Tuesday, September 21, 2010

History of Asthma: 1981 (Asthma medicines)

To start our history of asthma, let's travel back to 1981. This information is from a package I received when I was a patient in 1985 at National Jewish Health (NJH). Back then the hospital was called National Jewish Hospital and Research Center/ National Asthma Center (NJH/NAC), and the package was titled, "Learning about asthma."

In the last section of the packet is a list of all the medicines used to treat asthma at that time. Most of these medicines I was on, and if you had asthma in the 1980s, chances are you were on one or more of these too.

So, without further adieu, here is the list of the top line asthma medicines for 1981. Or rather, here is the medicine and the facts about them as per 1981 wisdom. I'm going to reproduce it here as it was actually written in lecture format:

I. Facts about medicine for the child with asthma

A. No curative medicine
B. Control asthma when taken as prescribed
C. Medicine must be evaluated for effectiveness
D. Take only the medicine prescribed for you

II. educations

A. Theophylline

1. Most effective and used medicine
2. Action on the bronchial muscles and known as a "bronchodilator"

3. Prescribed under many brand names:
  • Aminophylline
  • Somophyllin
  • Choledyl
  • Elixophyllin
  • Theolair
  • Slophyllin
  • Theodur
  • Theospan and many others
4. Side effects
  • Gastro-intestinal system
  • Central nervous system
5. Evaluated by blood level determinations

B. Beta2 Adrenergics and related medicines

1. Medicines similar to epinephrine and are bronchodilators
  • Metaproterenol (Alupent and Metraprel)
  • Terbutaline (Bricanyl and Brethine)
  • Isoetharine (Bronkosol)
  • Isopreterenol (Isuprel)
  • Epinephrine (Adrenalin)
2. Side effects
  • Gastro-intestinal system
  • Central Nervous system
C. Cromolyn (Intal)

1. Acts by lessening response of lungs to triggers
2. Needs to be taken regularly
3. No effect after wheezing starts
4. Inhaled as a dry powder and may stimulate coughing

D. Steroids

1. Related to cortisone, a hormone naturally secreted by the adrenal glands
2. Inhibit inflammatory reaction
3. Most effective medicine for a flare-up of asthma symptoms
4. Side effects
  • Change in body shape: (1) Increase appetite, (2) Weight gain, (3) Round-faced look
  • Change in growth: (1) Growth interfered with during long term use, (2) Severe asthma my interfere with growth
  • Adrenal suppression: (1) Adrenal glands become "lazy", (2) Gradual reduction of steroids to stimulate production of glands again
5. Common medicines

a. Prednisone (Deltasone, Paracort, Meticorten)
b. Prednisolone (Sterane, Delta-Cortef)
c. Methylprednisolone (Medrol)
d. Beclomethasone (Vanceril, Beclovent)
  • Inhaled into lungs
  • Avoid side effects of steroids taken by mouth
  • Disadvantages: (a) Difficult for small children to use, (b) Not effective for acute attacks of asthma, (3) May irritate the throat, (4) May allow thrush to develop in mouth
E. Other medications

1. Decongestants and Antihistamines
a. Given for relief of congestion and/ or allergic rhinitis
b. Many brand names
  1. Antihistamines: (a) Chlortrimeton, (b) Teldrin, (c) Atarax, (d) Benadryl
  2. Decongestants: (a) Sudafed
  3. Combination (Antihistamines and Decongestants): (a) Drixoral, (b) Actifed, (c) Dimetapp
c. Side effects
  1. Drowsiness
  2. Hyperactivity
2. Anti-Cholinergics

a. Atropine
  1. Inhaled
III. Administration of medicine

A. Take as prescribed by physician
B. Learn all about the medicine
C. Devise a system of taking medicine to help with compliance
  1. Self-care model

So you can see there have been a lot of changes as far as medicine is concerned when it comes to treating asthma since the 1980s. I was actually surprised to see Theophylline as the #1 asthma medicine, but I shouldn't have been. It was a top line medicine from the 1950s until about 2000.

This era was right at the peak of trying to prevent asthma attacks as opposed to just treating acute asthma symptoms. Yet it was known back then that airway swelling (inflammation) was involved in the acute asthma attack, it was not known asthma was a disease of chronic (always there) inflammation.

