Closely linked to allergies, asthma is a chronic inflammatory disease that makes a person’s airways (bronchial tubes) particularly sensitive to irritants. During an asthma episode, an individual might experience a tightening in the chest or a cough, shortness of breath or wheezing. It is often difficult for the asthma sufferer to move air in and out of the lungs.

Asthma triggers may be allergens but may also be other environmental factors such as pollution, strong odors or weather changes. Stress or illness may also trigger an asthma episode. What actually triggers an asthma flare up can vary greatly from person to person.

Asthma affects people of all ages. However, it is the leading chronic illness of children in the United States and the leading cause of absenteeism due to chronic illness.

Asthma affects people of all races. However, African Americans are more likely than Caucasians to be hospitalized for asthma attacks and to die from asthma.

A trusted adage in management of pregnancy is to take as few medications as possible. This paradigm developed after the thalidomide disaster in the early 1960s that resulted in many horrifying birth defects. In managing diseases like asthma during pregnancy today, however, one can expect fewer birth defects by using appropriately selected medications. While there are still too few data assessing the actual risk of medications to unborn children, the past twenty years have shown how important it is to reduce swelling and inflammation in the lungs. Many studies have compared benefits of taking inhaled steroids versus not using preventative medication. Results consistently show better outcomes for both mother and baby by emphasizing this paradigm: "Keep mom free of asthma attacks and lessen the chance of dangerously low oxygen levels for the fetus." In other words, the danger of untreated asthma far outweighs the potential danger of the medication.

A few asthma medications, including Pulmicort and Singulair, are FDA Pregnancy Category B. The FDA Pregnancy Categories were established to aid physicians in selecting medications with the least risk for pregnancy. Although the categories are useful, "the letters imply a gradation of risk that doesn't necessarily exist," says Dr. Sandra Kweder, the FDA's deputy director of the office of new drugs. I don't know anything that is Pregnancy Category A except pre-natal vitamins. Category B may imply better safety than Category C or D, so we often consider using them first. Nonetheless, allergists are comforted by the consistently good safety results of Pulmicort. Does that mean every woman with asthma should change to Pulmicort before attempting pregnancy? No, that's a decision best left to the doctor and patient. So the take home message is, "Breathing for two can be made easier with appropriate use of medications."

Many patients with asthma have had trouble getting their generic albuterol inhalers filled. The propellant of the generic albuterol is chlorofluorocarbons (CFCs), and all CFC-containing albuterol inhalers in the United States must be withdrawn by the end of 2008. Replacing them are albuterol HFA products. The HFA propellant does not damage the ozone like CFC's do. Further, the HFA is a better propellant; it places albuterol into solution, rather than suspension like CFC's.

Better dissolved, the albuterol can penetrate into deeper parts of the lung, allowing for better dilatation of the breathing tubes. Since no HFA albuterol is generic, they are more expensive to buy; however, the ProAir HFA brand has a $15 discount voucher you can print out at its website, www.proairhfa.com. Temporarily, there is also a link to get a whole prescription of ProAir HFA for free on the same web site.

You'll still need a prescription from your doctor. HFA's feel different from CFC inhalers. They're not as cold, and they come out at 40 mph instead of 70 mph. That makes it easier to inhale them into the lungs instead of having most of it whack into the back of your throat. But you have to rinse out your HFA device with running water every few weeks or it may clog up. Instructions are available online at www.proventilhfa.com. Their site also has a $15 rebate you can print out, and temporarily also has a transition kit that includes a voucher for a whole prescription of Proventil HFA for free.

Some patients really prefer the old inhalers. For them, I recommend asking their doctors to consider changing them to Maxair Autohaler or Alupent inhaler. Unlike albuterol, neither of those asthma rescue medications is affected by the 2008 deadline. According to the March 29, 2007 issue of New England Journal of Medicine, they are "subject to withdrawal in the future".

No matter which asthma rescue drug you use, if you're using it more than once a week, ask your doctor if you would benefit from an asthma controller inhaler. These wonderful additions prevent the swelling and inflammation that causes asthma in the first place.