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PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Controlla, controlla

You know what?  There are a lot of different respiratory medicines around—seems like a lot of people have trouble breathing.  And I’m not really talking about coughing; mostly I’m talking about being short of breath or wheezing. If you’re confused about keeping all these medicines straight, you’re like many of the patients that I’ve seen recently, and you aren’t alone. I’ve left work these past few times feeling like lots of folks are using their medicines incorrectly, and as a double whammy, the packaging looks alike.  And—sort of a true confession—I was also inspired to write on this topic when I heard that Drake song “Controlla.”  Alright.  You got me.

See, breathing medicines for people who wheeze regularly are divided into two categories:  rescue medicines and controller medicines (see recent Drake tune).

What I’ve noticed is that many people stop taking the controller medicine when they or their child aren’t having breathing difficulty, then start it up again when the wheezing or chest tightness begins.  Well, folks, that’s an excellent way for that medicine NOT to work.  The controller medicines are typically inhaled steroids (not anabolic steroids, rather an anti-inflammatory kind) that only go to the lungs and when given regularly decrease acute wheezing flares.  This means you have to use these medicines DAILY to achieve the desired effect.  They come in both inhaler form (like a pump spray) and nebulizer form (aerosolized via a machine).

In contrast, the RESCUE medicines are the bronchodilators.

These run the gamut from short acting medicines (albuterol is the most common one) that can be given frequently to long acting formulations that only need to be given once a day.  For MOST people, daily use isn’t needed, and these medicines are only effective when the airways are in spasm, which is part of what happens with wheezing/asthma.

So how do you know if you need a “controlla” medicine? (I kill myself! Haha.)  If your child needs to use the rescue medicine more than a few times a week and has regular nighttime awakening from symptoms, then it’s probably time to talk to your doctor about starting one.  Another day we should probably address the details on this, because it’s fairly well outlined.

During an acute flare, I like to tell my patients that if they are having to use the rescue inhaler more often than every 4 hours at home, then it’s time to get looked at.  In the monitored clinical setting these bronchodilators can be given continuously if needed, but I emphasize the word MONITORED here—it’s just not safe to be giving the rescue medications so often at home.

We could talk for hours about wheezing/asthma action plans and different nuances of medications, but mostly I wanted to write CONTROLLA a few times plus get the message out to everyone that you really need to know which medicine is which.  To review:

Inhaled steroid = CONTROLLA, needs to be used daily to be effective.
Inhaled bronchodilator = RESCUE medicine, during an acute flare.

 

If everyone could do a little bit better job at the discipline part of keeping this sorted then my guess is we’d all have a little more time for some groovy music, since we’d be spending less time dealing with our respiratory exacerbations.  I’ll jam to that.

 

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