History of medication
In 1949, a scientist called Hench and his team developed synthetic cortisone, which mimics the body’s own naturally produced steroid. They were later awarded the Nobel Prize for Medicine for their achievements. Although steroids were introduced in the 1950s, there was very little known about what the correct dosage should be. As a result, large doses were prescribed resulting in many side effects. As soon as patients came off steroids, they suffered relapses and so required long- term treatment for control of asthma.
The serious side effects caused medical professionals to switch to bronchodilator reliever drugs as the favoured treatment for asthma. Reliever medication has a very powerful, quick acting effect, relaxing muscles to force the airways open. One puff of a short-acting reliever, such as Ventolin, will bring relief for three to four hours. The premise was that by taking a reliever on a regular basis, control could be maintained over the long term. However, over time, it was realised that this too may not be the best approach.
The relationship between an increase in the death rate and the increased use of reliever medication has been well documented. For example, deaths in Britain rose from 1,500 a year to 2,000 a year while prescriptions for reliever medication increased from eight million to 15 million.9 In New Zealand an epidemic of asthma deaths occurred during the ‘70s and ‘80s believed to be caused by the reliever drug Fenoterol. Studies concluded that patients who used Fenoterol had a far greater chance of suffering a fatal asthma attack than those who didn’t. While this drug has been banned in New Zealand, it is still prescribed in Britain.10, 11, 12, 13
Overuse can be classified as taking more than three puffs of Ventolin per day. If this is the case then reduced breathing should be applied intensively. If it is not proving possible to reduce the need for reliever medication to three puffs within a short time, then preventer medication is necessary for a short period.
Taking a large quantity of reliever inhaler every day leads to increased tolerance to the medication.14 There is a great risk with this, as the reliever eventually may not work in an emergency situation.15, 16 Overuse of reliever medication has been described as putting paint on rust; the symptoms are suppressed while the underlying condition gets progressively worse. The body fights back because the protective mechanism is removed by the reliever. This results in greater difficulty maintaining control and increases the risk of a serious attack.
Regular use of short-acting reliever inhalers leads to increased exercise induced bronchoconstriction.17 This is not particularly well known among many sports coaches who always recommend taking reliever medication before exercise. The continuous use of reliever medication will in the long term exacerbate exercise-induced asthma. If reliever medication is required before exercise it begins to cause chronic hyperventilation and therefore the likelihood of having an attack during exercise is high. It would be far safer to refrain from competitive sport until the control pause is high and it is possible to participate in exercise without the need to take the inhaler beforehand. Alternatively an exercise such as walking that does not require advance reliever medication should be chosen. See the section on sport for how to prevent an asthma attack during exercise.
Towards the late ‘80s, the emphasis switched back to using steroids but this time in far smaller doses administered by inhaler; reliever medication was to be taken only when needed.
This change has reduced the death rate and highlights that it takes many years of trial and error before medical drugs are introduced and before the effects of them are fully known. When drugs are initially tested, it is for a relatively short period of time and just on a small sample of the population, maybe one or two thousand.
Since the 1990s there has been a decrease in the death rate directly as a result of introducing steroid inhalers. Steroids can cause side effects when taken in large quantities and over a long period of time. However, the quantities involved in inhaled steroids are too low to generate concern. Some people are very hesitant of taking steroids partly because of the mistakes made in the ‘60s and partly because of the misconception that they may be anabolic steroids. However, if you require inhaled steroid, the risk from not taking it is far greater than from taking it. Reliance on reliever medication causes irreversible damage to the airways and increases the risk of serious and fatal attack. Once admitted to hospital, the amount of steroids administered would be a lot greater, so it makes more sense to manage asthma with a small quantity of inhaled steroid in the long term to avoid this risk.
The human body produces natural steroids in the adrenal cortex located on the outer surface of the adrenal gland. Without this natural steroid, the body would cease to function. It is believed by Professor Buteyko that hyperventilation causes the adrenals to produce fewer steroid than what is required by the body. As a result there is a need to supplement the difference between what the body produces and what is required with synthetic steroids. While the direct relationship between hyperventilation and inflammation may never be proven, scientific trials have demonstrated a reduction in the need for steroids when hyperventilation is reduced. For example, the volume of breath per minute of the Buteyko group at the trials at the Mater Hospital, Brisbane, was 14.1 litres. After three months, this had reduced to an average of 9.6 litres and the need for steroids had reduced by forty-nine percent.
Since the mid 1990s long-acting bronchodilators and combination inhalers containing this medication have become very popular. Common long-acting bronchodilators are traded under the brand names of Serevent, Oxis, Spireva and Foradil. On January 23rd, 2003 the Food and Drug Administration (FDA) in the US announced: “The drug [Serevent] may be associated with an increased risk of life-threatening asthma episodes or asthma related deaths, particularly in some patients.”18 Then, on August 14th, 2003 the Reuters newsagency headline read: “New warnings added to Glaxo Asthma Drugs” and the report declared that “Serevent and Advair will carry new warnings about a higher, though small, risk of life-threatening asthma attacks and deaths, U.S. regulators said.”