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Bronchodilators are medications that relax the bronchial muscles. Relaxing these muscles makes the airways larger, allowing air to pass through the lungs easier. This helps people with COPD breathe better. Many different kinds of bronchodilators are available. They can be grouped according to how long they work (called short- and long-acting drugs) or the way in which they widen or dilate the airways (beta-agonists, anticholinergics or theophyllines). While all bronchodilators widen the airways, they work in different ways to do so. It is therefore possible to combine bronchodilators in order to achieve maximal benefit. Many people with COPD experience constant breathing difficulty. Bronchodilators therefore need to be taken regularly to keep breathing under control, this is called maintenance medication. Conversely, reliever medications are used for temporary breathless.
What kinds of bronchodilators are there?
The three main groups of bronchodilators are beta-agonists, anticholinergics and theophyllines. Bronchodilators are important in treating the symptoms of COPD, such as breathlessness, cough and sputum production. People with COPD are generally prescribed at least one bronchodilator, however, sometimes two or three medications are needed to control symptoms. Bronchodilators can also be used to "relieve" worsening symptoms. Reliever drugs are usually short acting and, therefore, are not the best way to control day-to-day symptoms. In order to give you regular control or to maintain your breathing, these shortacting bronchodilators would have to be taken frequently, day and night, 24 hours a day. This is not very practical for most people. It is unusual to find two people with COPD on the same program of medication. Some need bronchodilators from only one group, while some need bronchodilators from all three groups. For example, a person may need a beta-agonist as well as an anticholinergic and a theophylline drug. The number of different bronchodilators people with COPD need depends on how well their symptoms are controlled.
MECHANISM OF BRONCHODILATOR DRUGS
Inhaled allergens stimulate sensory nerve endings called irritant receptors lying below the airway epithelium. Stimulation of these irritant receptors causes parasympathetic nerves to release acetylcholine (ACh). When acetylcholine binds to M3 muscarinic receptors on airway smooth muscle, a series of events is initiated which results in an increase in intracellular calcium (Ca2+) and smooth muscle contraction (bronchoconstriction or bronchospasm) Some inflammatory mediators such as histamine (not shown in illustration) can also increase intracellular calcium and cause bronchospasm. There are drugs that can be used to counteract this bronchoconstriction.
Beta-2 agonist drugs bind to beta-2 receptors on airway smooth muscle and cause an increase in the concentration of cAMP in the muscle cell which results in smooth muscle relaxation. When airway smooth muscle relaxes, the diameter of the air passages is enlarged. Aminophylline blocks the action of phosphodiesterases and prevents the breakdown of cAMP to 5'-AMP. This also has the effect of relaxing smooth muscle and allowing the airways to dilate.
The bronchoconstricting effects of acetylcholine can be blocked by muscarinic antagonists such as ipratropium bromide. Muscarinic antagonists bind to muscarinic receptors and prevent acetylcholine from binding (see illustration). Bronchodilation can also be achieved by alpha-2 agonist drugs that bind to alpha-2 receptors on parasympathetic nerves and prevent acetylcholine from being released. The following schematic illustrates the mechanism of action of the various types of bronchodilator drugs.
What Are Steroids?
Drugs commonly referred to as "steroids" are classified as anabolic (or anabolic-androgenic) and corticosteroids. Corticosteroids, such as cortisone, are drugs that doctors typically prescribe to help control inflammation in the body. They're often used to help control conditions like asthma and lupus. They're not the same as the anabolic steroids that receive so much media attention for their use by some athletes and bodybuilders. Anabolic steroids are synthetic hormones that can boost the body's ability to produce muscle and prevent muscle breakdown. Some athletes take steroids in the hopes that they will improve their ability to run faster, hit farther, lift heavier weights, jump higher, or have more endurance. In the United States, it is against the law to use anabolic steroids without a prescription. Androstenedione, or "andro," is a kind of anabolic steroid taken by athletes who want to build muscle. But research suggests that andro taken in large doses every day can significantly increase levels of testosterone, which can lead to a number of health problems.
How Do Anabolic Steroids Work?
Anabolic steroids are drugs that resemble the chemical structure of the body's natural sex hormone testosterone, which is made naturally by the body. Testosterone directs the body to produce or enhance male characteristics such as increased muscle mass, facial hair growth, and deepening of the voice, and is an important part of male development during puberty. When anabolic steroids increase the levels of testosterone in the blood, they stimulate muscle tissue in the body to grow larger and stronger. However, the effects of too much testosterone circulating in the body can be harmful over time.
Dangers of Anabolic Steroids
Steroids are dangerous for two reasons: they are illegal, and they can damage a person's health, especially if used in large doses over time. Also, the health problems caused by steroids may not appear until years after the steroids are taken. Although they might help build muscle, steroids can produce very serious side effects. Using steroids for a long time can negatively affect the reproductive system. In males, steroids can lead to impotence, a reduction in the amount of sperm produced in the testicles, and even reduced testicle size.
Females who use steroids may have problems with their menstrual cycles because steroids can disrupt the maturation and release of eggs from the ovaries. This disruption can cause long-term problems with fertility. Steroids taken for an extended period of time also can cause: stunted growth in teens (by causing bones to mature too fast and stop growing at an early age) liver tumors abnormal enlargement of the heart muscles violent, aggressive behavior and mood swings blood lipid abnormalities that contribute to heart disease acne (or a worsening of acne) increased breast growth in males, especially teens irreversible stretch marks a heightened tendency for hair loss and male-pattern baldness muscle aches Teen girls and women risk these additional side effects: male-type facial and body hair growth and male-pattern baldness deepening of the voice enlargement of the clitoris
Drug Testing In addition to the health risks, kids who use steroids without prescription are breaking the law. Drug testing for all athletes has become more prevalent, and those who fail a drug test for steroids can face legal consequences, including jail time, monetary fines, exclusion from an event or team, or forfeiture of trophies or medals. Andro use has been banned by many sports organizations, including the International Olympic Committee, the National Football League, the National Basketball Association, the National Collegiate Athletic Association, the Association of Tennis Professionals, and most high school athletic associations. Talking to Kids About Steroids Many pressures may drive young athletes to experiment with steroids. Although most athletes exercise hard, eat properly, and take care of their bodies to maintain optimal fitness and performance levels, athletic competition and the desire to look physically toned and fit can be fierce. Help kids handle these pressures by: discussing healthy competition with them talking about the coaches' and team members' attitudes toward steroids knowing what kind of sports environments they compete in encouraging them to prepare mentally and physically for competition by eating well and getting enough rest
If you suspect your child is using steroids, watch for these warning signs: o o o o exaggerated mood swings worsening acne unusually greasy skin with stretch marks a sudden increase in muscle size
If you see any of these signs in your child, talk with your doctor. Steroids may give kids the sense that they're stronger and more athletic, but the consequences are too dangerous to risk. Help kids stay away from steroids by encouraging healthy eating and fitness habits that will help them feel well prepared for competition. When steroid use among pro athletes is in the news, use that as a launching point to discuss the issue, making sure your child understands the health risks, the possibility of legal trouble, and the concept that using steroids is cheating.
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