Best drugs for asthma?
Discussion
I have an old friend who's lungs are pretty shot, he still works as a greenskeeper at my local golf course but if he has to do any manual work he's huffing and puffing as soon as he's started. He may not be long for this world so taking a drug that has long term detrimental side effects is probably not an issue, is there anything out there that could really help him in the short term?
If it's really asthma and not something else, he should be using a brown (steroid eg beclometasone) preventer inhaler daily, with occasional use of a blue (eg salbutamol) reliever inhaler when necessary.
That's assuming he doesn't know what's triggering the problem. If it's an avoidable allergen then a "lifestyle change" could help a lot (eg get rid of the cat/dog/house-dust).
That's assuming he doesn't know what's triggering the problem. If it's an avoidable allergen then a "lifestyle change" could help a lot (eg get rid of the cat/dog/house-dust).
Edited by Nimby on Friday 11th December 14:37
What you're describing doesn't sound like asthma, it would also be highly unusual in the elderly (I'm assuming from your description that he is). What treatments could be tried depends on the exact underlying pathology. Does he have COPD? Was he a smoker? Does he have alpha-1-antitrypsin deficiency? Does he have idiopathic pulmonary fibrosis? Or something else entirely?
QuickQuack said:
What you're describing doesn't sound like asthma, it would also be highly unusual in the elderly (I'm assuming from your description that he is). What treatments could be tried depends on the exact underlying pathology. Does he have COPD? Was he a smoker? Does he have alpha-1-antitrypsin deficiency? Does he have idiopathic pulmonary fibrosis? Or something else entirely?
Hi QuickQuack, thanks for your reply, I'm sorry I'm not sure of his exact diagnosis. Yes, he was a smoker, stopped at aged 50, he's now 68.What I do know is that his breathing is constantly very laboured and he uses a breathing mask to sleep at night. I have to be careful probing him for a prescribed illness as he's quite a traditional chap who dismisses it as, in his words, "Arrrggh, yeah me lungs are a bit f
ked". I'll ask his wife when I next see her. My thoughts are that he may not be with us by this time next year and if there's a chance through strong medication that he could get some quality, rather than quantity, of life in the meantime it would be great to see.cheddar said:
Hi QuickQuack, thanks for your reply, I'm sorry I'm not sure of his exact diagnosis. Yes, he was a smoker, stopped at aged 50, he's now 68.
What I do know is that his breathing is constantly very laboured and he uses a breathing mask to sleep at night. I have to be careful probing him for a prescribed illness as he's quite a traditional chap who dismisses it as, in his words, "Arrrggh, yeah me lungs are a bit fked". I'll ask his wife when I next see her. My thoughts are that he may not be with us by this time next year and if there's a chance through strong medication that he could get some quality, rather than quantity, of life in the meantime it would be great to see.
Hi Cheddar,What I do know is that his breathing is constantly very laboured and he uses a breathing mask to sleep at night. I have to be careful probing him for a prescribed illness as he's quite a traditional chap who dismisses it as, in his words, "Arrrggh, yeah me lungs are a bit f
ked". I'll ask his wife when I next see her. My thoughts are that he may not be with us by this time next year and if there's a chance through strong medication that he could get some quality, rather than quantity, of life in the meantime it would be great to see.Based on hat, he almost certainly has severe COPD and the mask he's using at night is what's called a non-invasive ventilation (NIV) device, most likely a nose mask that keeps his airways open at night and lets him sleep without stopping breathing. There are lots of different forms, terms and devices but he's most likely to be using a NIPPY or something similar.
This bit is mainly for interest because it sounds like you'd like to understand your friend's problem and help if you can, and is hugely simplified. The physiology is complex, but one of the problems in COPD is that small and medium sized airways collapse. Lungs are made of elastic material like a balloon, and just like a balloon, the most difficult part of opening them up is right at the beginning when you need high pressures. To cope with the collapsing airways, most COPD patients develop an adapted type of breathing where they purse their lips and essentially blow their breath out against high pressure. That keeps a constant positive pressure in the airways and stops them completely collapsing at the end of a breath (under normal circumstances, the pressure in the chest at the end of breathing is negative), therefore making taking in the next breath easier. This is referred to as auto-PEEP or self-PEEP breathing (PEEP stands for positive end expiratory pressure). This is under conscious control which is lost when you're asleep, therefore the patients constantly keep waking up very breathless because their airways collapse very soon after falling asleep, they can frequently stop breathing momentarily. In later stages, this can be life threatening. The NIV devices keep a constant pressure (they can cycle and vary inspiratory vs expiratory pressures etc. but ignore that for now) in the airways so stop the airways collapsing when the patient falls asleep and help them breathe semi-normally. This is very very effective, far more effective than any drug. This is the simplest way I can think of explaining it.
The consequence for your friend isn't very good I'm afraid, there really are not many good medicines, inhalers or otherwise, which can improve things to any degree more than marginally. There certainly is nothing which can reverse the damage caused by smoking. He is likely to be at max drug therapy although he may progress to needing home oxygen in addition to the night mask in the future. COPD can cause complications which may require surgery but these are procedures for symptom control, not curative. If he has been deteriorating recently, I fear that you are likely to be very correct in your assessment of his chances of being here this time next year. He sounds like he knows but doesn't wish to discuss which is a common phenomenon. I wouldn't say a word other than your usual banter, to be honest. In fact, try to stay as normal as possible, that's far more likely to help him (mainly psychologically) than anthing else.
Regarding smoking, and this is my evangelical bit due to my work so apologies, the younger one starts, the worse the damage, so if you start at 10 years old and give up at 40, assuming number of cigarettes smoked id the same, that's worse than starting at 20 and giving up at 50. Risk of lung cancer is a different issue altogether, 20 years after stopping smoking, one's risk of lung cancer is almost back down to the background population who never smoked, however, the structural damage to the lung tissue never goes away. Lung cancer kills you quickly, but the effect of the structural damage to one's lungs can make life a misery for years or even decades. It isn't always apparent either and can catch up with you decades later. I wish this was understood far more widely. And then there are its effects on your arteries everywhere in your body (heart, brain, arms, legs, guts, kidneys, everything!), its effect on the bladder (the commonest cause of bladder cancer is smoking, over 95% for UK), throat (cancers), mouth (cancers)... You get the picture. Unlike alcohol, there is no safe level of smoking.
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