Asthma and the Everyday Struggle for Air

What is in my Medicine Cabinet

Asthma is a deadly disease affecting the airways of the lungs making it hard to breathe. The asthma attack can happen at any moment and can be mild, moderate, serious or life threatening. I know first hand what it is like to live with serious asthma because I had it since I was about two years old. This is a chronic condition and I have been told there is no cure, but I will always remain hopeful to be cured one day. Asthma is currently the leading chronic disease in children. My treatment for asthma are two inhalers, QVAR and Proair. I always carry them with me in my purse, car, backpack, gym bag, and night stand because I never know when I will need my inhalers.

According to the CDC, 26 million Americans suffer asthma, affecting 1 in 13 people (Center for Disease Control [CDC], 2018). The number of people diagnosed with asthma has been continually rising since the early 1980's across all gender groups, age groups and racial groups (CDC, 2018).

Asthma symptoms usually include coughing, wheezing, tightness in chest and inability to get air into your lungs. Usually, when you begin to feel any of the above symptoms you reach for an inhaler and take two puffs. I have been on several inhalers throughout my life, but for the past three years I have been using a long term inhaler, Qvar, and a rescue inhaler, Proair.

QVAR RediHaler is a metered dose inhaler containing beclomethasone dipropionate HFA used for maintenance control and prevention of attacks in asthma (QVAR.com, 2018). (https://www.qvar.com/) The indications of QVAR are for the asthma maintenance treatment as prophylactic therapy in people four years and older (QVAR.com, 2018). According to the website PubChem, beclomethasone dipropionate is a synthetic glucocorticoid with anti-inflammatory, vasoconstrictive and immunomodulating effects (PubChem, 2018). Glucocorticoids are a type of corticosteroids with anti-inflammatory activity affecting the metabolism of carbohydrates within your body. Adrenocorticotropic hormone secretions is also inhibited (PubChem, 2018). Other roles glucocorticoids have within your body are protein and fat metabolism, reduction of lymphocytes in circulation, change in the connective tissue response to injury as well as central nervous system functions (PubChem, 2018).

The mechanism of action of beclomethasone binds to interleukin-13 to prevent cytokines preventing inflammatory chemicals in circulation. (PubChem, 2018). The unbound corticosteroids are able to cross the cell membranes specifically binding to cytoplasmic receptors preventing a leukocyte response where the inflammation is occuring causing an interference with the inflammatory response and suppression of the body's humoral immunity response and edema reduction at the site (PubChem, 2018).

Acute toxicity of beclomethasone dipropionate is low but overdosing causes suppression of the hypothalamic-pituitary-adrenal (HPA) function. Chronic use of beclomethasone dipropionate can cause suppression of the adrenal glands (PubChem, 2018). Reproductive toxicity can occur to the fertility of women or her unborn fetus (PubChem, 2018). Beclomethasone is unknown to pass into breast milk according to QVARS's website and WebMD but I don't know why it has not been tested thoroughly yet with such a popular asthma medicine especially when the drug is known to slow growth in a child's height and organ failure. There has been one study listed on the U.S. National Library of Medicine that consisted of only three infants breastfed for six months while the mother was using beclomethasone dipropionate for asthma treatment and it was thought QVAR is probably safe for most women who are breastfeeding (Monson, 2016). The data that is being used is from 1975 with three infants.

According to WebMD, other side effects include dry mouth, nausea, dysmenorrhea, headache, vision problems, bruising, increased thirst/urination, puffy face, thinning skin, lethargic, muscle weakness, sleep disorder, and oral thrush (WebMD). Precautions should be made if you are having surgery or are sick because the medication can hide infection signs. The medication suppresses the immune system and WebMD states do not have vaccinations or immunizations while using beclomethasone and also avoid people who recently receive live vaccines.

I noticed a few months ago, my QVAR inhaler was different and the packaging was different, the QVAR was now the first and only breath-actuated metered dose corticosteroid inhaler in the United States. I simply take a breath and the medicine shoots into my mouth and lungs with ease. I no longer needed the hand-breath coordination during an inhalation or the need for a volume holding chamber. The inhaler is ready to use and does not require any preparation such as shaking before use. Treatment of asthma with a MDI requires proper technique and nearly 68 percent of people do not use MDIs properly to benefit from the medication (Fink, 2005). The problem doctors face is the asthma patient has uncontrolled symptoms which can be dangerous for the patients (Price, et al., 2013).

QVAR is an important part of my life and I consider my dependant on a long term inhaler as well as a rescue inhaler. I have used inhalers my whole life and I never was told by my doctors any of the side effects and precautions associated with a beclomethasone dipropionate inhaler. I used my inhalers before I was pregnant, while I was pregnant and throughout breastfeeding. I never knew the inhaler could be any danger to my baby. I was never told by any of my doctors that is was harmful. I have been feeling off for many years now and many of the signs listed are the symptoms I have been feeling. Asthma is an expensive disease and can cost $80 for a rescue inhaler to $185 for my QVAR without insurance. I would love to one day not have to use my inhalers by eliminating my triggers that cause a reaction but for now I will continue using my QVAR as little as possible.

References

Akinbami, L.J. The state of childhood asthma, United States, 1980-2005 (2006, December). Advance Data from Vital and Health Statistics: No. 381, National Center for Health Statistics, 2006. Retrieved from https://www.cdc.gov/nchs/data/ad/ad381.pdf

American Lung Association, Epidemiology and Statistics Unit, Research and Program Services. (2009, January). Trends in asthma morbidity and mortality. Retrieved from https://www.lung.org/assets/documents/research/asthma-trend-report.pdf

Brown, HM., Storey G. (1975) Treatment of allergy of the respiratory tract with beclomethasone dipropionate steroid aerosol. Postgraduate Medical Journal. 51(4), 59-64. PMID: 1105520

Centers for Disease Control and Prevention. (2017, May). Asthma in schools. Retrieved from https://www.cdc.gov/healthyschools/asthma/

DrugBank. (2018, November). Beclomethasone dipropionate. Retrieved from https://www.drugbank.ca/drugs/DB00394

Fink, JB, Rubin BK. (2005) Problems with inhaler use: a call for improved clinician and patient

Education. Respiratory Care. 50 (10),1360-1374.

Fukushima, C., Matsuse, H., Tomari, S., Obase, Y., Miyazaki, Y., Shimoda, T., Kohno, S. (2003, June) Oral candidiasis associated with inhaled corticosteroid use: comparison of fluticasone and beclomethasone. Annals of Allergy, Asthma and Immunology. 90(6),646-51. DOI: 10.1016/S1081-1206(10)61870-4

Price, D. , Bosnic-Anticevich, S., Briggs, A., Chrystyn, H., Rand, C., Scheuch, G., Bousquet, J. (2013). Inhaler competence in asthma: Common errors, barriers to use and recommended solutions. Respiratory Medicine. 107, 37- 46.

National Center for Biotechnology Information. PubChem Compound Database (2018,

November). CID 21700. Retrieved https://pubchem.ncbi.nlm.nih.gov/compound/21700

Monson, K., Schoenstadt, A., (2016). QVAR and Breastfeeding. MedTV. Retrieved from https://asthma.emedtv.com/qvar/qvar-and-breastfeeding.html

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