Asthma Medication
Medication: Be aware
Medication is very important for the control of asthma. The following information regarding medication is based on regular questions I have received from concerned users attending Buteyko courses. The first point I would like to make is under no circumstances should you change or reduce your prescribed medication without first consulting with a practicing medical doctor.
Medication can be divided into two main groups; reliever medication (bronchodilator) and preventer (steroid).
Reliever medication
Reliever medication is further divided into short and long-acting and comes in grey, green or blue inhalers. Short-acting reliever inhalers are to be taken only when needed and last for 3 – 4 hours. Commonly prescribed short-acting reliever medications - containing the drugs Albuterol or Salbutamol - are Ventolin and Proventil.
Long-acting reliever inhalers such as Serevent, Spiriva, Oxis and Foradil are to be taken at regular times and last for about 10 hours.
Preventer medication
Preventer medication is predominantly steroid-based and must be taken all the time according to doctor’s instructions. Preventer medication comes in red, brown or orange inhalers. Commonly used preventer medications are Flixotide, Azmacort, Becotide, Pulmicort, Qvar, Flovent, Asmanex and Aerobid.
Combination Medications
Combinations inhalers contain two different types of asthma medication. For example the inhaler Advair contains the preventer medication Flixotide and the long-acting reliever Serevent. Another popular combination inhaler is Symbicort, which contains the preventer medication Pulmicort and the long-acting reliever Formoterol.
Medication that targets specific cells.
Leukotriene modifiers are the name given to oral tablets that target specific cells involved in inflammation. They are newer forms of medications. Examples include Singulair, Accolate and Zyflo.
Instructions for visiting your doctor to have your medication evaluated.
Over the years, I have observed thousands of asthmatics reduce or eliminate their need for medication as long as they follow the instruction contained in this book. Prescribed medication should be altered only in conjunction with a medical doctor.
Before seeking to have an evaluation of your asthma medication with your doctor, it is necessary to meet the following criteria:
- Your Control Pause is greater than 20 seconds for 4 weeks.
- You have no need for short acting reliever medication for 4 weeks.
- You have no asthma symptoms for 4 weeks.
Your asthma medication should never be completely stopped at once. This is extremely dangerous. Instead, asthma medication should be gradually altered to the condition of the patient.
Asthma medication increases the BUTEYKO CP, therefore, each time your medication is reduced a little, your BUTEYKO CP will drop. Taking this into account; it is necessary to have a BUTEYKO CP of at least 20 seconds before changes are made to your medication. For example if your BUTEYKO CP is 13 seconds, and you decide you reduce your medication; your BUTEYKO CP could drop to below 10 seconds, resulting in very unstable asthma.
It is also necessary to increase your BUTEYKO CP to 20 seconds before you proceed from one Stage to another. (Three Stages are described below) It is only by addressing your chronic hyperventilation that you will be able to reduce your need for preventer medication.
The Stages below will depend on what medication you take. For example if you only take a preventer medication, then proceed to Stage 3. If you are taking Singulair and Advair or similar, you will need to begin at Stage 1. If you are on oral steroids, then the stages below will not apply. Instead visit your doctor or consultant for a review when you have achieved a BUTEYKO CP of 20 seconds for at least 4 weeks.
STAGE 1
When you have no asthma symptoms, no need for reliever medication and your BUTEYKO CP is greater than 20 seconds for 4 weeks, then request your doctor to;
- reduce or eliminate add-on medications such as Slophylin, Accolate, Singulair or Zyflo.
STAGE 2
Before proceeding to Stage 2, wait until you have no asthma symptoms, no need for reliever medication and your BUTEYKO CP is greater than 20 seconds for 4 weeks, then request your Doctor to;
- Switch from long-acting reliever medication such as Serevent to Ventolin or Bricanyl.
- Switch from combination inhalers which contain both preventer and long-acting reliever to a separate preventer and short-acting reliever.
