Asthma: Side effects of medications

This is in response to the article on handling asthma attacks. I have had asthma since I was 14, and my son also has it. For years I took Proventil, and thought the jitteriness and "speediness" was part and parcel of the treatment. It wasn't until a few years ago when a doctor prescribed Ventolin rotocaps that I discovered I didn't have to experience those symptoms in order to get the treatment. Perhaps some of the side effects are from the propellants - not just the medication. Is this possible?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Medications used for asthma are trickier than one might think. Unlike medicines we take for other illnesses where swallowing a pill is as complicated as it gets, many asthma medications are taken in such a way to allow the medication to deposit in the lungs directly, namely inhaling them. All medications have side effects, however, inhaled asthma medications are unique in that they may have side effects related to how they are taken in addition to what  is taken.

Let's consider the most common inhaled asthma medication, albuterol. There are a number of trade names for albuterol such as Ventolin and Proventil, but they are the same drug. This medication is most commonly inhaled through a device called a metered dose inhaler or MDI. Some people call this a puffer. This device releases a fine mist when the canister is pushed. It may also be inhaled through a nebulizer machine which takes a liquid and makes a fine mist that may be inhaled through a mask or tube. Albuterol also comes in a very fine powdered form which may be inhaled through a device called the Rotacap.

The drug works by acting on the tissues in the lungs. Its side effects occur when the drug gets absorbed to the rest of the body. These side effects are mainly an increase in heart rate, slight upset stomach, and feeling a little "hyper". How does it make it into the rest of the body? Well, because the medication must go through the mouth on its way to the lungs, some of the medication will not make it because it hits the walls of the mouth and gets swallowed. When the medication deposits on the mucous membranes of the mouth or is swallowed, then it gets absorbed to the rest of the body.

Therefore, the best way to avoid side effects is to maximize the amount of albuterol that makes it to the lungs while minimizing the amount deposited in the mouth. There are a number of ways to do this. For the metered dose inhaler (MDI or puffer), using a spacer to breathe through instead of inserting the MDI directly into the mouth will significantly reduce the amount of albuterol wasted by depositing in the mouth. The other way is to use the Rotacaps. Rotacaps work by being released and inhaled solely by the inhalation of the person using it. This is opposed to the MDI which squirts out when squeezed. While it is certainly possible to have the fine powder of the Rotacaps land only in the mouth, many older children and adults find it easier to use correctly than the MDI.

I suspect that your success in avoiding the side effects of albuterol were primarily due to you being more efficient at using the Rotacap method than the MDI. To answer your question, although the propellants are supposed to have no effect, there are some studies to suggest in about 2 percent of people with asthma, the propellant may make their asthma symptoms a little worse a few minutes after using the MDI. However, there is nothing to suggest that the propellants cause any of the symptoms you outlined above. I suggest if your son is using an MDI, he should always use a spacer with it. This will not only cut down on the side effects, but it will give him more medication with each puff where it is needed most.

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