MD (Medicine), FAMS, FCCP, FNCCP
(Former Professor & Head, Department of Pulmonary Medicine,
PGIMER, Chandigarh, India)
Jindal Clinics, SCO 21, Sector 20 D, Chandigarh, India 160020
Inhalational drugs constitute the mainstay for treatment of asthma and other obstructive respiratory disorders such as the chronic obstructive pulmonary disease (COPD). Asthma in particular commonly starts in childhood when drug administration with the use of an inhaler is considered a taboo. Parents get worried the moment they are advised to use an inhaler for management of a child’s problem of asthma. Similarly the other patients particularly the young individuals immediately pose the most frequently asked questions to the doctor: “Don’t you think that the inhalers are the addicting drugs? I do not wish to get addicted to them for the rest of my life”.
It is a genuine concern of any right thinking individual. Addiction is a dreadful habit which must be avoided at all costs. But do the inhalers truly end up in addiction?
Inhaler-addiction is a misconception – a wrong belief which somehow continues to propagate in spite of the evidence to the contrary. Addiction commonly results from misuse or abuse of drugs which act upon the brain to produce a stimulatory, euphoric, soothing or hallucinogenic effect. Importantly, an inhaler is only a device for administration of a drug used for asthma. It is not a drug by itself. Therefore, there is no question of inhaler-addiction. If at all, the addiction will happen to anti-asthma drug/s, and not the inhalers.
Why not give drugs by mouth as pills or syrups? The answer to this question is simple – the inhalational dose is several times smaller (in micrograms). Therefore, the side-effects are much less, almost negligible. This is particularly important in case of corticosteroids which are essentially required for maintenance treatment of asthma. Moreover, the inhalation produces a quick effect like a locally administered drug.
Corticosteroids remain the most feared drugs because of their numerous side-effects when used for prolonged periods. This fear is practically reduced to negligible when used in smaller doses by inhalational route. Unfortunately, there is no other good substitute to inhalational corticosteroids for treatment of asthma.
The misconception about inhaler-addiction is largely based on the fact that the treatment is required to be continued for longer periods, sometimes indefinitely. This produces a false notion that there occurs an addiction to the treatment. Factually, continued treatment is the essential requirement for disease-control. The continued use is not in any case akin to the use (or abuse) of an addicting psychotropic drug. This is one misconception which must be get rid off – the earlier the better.