Prednisone only one of many asthma drugs

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DEAR DR. DONOHUE: My wife has had asthma since 1998. She weighed 130 pounds then. She has been on prednisone for a few years, and her weight has gone up to 174 and it is all in her middle. Is there anything besides prednisone that would work for her? – M.D.

ANSWER: Asthma makes people’s airways (bronchi) very sensitive to the slightest irritation. If they breathe things that wouldn’t bother the rest of us, their airways constrict, and that makes the passage of air into and out of the lungs difficult. The wheezing sound they make when they breathe is an indication of air obstruction. Furthermore, the mucous glands of their airways secrete copious amounts of thick mucus, another impediment to getting air in and out of the lungs.

Prednisone belongs to the cortisone drug family, the most powerful anti-inflammatory and anti-irritant drugs in medicine. High doses of cortisone drugs or their prolonged use has a number of distressing consequences. Protein breaks down, so muscles become weak and shrink. Fat redistributes; it moves from the arms and legs, and migrates to the back of the neck, the face and the stomach. Weight is gained. Blood pressure can rise. Skin becomes thin and develops stretch marks. Acne might appear. Women can sprout facial and chest hair. The ability to resist infection weakens. In some instances, when these are the only drugs that control a person’s asthma, then the side effects have to be tolerated.

However, there are many other asthma drugs, and your wife should be given a trial of them. She has to come off her prednisone slowly. Inhaled cortisone drugs have fewer side effects than oral ones. Proventil can dilate constricted airways during an asthma attack. Accolate, Singulair and Zyflo stop the body’s production of chemicals that incite inflammation. Theophylline has been used as an asthma medicine for many, many years. Atrovent is an inhaler medicine that has also seen long use. Your wife should inquire about whether she could use these drugs.

The asthma booklet provides more information on this condition. Readers can obtain a copy by writing: Dr. Donohue – No. 602, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: You mentioned gastric bypass surgery a while back. I also saw an article about a man who promoted the operation for seniors because Medicare might pay for it. My sister-in-law, age 67, had it done six months ago. She was at home for only a few days when she began having extreme pain. She was hospitalized and spent the next six months in intensive care and in the intensive-care step-down. She had many operations to close the hole that developed during surgery. Bile and feces flowed into her abdomen. She died yesterday.

I would not recommend this surgery for anyone. – D.S.

ANSWER: I can’t offer a satisfactory explanation of why this happened to your sister-in-law, nor do I have the words to ease her family’s and your pain. No surgery should be taken lightly. Bad things can happen no matter how skillful the surgeon is.

The problem with medicine is that people suffer when things go wrong. Women have died – and still do – during childbirth. You can imagine the anguish of all, doctors and family, when this happens. I am sure your story will make readers consider the seriousness of all operations, but it shouldn’t discourage them from surgical procedures that are necessary, including this kind of surgery.

DEAR DR. DONOHUE: I see and hear the words “cardiac arrest” used all the time. Is it the same thing as a heart attack? – R.S.

ANSWER: Cardiac arrest means a stopping (an arrest) of heart pumping. Quite often, it’s due to ventricular fibrillation, the fluttering of the heart’s pumping chambers. The erratically fluttering heart muscles cannot pump blood out of the heart.

They have to be shocked into coordinated muscle contractions quickly.

Cardiac arrest is sometimes the consequence of a heart attack, but the two are not synonyms.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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