The Prairie Doc Perspective

Attack Asthma

By Richard P. Holm MD

I remember my first asthma-attack. My family was traveling, before the interstate was built, in our old Chevy, down two-lane highways from DeSmet, South Dakota to the Ozarks of Missouri to visit relatives at Christmas, and my sister and I were exploring under the seats in the back, stirring up dust as we were discovering lost coins and toys. Not long after, I could not get my breath.

What followed was years of asthma. I remember many nights lying awake having trouble breathing, until my doctor provided an adrenalin-like rescue inhaler. Wow! One puff of the rescue medicine meant airways opened and I could breath, and so I could sleep. It changed my life.

Asthma, like chronic bronchitis and emphysema, is a wheezing condition where airways are partially blocked or obstructed while trying to breath out, trapping air, and over-expanding the lungs. The cause of obstruction in asthma is from bronchial tube inflammation and results in twitchy-over-tightened-tiny muscles that surround bronchial tubes. Adrenalin-like medicines, also called beta-agonists, are the rescue wonder-drugs of asthma since they very quickly relax those twitchy muscles giving immediate relief to an asthmatic.

However, this does not touch the inflammation – and when beta-agonists are used too often, bronchial muscles get used to the drug and develop resistance and higher doses are required, and bronchial tubes and tiny muscles get even more irritable. Here is the rub: studies have found increased asthma deaths occur when beta-agonist inhalers are over-used. What works so good… can kill you? Whoa!

But all is not lost. Steroid inhalers turn off the primary cause for asthma: inflammation. And when inhaled steroids are added, it breaks the cycle, and even can protect the patient from danger resulting from beta-agonists. Thus, clinicians should always prescribe steroid inhalers when asthma gets bad enough. Drug manufacturers are now putting together beta-agonists with steroids into one inhaler, which give patients immediate relief provided by beta-agonists and get to the inflammatory bottom of the problem with steroids. Since beta-agonists work so fast, they almost trick patients into using steroids that take time to work.

Remember: beta-agonists should only be used alone as an occasional rescue medicine, and if they are needed daily or too frequently, then the patient needs more anti-inflammatory steroids.

So stirring up dust in the back seat of the old Chevy does not have to make your life so miserable.

Dr. Rick Holm wrote this Prairie Doc Perspective for “On Call®,” a weekly program where medical professionals discuss health concerns for the general public.  “On Call®” is produced by the Healing Words Foundation in association with the South Dakota State University Journalism Department. “On Call®” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain. Visit us at 

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