Long-term treatment of asthma and its influence on driving

The greater the knowledge of asthma by the patients and their relatives about the triggering factors and the appropriate drugs and doses and administration routes, the better these patients will be.

The drugs most commonly used are

• Beta-adrenergic agonists such as isoetarin, terbutaline, salbutamol, orciprenaline, fenoterol, salmeterol, and isoprenaline. Its potential side effects are paradoxical bronchospasm, mild hand tremor, headache, hypotension, and tachycardia, palpitations and possibility of arrhythmia such as atrial fibrillation and muscle cramps. Sleep disturbances and behavior disorders have been seen, including agitation, hyperactivity, and restlessness. Formoterol fumarate can cause tremor and agitation interfering with driving.
• Methylxanthines such as theophylline and its derivatives can be administered orally, and dose titration is sometimes not easy and changes with age, liver insufficiency, heart decompensation, cor pulmonale, and fever. Many substances such as tobacco and drugs including phenobarbital and diphenylhydantoin, also influence reducing the half-life of theophylline. Erythromycin, allopurinol, cimetidine and propranolol have the contrary effect. Its possible side effects, particularly with plasma levels over 20 mcg/ml, are nausea, vomiting, diarrhea, epigastric pain, intestinal bleeding, and hematemesis. Also symptoms of central nervous system stimulation, with irritability, nervousness, headache, insomnia, muscle spasticity, reflex hyperexcitability and sometimes generalized tonoclonic seizures. Cardiovascular symptoms sometimes occur, including palpitations, tachycardia, extrasystoles, or ventricular arrhythmia, peripheral vasodilatation, and hypotension. In order to prevent the symptoms, serum levels of the substance must be measured, with the subsequent dose adjustment.
• Glucocorticoids such as budesonide and beclomethasone are the most common in inhalations, are well tolerated at the standard doses, and their side effects such as irritative cough or dysphonia are poorly significant. Other oral corticoids used in severe asthma, always at the lowest dose required, are prednisone and methylprednisolone. The possible side effects in long-term treatments are Cushing syndrome, hyperglycemia, osteoporosis, hypertension, edema, psychotic states, muscle atrophy, cataracts, glaucoma, peptic ulcer, digestive bleeding, aseptic bone necrosis, thrombosis, etc.
• Sodium cromoglycate is useful as long-term treatment or prevention, and is administered in inhaler or nebulizer. It can cause sneezing, burning, or irritation, and less frequently nausea, headache, bronchospasm and epistaxis.
• Anticholinergics such as atropine and related compounds of ipratropium type are applied in aerosol. They can cause dry mouth, sore throat, cough or allergic reactions and paradoxical bronchospasm. In patients with narrow angle glaucoma, intraocular pressure elevation can occur if the substance enters the eye. The advent of meters for home measurement of peak expiratory flows guide in the treatment regimen, in the appropriateness of asking the physician, and surely in the pulmonary capacity of the driver before starting the car. At present the international guidelines prepared for the approach of asthma base their therapeutic strategy on following the severity of the patient, considering two main symptoms that are the daily number of rescue drug inhalations with corticoids and the number of night awakenings.

Advice on Long-term treatment of asthma

• The patient with severe asthma cannot drive.
• The patient not resting for nocturnal episodes of undiagnosed asthma is at a higher of falling asleep when driving if this situation is compounded by the frequent self-medication with antihistamines causing somnolence.
• The asthmatic patient used to managing his drugs can abuse of the dose in quantity or frequency, expecting to obtain a faster benefit, but does not know the side effects of the drugs.
• Physicians should warn the patient of the side effects of antiasthmatic drugs and their interference with driving, since although respiratorily the patient feels well to drive, pharmacological symptoms would disable him from driving safely.
• The asthmatic patient should take a copy of the physician’s report in the car, so that in case of emergency he can be adequately assisted.
• If the asymptomatic asthmatic driver notices the start of difficult breathing, he must park the car as soon as possible in an area free from accidents, relax, take the medication and, if he does not improve, ask for help.
• From the above, it is concluded that should we advice our drivers about the added risks caused by asthma and its treatment, many accidents could be avoided.