Theophylline is now rarely used, and Intal is off the market. Epinepherine is rarely used, replaced by Ventolin (continuous if necessary) in emergency rooms. All the other beta adrenergics listed above are no longer available due to side effects.

I was surprised to see that Ventolin, Azmacort and Atrovent weren't on the above list, as they were all on the market.  One reason may be (I'm guessing here) was that they were all under patent and more expensive than other options on this list.  Of course this list was made in 1981 and I was a patient in 1985, and was prescribed a ventolin inhaler and azmacort.

Some pretty good opitons were available back then.  We asthmatics were pretty fortunate compared to... well, we were just fortunate.

4 comments:

  1. I remember Beclovent! I was on it as a little kid in the early 90s. I remember that it was the first asthma inhaler I was started on that actually had much effect... the others didn't seem to dent my frequent trips to the ER or my chronic breathlessness, and even as a kid, I knew it helped a lot. It even let me get off of theophylline, which my parents were thrilled about! I have fond memories of beclovent, and I was very upset when it was discontinued in my area and I had to move to a fluticasone MDI - which didn't work nearly as well, though to be fair to fluticasone, it may have been because as a six-year-old, I didn't exactly have the coordination to use an MDI effectively, and my parents didn't know to get me a spacer, so probably, most of it ended up on my mouth and throat (which would make sense considering how often I got thrush back then...).

    Also, am I crazy here or was salbutamol ever available as a DPI? I remember my rescue medicine being in a blue DPI with the same sort of "rotacap" design that the Beclovent had at the time. But that may have been a different control med, and it might be that my six-year-old mind associated blue with rescue because where I'm from, salbutamol is always in a blue inhaler.

    Finally, was there ever an oral rescue medicine? My mother has mentioned they used to give me some sort of oral syrup rescue med when my flares were too bad for the puffer to work, as a last-ditch, "let's see if we can avoid the ER" thing... it never worked that I can recall (though since most of the time I was on it, I wasn't even school age yet, I'll admit my memory is far from reliable), and I remember that it had a horrible taste, but Mom said I tolerated it better than a puffer.

    Sorry for asking a bajillion questions, but this sort of stuff interests me. :)

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  2. I do believe albuterol used to be available as a DPI. Yet since DPIs cost too much to make, and since most asthmatics use their albuterol more than once a day, a DPI albuterol would not be cost effective. So cost is the reason albuterol DPI was discontinued.

    Yes, there were many syruppy asthma medicines. I know I used to take a syrup version of Alupent, and I know there used to be an Albuterol pill too.

    There was also a syrup version of Theophylline too.

    I do remember the horrible taste.

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  3. In the UK Aminphylline is used widely. I am on oral Aminophylline bd, and it is my wonder drug. If I stopped taking my tablets for a day I'd be super sick very quickly. When I arrive in the ER-and I just did on Sunday night, it's the first IV they hook up for me. I get 1g over 24 hrs and can feel it working immediately.

    Other archaic asthma meds I remember are Volmax-salbutamol tablets, oh and I used to have ventolin in syrup form as a teenager.

    And do you remember the rotahaler devices for ventolin rotacaps. weird and fiddly. Oh yes and then Ventadisks-what was that all about!

    I went through the whole rainbow of Beclamethasone inhalers too, in the 80s and 90s in the UK. They were beige, brown and red. The red one was super strong and was called Becloforte and it ruined my voice.

    The were replaced by Flovent and Serevent which of course then became Advair. Hooray for Advair.

    But just saying, I have an issue with landing in the ER in the US if they can't give me Aminophylline. Yikes!

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  4. I've been trying to remember the name of the syrup I used to take in the mid to late 1970s for my asthma. I haven' seen a name in the searches I've done that rings a bell. I want to say it was something that starts with an M and my mom said she remembers it being red. I remember that a spoonful always made me want to shake my head after I swallowed it. Maybe I'm mis-remembering. But I'm wondering now what the side effects might have been that took it off the market. The doctor that used to prescribe it is no longer available and there are no records.

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