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Albenza (Albendazole)

Asthma is a serious and potentially life-threatening condition. Over the years medical research has developed drugs which are both safe and effective in preventing the attacks occurring. It may seem strange therefore that the number of hospital admissions – and indeed deaths – is still increasing each year. I am certain the main reason is that parents are reluctant to let their children take medication on a regular basis because of the fear of side-effects. While this is generally an excellent principle, in asthma the situation is different. If a wheezing episode is prevented then not only does it save the child tremendous suffering but it also means that the much stronger drugs which must be used in an attack will not be necessary.
Let us consider Julie aged 4. Following her severe attack Julie’s parents were very concerned that it might happen again – they had been convinced at one stage that their daughter’s life was in danger. However, they were worried about any harmful effects of continuous therapy and asked me to explain the situation fully to them. Fortunately modern drug development has enabled the present preventive medicine to be breathed directly into the lungs using a small device called an inhaler – commonly known as a ‘puffer’. Until this technique was perfected, all anti-asthma drugs had to be given either in medicine or tablet form. These would be ingested in the stomach before passing into the bloodstream and would then travel through every part of the body, producing their various unwanted effects before finally arriving at the lungs. For this reason these drugs were slow to work and often associated with unpleasant side-effects. Contrast this with the newer medications which are inhaled directly to the trouble spot so their mode of action is very fast. As they are not absorbed into the rest of the body there are almost no adverse effects.
I reminded Julie’s parents that there were two main changes in the lungs during an asthma attack. Firstly there is a tightening – or spasm – of the muscles in the breathing tubes, and secondly the lining of these tubes becomes swollen. The effect of both of these factors is to make the airways much narrower, so the child becomes short of breath and wheezy. The preventive medication that has been developed is aimed at stopping this spasm and swelling from developing. It may not be necessary for your own child to have both forms of treatment; in Julie’s case I suggested she should start on an inhaler only to stop the spasm. Particularly effective is a substance known as Intal which must be taken between two and four times a day. When this was discovered it completely revolutionized the management of asthma as here was a method of controlling the condition without the risk of side-effects. It is taken through a special kind of inhaler called a ‘spinhaler’.
Intal is a dry powder, and a measured dose is contained in a small plastic capsule. This is inserted into the spinhaler and is punctured by sliding a small cutting device. The end of the inhaler is then placed in the child’s mouth and when the next breath is taken the Intal powder is sucked into the lungs. I showed Julie how to do this but as often happens in young children she was not very keen at first. This reluctance was easily overcome by attaching a whistle to the end of the spinhaler so when she inhaled a loud whistling sound was produced. Naturally this was great fun and all her previous inhibitions were soon forgotten!
By using this Intal spinhaler three times a day Julie was able easily to control her asthma. Her mother asked how long it would be necessary for Julie to stay on this treatment and I warned both her parents never to become complacent about this condition. The problem with being well controlled is that it is difficult to tell whether the child has grown out of the asthma or if the improvement is solely a result of treatment. It is vital therefore never to stop Intal suddenly, and I usually recommend six months to a year of continuous use, free from attacks, before a reduction is made. Even then it is important to reduce the doses in stages.
Generally Intal is very easy to use, but one of the difficulties I found at home with my children was that if the capsules became damp, the cutting device in the spinhaler would not puncture the plastic. The design does not allow you to see if this has happened and sometimes my son Ross would become exasperated when sucking away at his inhaler only to find nothing coming out.’ There is no option when this happens but to go back to your doctor for another prescription. The capsules are supplied in a damp-proof container, but children tend to forget and leave the top loose which allows the moisture to seep in.

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