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Treatment of Bronchial Asthma by Ventolin Inhalers
Various drugs and methods have been used in the treatment of asthma in Japan. The basic treatment in Japan is presumably similar to other countries. For symptomatic treatment, bronchodilators which include β-agonists and xanthine derivatives, are considered to be the first choice drugs. Steroids are used for intractable or life-threatening asthma. Other medications include anticough preparations, expectorants, and anti-cholinergic drugs. For prophylaxis, disodium cromoglycate or similar anti-allergic drugs are used. β-agonists, steroids and anti-cholinergic drug inhalation are also used for the prevention of asthma. Chinese herb medicines, calcium antagonists, hyposensitization therapy, gold salt, histaglobin, acupuncture, and moxibustion have also been used to some extent in Japan.
β-agonists
Many β-agonists have been used in Japan. For instance, epinephrine, isoproterenol, metaproterenol, trimetoquinol, terbutaline, salbutamol, tulobuterol, and procaterol are available. Trimetoquinol was discovered in 1967 and other Japanese products, namely tulobuterol and procaterol, have been used in the last several years. The available p-agonists are long acting and specific to β-receptors, resulting in fewer side effects. Oral preparations are the most commonly used form of beta-agonist in Japan (Fig 1). Asthma treatment is a long-term and undertaking process. The treatment may be begun with asthma ventolin inhalers online. It means that you may order inhalers via the Internet.
Ventolin Inhalers of p-agonists has been used for acute asthma attacks and is considered the first choice in such a condition. The number of inhalation puffs should be limited to several times in a day. Recently, there has been a trend to use inhalers for prophylaxis. For instance, the inhalation of P-agonists has been used three to four times in a day for chronic asthmatic patients, even though no wheezing or shortness of breath is clinically experienced. The mild airway obstructive changes may not be recognized by the patients, but, if not treated, may precipitate an acute asthmatic attack. Consequently, the prophylactic use of cartridge inhalers is quite popular in Japan.
Injection of β-agonists is limited in Japan. Only epinephrine has been injected during an acute asthmatic attack. Susphrine provides rapid and sustained action of epinephrine, but has not been adopted in Japan. The sublingual route of isoproterenol and rectal suppository of salbutamol or other forms of P-stimu-lants are not used in Japan.
Xanthine Derivatives
Aminophylline is available for intravenous, oral and rectal administration. Intravenous aminophylline is widely used to control the acute attack. Rectal use has only very limited value, since Japanese people are not accustomed to using suppositories. Overall, the use of xanthine preparations is still quite limited (Fig 2).
At the present time, the number of xanthine derivatives available is limited in Japan, although long-acting drugs such as Theodur are available. The use of a β-agonist or xanthine derivative alone is appropriate if effective. In many situations, however, a combination of both drugs is necessary to achieve adequate effectiveness, and combined usage of β-agonists and xanthine derivatives is common practice in Japan as in many other countries. Long-acting theophyllines have been adopted in Japan and the dose is monitored according to the clinical response and blood level. Measurement of theophylline blood levels has become popular in Japan.
Steroids
In life-threatening asthma, use of corticosteroids are essential. Their potentially serious side reactions, when used systemically, limit such use to those situations when other measures do not provide sufficient control of symptoms. Repository injectable preparations of steroids such as triamcinolone are available and convenient in some acute cases, as asthmatic symptoms subside for several weeks following the single injection of 20-40 mg. However, these preparations should be used cautiously since profound and long-lasting adrenal suppression is observed.
Aerosol steroids such as beclomethasone dipropionate have been used in Japan for more than ten years and have proved quite effective in controlling asthma. While useful in reducing the need for systemic corticosteroids, there is no place for this aerosol in the treatment of an acute attack. Because of the general prejudice against using steroids, steroid inhalation has not been popular among general practitioners in Japan; however, there is an increasing frequency of use of aerosolyzed steroids. The number of steroid-dependent patients in Japan is estimated to be less than 1 percent.
Figure 1. Proportion of different forms of p-stimulants in Japan.
Figure 2. Proportions of bronchodilators and anti-asthmatic drugs used in Japan.
