (Prednisolone @ 1 mg/Kg/Day and should be less than 40 mg/day). Humans naturally make Cortisone and without it we cannot exist. A two or three day course of Prednisone or Prednisolone on hand may keep most patients out of the hospital or the emergency room when the doctor is not available. All asthmatics should have a small supply of this Medicine readily available-in case of a crisis or if the doctor is not available. No patient should try to get cortisone products on his own and without the proper medical supervision.
Nasal congestion may be of therapeutic benefit since it increases the nasal's surface and promotes an immune response to the allergen (natural immunotherapy). The allergen may be swallowed instead of being inhaled into the lungs.
The vomiting associated with asthma may be life saving. It helps to clear the bronchial passages. Too often, however, I have seen doctors prescribe an anti-emetic (against vomiting) by mistake.
Asthma runs its natural course over 3 to 5 years, and I have not seen it cause permanent lung damage as claimed by some "experts." I have followed specific patients for over 20 years. Immunotherapy is of marginal benefit, and I have seen children that were having psychologically trauma as a result of "allergy shots." An allergist may tell you differently since "allergy shots" are lucrative.
A common error by emergency room providers is the failure to diagnose asthma. They often treat it as "just a cold" and prescribe a non-therapeuric over-the-counter (OTC) drug like Triaminic®, Pediacare® or Dimetapp®. On Monday, 2/l5/07, a pregnant woman (@ 5 months) with acute asthma was treated with inhaled cortisone, but later had to be rescued. Acute bronchial asthma can develop as early as a few weeks after birth. Bronchiolitis is an infection that occurs in children under age 2, is associated with wheezing, and is caused by a virus (Influenza, Adenovirus, Parainfluenza or RSV). Ask your doctor about this information.
Another common emergency room error is to treat only the bronchospasm component associated with asthma with just Albuterol. Over two decades ago, it was determined that if asthmatics that present to an emergency room were to receive just one dose of a systemic corticosteroid (Prednisone), it would reduce the hospitalization rate by 85 percent. The clinician has to be very skilled in diagnosing the subtleties associated with asthma. The medical history usually provides the diagnosis of asthma. Parents must learn to accept the diagnosis of asthma. Otherwise, their child may be improperly treated in the future.
Which one is better for wheezing (bronchospasm) Albuterol versus levalbuterol (Xonepex®)? According to The Medical Letter, a highly respected publication that accepts no pharmaceutical money, they are comparable except that Xonepex® is at least five times more expensive. "Specialists" readily prescribe Xonepex®, why?" One lung doctor vehemently defends Xonepex® as being superior to Albuterol. This doctor, I found out, has four ex-wives to pay off. He takes lot money from the maker of Xonepex®. How do we find the truth? You can simply write to the FDA and ask them, as I do. The maker of Xopenex®, Sepracor Inc., was formally criticized by Joan Hankin, JD, an FDA attorney, for making misleading statements about its efficacy, side effects, and Ms. Hankin ordered the company to stop "The distribution and use of any materials containing these and similar violative claims cease immediately, including but not limited to, the removal of this press release from the PRNewswire website.
You as a consumer must make sure you doctor is not closely allied with a drug maker nor does he accept 'free continued medical education' (CME) from the drug industry. I pay for my medical journals and CME. My only duty is to the patient and the public that paid for my medical education through UCLA. I am thankful.
Luis Lomeli MD/Beta
Author: LuisLomeliMD
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