Intended for healthcare professionals

Student Education

Hidden confusion: the options for treating asthma

BMJ 2002; 324 doi: https://doi.org/10.1136/sbmj.0204104 (Published 01 April 2002) Cite this as: BMJ 2002;324:0204104
  1. Daniel Aston, fourth year medical student1
  1. 1University College London

Asthma treatment involves a bewildering array of factors. Daniel Aston tries to clear a way through the quagmire that is inhalers, guidelines, drugs, and more…

For a respiratory consultant who sees patients with asthma every day it is probably second nature to prescribe a “Ventolin metered dose inhaler with a Volumatic spacer.” They will know that the patient will soon be happily inhaling salbutamol because the two devices fit together properly and the correct drug has been prescribed.

For medical students attached to a respiratory firm for less than two months, it is difficult not to envisage prescribing a “Serevent metered dose inhaler with a Nebuhaler spacer” in the hope that the patient will somehow be able to get a good dose of fluticasone from them.

Confused? Not surprising, as asthma treatment is a confusing business to all but the very experienced. This article will try to clear up some of the confusion and explain some of the other points about treating asthma.

Criteria for prescribing an asthma drug by its trade name

  • The pharmacokinetics of a drug differ from one brand to another

  • The therapeutic range is close to the toxic range

  • The toxic effects of the drug are potentially serious

The drugs

Generic or brand name?

The British Thoracic Society's guidelines have been developed to provide a structured approach to treating asthma.12 However, with the vast array of drugs--and devices for administering them--the reality of treating asthma may seem more complicated and confusing than a glance at the guidelines first suggests. Each drug has a generic name and a trade name, and there is more than one drug for most indications.

The first step of the guidelines recommends that the patient is started on a short acting β2 agonist. The physician then has a choice between salbutamol and terbutaline (generic names)--that is, tradenames Ventolin and Bricanyl.

In step two of the …

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