With a BUTEYKO CP of over 20 seconds for 4 weeks and no asthma symptoms, you will have far less need for reliever medication. However, the combination inhalers such as Advair (Seretide) and Symbicort contain a very powerful reliever. Because it is combined, you are unable to alter it according to your needs and so may end up taking medication that you have no need for. A recommendation therefore is to ask your doctor to divide your combination inhaler into a separate preventer and short-acting reliever. Please find example below;
Replace Advair or Seretide with Flixotide and Ventolin
Replace Symbicort with Pulmicort and Ventolin
STAGE 3
At this point your medication will consist of preventer and short-acting reliever. Before proceeding to Stage 3, wait until you have no asthma symptoms, no need for reliever medication and your BUTEYKO CP is greater than 20 seconds for 4 weeks, then request your doctor to taper your preventer medication to what you require.
The guideline with reducing preventer medication is that the dosage should never be reduced by more than one quarter at any one time. Each time your preventer medication is reduced a little, wait until your BUTEYKO CP is back at 20 seconds for 4 weeks, you have no need for reliever medication and no symptoms before you revisit your doctor for a further decrease.
An example of reducing from 1,000 mcg per day to 0 would be as follows:
1,000 – 800 - 600- 500 - 400 –300 – 200 – 100 – 0.
Each time a reduction is made, reduce your breathing and wait until your BUTEYKO CP has increased to 20 seconds for 4 weeks.
You will be able to maintain no need for preventer medication on a permanent basis when your BUTEYKO CP is 40 seconds for 6 months. Your main symptoms will be gone when BUTEYKO CP is 20 seconds, but a trigger may produce symptoms.
Continue to carry short acting reliever medication at all times.
When to increase inhaled steroids?
While it is beneficial to alter your medication with your doctor as your condition improves, it is even more important to make sure that you have sufficient steroid when your BUTEYKO CP is low or when you have chronic breathing difficulties. If your BUTEYKO CP is less than 10 seconds and/or you need to take more than 3 puffs of Ventolin in one day, then it is a sign that you might be insufficient in steroids. Another indication of steroid deficiency is having a resting pulse of 100 or greater over a 24-hour period. In this instance, it is advisable to visit your GP to have your steroid medication reviewed.
If so, it will be difficult to correct your breathing and increase your BUTEYKO CP as the drive to breathe will be too strong. In this situation, the advice is to visit your doctor to have your medication reviewed.
Asthma Medications - are we informed?
Over the years, a number of questions have arisen regarding asthma medications. One asthma inhaler called Fenoterol, which was heavily prescribed in the 1970’s, caused thousands of asthma deaths in New Zealand and other countries1-3. The Wellington Asthma Research Group of Richard Beasley, Carl Burgess, Julian Crane, and Neil Pearce first uncovered this startling link. However, before their discovery was accepted, their findings were subjected to major criticism and obstruction from the manufacturer of Fenoterol; Boehringer Ingelheim, and more surprisingly from an Asthma Task Force which consisted of the then Professor of Medicine at the Wellington School of Medicine and three respiratory physicians.
Boehringer went to great lengths in organising lavish international meetings with carefully selected asthma “experts” to defend the drug, and bulky publicity packages were delivered to almost all doctors, pharmacists and health reporters in New Zealand. The package contained tables and other information "which it claimed demonstrated a lack of association between Fenoterol sales and asthma deaths." 1
Eventually, the New Zealand Department of health took action by "severely restricting its availability, thereby allowing an 'experiment in prevention' to be undertaken. These regulatory actions, which effectively removed Fenoterol from the market in New Zealand, were associated with a sudden and marked reduction in asthma mortality, providing further evidence for a causative role of Fenoterol in the epidemic of asthma deaths in New Zealand". 3
A paper written by Professor of Medicine Evan J Begg, and published in the New Zealand Medical Journal, concluded as follows: "In the end, this was a win to Neil Pearce and his colleagues, and to the people with asthma whose lives were sa0ved. It was a loss for the New Zealand Asthma Task Force and for Boehringer Ingelheim, whose respective behaviours were reprehensible. While it was reasonable for them to question a new finding, particularly if it seems out of left field, it is not reasonable to use power and money aggressively to suppress data with life-threatening implications". 2
Quotations regarding present day asthma medications
Asthma has been around for about five thousand years yet "in the 19th and 20th centuries, before 1920, death from asthma was considered to be rare by many leading authorities". 4
Nowadays we are presented with a totally different picture; asthma has increased exponentially over the past 30 years and claims the lives of thousands of children and adults every year.
