Q: There are many cases of asthma in my family. My father, who died at 93, had an extreme case of asthma from 1930. One day my sister saw an advertisement for pills called Asmotabs. He took one pill a day and no more asthma, even when he was around horses and cows on the farm.
A Camrose, Alta., doctor, now deceased, prescribed them, but the records are gone and other doctors have not heard of this medication. Can you help trace it for me?
A: I cannot find a record of this medication. Perhaps a reader can help. I think the pills probably exist under another trade name.
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Back in the 1930s, there were few asthma medications except for broncho-dilators such as theophylline (trade names Choledyl or Theo-Dur). These drugs widen the airways by relaxing the muscles in the bronchial tubes and improving the efficiency of the diaphragm. They are not recommended for people who have a tendency to panic since they can cause a rapid or even irregular heartbeat. They can also cause nausea and vomiting, and in rare cases, seizures.
There may have also been a few anticholinergic drugs around. Modern versions are known as Atrovent and Combivent. These are usually used in the form of inhalers.
Other more recent treatments for asthma include beta2 adrenoreceptor agonists. These include the commonly prescribed inhaled medication, Salbutomol. These are relatively safe and so are now a first-line treatment. They work by keeping the airways open by relaxing the muscles in the walls of the breathing tubes. Inhalers can be used at irregular intervals as needed.
If the asthma is thought to be due to allergies, sodium cromoglycate, or cromalyn, is effective. It comes in an aerosol solution or in a turbo-inhaler and works by preventing the release of the inflammatory substance histamine into the airways.
In extreme cases, corticosteroids may be necessary.
If there is an underlying infection, treatment with antibiotics may also be necessary. A recent study published in the journal Chest by researchers at the National Jewish Medical and Research Center found 31 of 55 chronic asthmatics showed evidence of infection with mycoplasma or chlamydia bacteria.
I will speculate that moulds found in barns and dusty hay might have the same effect. Researchers found after six weeks of treatment with the antibiotic clarithromycin, patients showed significant improvement in their lung function. The problem is that detection of these bacteria required nasty invasive procedures such as a bronchoscopy, which is not without risk.
The researchers did not recommend treating all asthmatics routinely with antibiotics, but felt they could be useful in cases where maximum doses of the standard medications are no longer working.
Chest is a journal published by the American College of Chest Physicians and can be viewed on-line at www.chestjournal.org.
Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
