# Asthma Question



## Acidian (Jan 23, 2008)

What the single most effective drug for asthma? and why is it so?

Our consultant asked us to find this out. I am only finding classes of drugs, eg. corticosteroids, nasal steroids, but no 1 single drug.

Thanks
Acidian


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## maik7upurz (Feb 28, 2006)

There is no single most effective drug for asthma, its a combination. Could use Montelukast to prevent symptoms, or stop them from getting worse, albuterol is only symptomatic treatment, have to keep using it, but side effects are horrible. Corticosteroids are terrible with side effects too but very effective, but usually people use them in combinations.

If there has to be a single drug, it would be the COMBINATION of a long acting beta agonist with corticosteroid, all in one inhaler!! Available but expensive. I speak as an asthma sufferer here, not just as a med student. Its a dumb question your consultant asked


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## Acidian (Jan 23, 2008)

It was oral corticosteroids. Our professor was referring to the best drug to control chronic asthma without taking into consideration of the many side-effects it can have.


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## maik7upurz (Feb 28, 2006)

In that case, why not IV corticosteroids?


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## Acidian (Jan 23, 2008)

Well we had a patient very severe asthma and he was given oral corticosteroids.
This was at outpatients (not in the ward).
This could be the reason why not IV (since it would be difficult for the patient to take IV steroids at home).
I will ask though.


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## maik7upurz (Feb 28, 2006)

You dont have to be admitted for IV Coriticosteroids, its one injection. If asthma gets so bad, the one thing better than oral corticosteroids is an IV Injection of Solu-Medrol. If one injection doesnt help, an injection daily or every other day for a few days even if their asthma is that bad. Technically its a last resort after trying everything but if he insisting single best, dont see why not this then. Strange teacher!

I guess the answer in general should be corticosteroids though, regardless of route. First Inhaled, then oral, and lastly parenteral


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## Acidian (Jan 23, 2008)

No not weird teacher. I checked with a class mate the question said "Which oral drug is the best for asthma?" So probably why not IV.
Anyway, our consultant studied in the US and he has many of these "in the us we do <insert some procedure> but here in Europe you don't" moments. Dunno if that makes him weird.


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## maik7upurz (Feb 28, 2006)

heh, well not him weird anyway, just weird question.. asthma, i looked it up, is treated in a step wise approach.. the oral drugs that can be used, can be oral albuterol, theophylline, and steroids. 

The initial question: What the single most effective drug for asthma? and why is it so?* Still waiting on the why!
*


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## Acidian (Jan 23, 2008)

The reason why oral steroids (and I believe even more IV steroids) is because they are the most effective at preventing asthma attacks and also reduce current asthma attacks, which inhaled steroids do not do.

This is what I was told.


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## MastahRiz (Jan 26, 2006)

maik7upurz said:


> * If there has to be a single drug, it would be the COMBINATION of a long acting beta agonist with corticosteroid, all in one inhaler!*


Agree 100%, plus Acidian didn't mention that we're limited to the oral route only.



maik7upurz said:


> Its a dumb question your consultant asked


Agree 100% 



Acidian said:


> It was oral corticosteroids. Our professor was referring to the best drug to control chronic asthma *without taking into consideration of the many side-effects it can have.*


Then what's the point? The inhaled combination of steroids + bronchodilators will still give you extremely effective control without side effects of steroids. I have to disagree with your professor unless he is strictly referring to patients in which all other therapies have already been attempted without sucess. Long-term oral use of corticosteroids should be reserved for chronic asthma only if other therapies fail; such use is preferable with an alternate day schedule, which may reduce side effects.



Acidian said:


> Well we had a patient very severe asthma and he was given oral corticosteroids.
> This was at outpatients (not in the ward).
> This could be the reason why not IV (since it would be difficult for the patient to take IV steroids at home).
> I will ask though.


Probably because he didn't respond to other therapies or may not even know how to use the inhaler properly. No one should be prescribing oral corticosteroids for asthma as a first line treatment.



Acidian said:


> The reason why oral steroids (and I believe even more IV steroids) is because they are the most effective at preventing asthma attacks and also reduce current asthma attacks, which *inhaled steroids do not do.*


No, steroids are steroids, the mechanism of action doesn't change depending on the route. Again, inhaled corticosteroids are extremely effective. Oral corticosteroids are never the first line therapy.

The question your consultant was asking is more likely to have been "In *this *patient, with a history of unresponsiveness to bronchodilators, steroid inhalers, or both, which is the single most effective drug in *this* patient?"

Answer: oral corticosteroids.


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## maik7upurz (Feb 28, 2006)

MastahRiz said:


> The question your consultant was asking is more likely to have been "In *this *patient, with a history of unresponsiveness to bronchodilators, steroid inhalers, or both, which is the single most effective drug in *this* patient?"
> 
> Answer: oral corticosteroids.


Couldn't have said it better. Was funny to say "what is the best drug, regardless of side effects". Obviously if we never took side effects into account, we could give everyone steroids , and tons of strong antibiotics for every infection. But ya, I think there was some miscommunication/misinterpretation on part of professor/teacher and student. MastahRiz did a good job of clarifying all points.


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## Acidian (Jan 23, 2008)

The patient we were with when he asked the question knew how to use inhalers and they worked well on her (during her rather long stay in hospital when it was made sure she was taking them). The patient was just non compliant and would not take any of the prevention meds (be it inhaled or oral corticosteroids) when back home and just use Ventolin when needed.



> Agree 100%, plus Acidian didn't mention that we're limited to the oral route only.


I was not told, the answer was limited to the oral route at first.
Look, I asked because I was perplexed by the question. I barely know any medicine right now and thought maybe it was from my part that I had no idea how to answer the question simply. I know I ain't the best of medical students.

P.S. Are Ventolin addicted patients common? Last time we encountered such a patient who when examined did not have asthma, COPD or any thing that required the drug.


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