In the United States an estimated 3,816 people died from asthma in 2004 and 3,857 in 2005. 5 In the UK, 1,300 people died in 2005. 6 Worldwide, it is estimated that 180,000 die from asthma each year. 7
Does this not point to the fact that something is amiss with the current treatment? Year on year, the incidence of asthma and the resulting death rate should be decreasing. Despite the billions of dollars invested in asthma research, the opposite is taking place. It is a very poor reflection on asthma authorities worldwide and hardly a success story. I am not anti-medication, but as someone who suffered from asthma for the greater part of my life, I feel very much let down by the medical community. Despite visiting many doctors as a child, I was never shown how to breathe through my nose or practice simple exercises to address my overbreathing. If I had not stumbled across this approach at the age of 25, God only knows what my asthma would be like today. Medication has a very important role, but so has the correction of chronic hyperventilation!
In addition, a number of popular modern day medications are of particular concern, but few lay people seem to be aware of them. For example, treatments such as Advair (Seretide), Symbicort, Serevent and Singulair have all received stringent health warnings from the US Food and Drugs Administration.
Even with the most diligent scientific medical trials, results are somewhat limited due to the time frame and population samples involved. To satisfy shareholders, drug companies need to get their medication to the market as soon as possible. The question to ask is whether short-term trials involving a relatively small number of people can replicate and forewarn the results that will arise from millions of people using these same products over many years?
Below, I have compiled a number of concerns from asthma experts and the FDA about present day medications. All links to the research below are available from www.buteykoclinic.com
Regarding Advair (also known as Seretide)
"If we got these drugs off the market, we could prevent 4,000 deaths a year", argues Shelley Salpeter, a Clinical Professor of Medicine at Stanford University who says both Advair and Serevent should be recalled.”8 Forbes News Magazine
Regarding Serevent
"Long-term treatment with inhaled β2-agonists may be associated with a deterioration in asthma control, potentially due to tolerance."9 Chest Medical Journal.
Regarding Salmeterol; (ingredient contained in Serevent, Advair and Seretide)
"Long-acting beta2-adrenergic agonists, such as Salmeterol, one of the active ingredients in Advair Diskus, may increase the risk of asthma-related death. Therefore, when treating patients with asthma, physicians should only prescribe Advair Diskus for patients not adequately controlled on other asthma-controller medications (e.g., low- to medium-dose inhaled corticosteroids) or whose disease severity clearly warrants initiation of treatment with 2 maintenance therapies..." 10 US Food and Drug Administration (FDA) March 2006
Regarding Symbicort
"In patients with asthma, LABA medicines such as Formoterol (one of the medicines in SYMBICORT) may increase the chance of death from asthma problems. In a large asthma study, more patients who used another LABA medicine, died from asthma problems compared with patients who did not use that LABA 2medicine. Talk with your healthcare provider about this risk and the benefits of treating your asthma with SYMBICORT." 11 US Food and Drug Administration (FDA) Oct 2007
Regarding Singulair
"FDA informed healthcare professionals and patients of the Agency's investigation of the possible association between the use of Singulair and behavior/mood changes, suicidality (suicidal thinking and behavior) and suicide. Due to the complexity of the analyses, FDA anticipates that it may take up to 9 months to complete the ongoing evaluations. As soon as this review is complete, FDA will communicate the conclusions and recommendations to the public" 12 US Food and Drug Administration (FDA) March 2008