The root of the allergy could be a slight malfunction in the immune system, having to do with essential fatty acids (EFAs). American immunologist and WDDTY panel member Leo Galland, who has performed a good deal of groundbreaking work in this field, cites several studies in Superimmunity for Kids (Bloomsbury £9.99) showing that children with asthma have difficulty converting EFAs into prostaglandins which regulate the function of the immune system. Prostaglandins are controlled by enzymes; a vital one in converting omega-6 EFAs into an intermediate stage from which they go on to become prostaglandins is D-6-D, or what Galland calls the Delta Force. Galland has found that in children and adults with allergic asthma (as well as eczema and hay fever) the Delta Force is much less active than normal. "As a result," he writes, "prostaglandin production is short circuited."
Drug treatment for asthma is given largely on a suck it and see (or more properly, an inhale it and see) basis, ending up with the patient taking a medicine chest of potentially lethal drugs. Recently the British Thoracic Society published new guidelines for following a "step" approach, only graduating on to the next step in terms of potency of drugs if the step before hasn't helped. It also advises that when control is established with one step, to consider moving down to the step below.
Step one begins with short acting inhaled beta2-agonists for patients who experience symptoms infrequently or with only mild exercise induced asthma. These adrenoreceptor stimulants cause the nervous system to act on adrenaline receptors throughout the body. But unless the drugs are highly selective, aiming only to stimulate "beta2" receptors (which relax bronchial muscles and reduce the chemicals causing inflammation) they can cause the heart to race and force it to produce larger quantities of blood, thus raising the blood pressure. In the past, doctors made use of non selective adrenoreceptor stimulants like adrenaline or isoprenaline, which work on the heart muscles. But other than for life and death emergencies, it's now agreed that drugs like adrenaline shouldn't be used since they can induce a heart attack.
The selective beta2-agonists of drugs are sold in the UK as salbutamol, or albuterol in the States (with brand names Ventolin ,Ventodisks or Salbulin), fenoterol (Berotec) and terbutaline (Bricanyl).
If inhaled beta2-agonists don't do the job or you find you're using them more than three times a week, the doctor moves up to step two, which includes anti inflammatories. Children are usually started on a six to eight week trials of sodium cromoglycate (Intal) three or four times a day. This drug, called a mast cell stabilizer, works by preventing the mast cells lining the bronchial tubes from releasing chemicals causing the bronchial muscles to contract. It is effective in preventing an attack from starting, but cannot treat an attack once it has begun.
A similar but more potent drug is deocromil (Tilade).
Most adults (and children who haven't been helped by the sodium cromoglycate trial) are placed on inhaled steroids, which are supposed to reduce the daily dose and hence the general risks of corticosteroids. These drugs include beclomethasone (Becotide) and budesonide (Pulmicort). This anti inflammatory drug is used concurrently with a beta2-agonist inhaled up to four times a day.