- The Washington Times - Sunday, August 13, 2000

Before heading off to soccer day camp this summer, the Finkel brothers Adam, 13, Lonnie, 11, and Jared, 8 each took a hit off a long-acting inhaled bronchodilator each morning to fend off a possible asthma attack.

The brothers, who live in Potomac, all have varying degrees of asthma. Their mother, Aimee Finkel, has become used to the combination of allergy pills and inhaled medicines that the boys take.

"Having asthma used to be pretty daunting when they were younger," Mrs. Finkel says, "but they lead a pretty normal life. We are able to manage it through medication. That is the key to anyone with asthma find a good doctor and get on a good management plan. There is some magic with that, though. Different things will bring an attack on, and different things will calm it."

Most allergists follow the National Institutes of Health's guidelines for asthma medications, which means following a sequence for trying different drugs to see what works, says Dr. Richard Rosenthal, chief of the allergy section at Inova Fairfax Hospital.

"There are new drugs coming out all the time," he says. "It is important to determine the right combination and have adequate follow-up."

The first class of medications are the bronchodilators, which usually come in inhaled form and quickly stop the symptoms and asthma, particularly the wheezing and trouble breathing that may come with exercise, which is called exercise-induced asthma.

The drugs begin working in about five minutes and can be taken by young children. There are both short-acting drugs and long-acting drugs, which can last about 12 hours.

If a patient is relying on the short-acting bronchodilators several times a day, he or she may need to move on to a controller medication. These medications are inhaled anti-inflammatory agents or corticosteroids that prevent and reduce airway swelling.

A new class of controller drugs called oral anti-leukotrienes are taken in pill form. These drugs fight potent chemicals called leuko-trienes, which are found in the blood and are responsible for airway inflammation.

Adam Finkel, whose asthma is more severe than his brothers' cases, takes an oral anti-leukotrienes pill in addition to inhaled corticosteroids. He also takes a prescription allergy pill. His asthma, like many other children's, can be triggered by common hay fever.

About 50 percent of childhood asthma sufferers outgrow the condition. The other 50 percent may continue to have it into adulthood, but a majority of them will not need to take medication, says Dr. Gail Shapiro, a Seattle allergist and president-elect of the American Academy of Allergy, Asthma and Immunology.

As children grow, their airways naturally enlarge and their immune systems mature, enabling them to better tolerate obstruction.

Mrs. Finkel says Adam's doctors have indicated he is not likely to outgrow his asthma.

To accommodate all three of her sons, Mrs. Finkel has made environmental changes in their home. They no longer have a cat and have to be wary of even visiting a family with a dog, as Adam is "ridiculously" allergic to dogs. She took up the wall-to-wall carpeting and replaced it with wood floors and washable rugs.

Experience also is key to managing asthma, Mrs. Finkel says. After Adam finally was diagnosed after being hospitalized as a toddler, the Finkels are more aware of the symptoms and triggers for an asthma attack in all three of their sons.

With medication and proper changes around the house, the boys are able to lead very active lives. They play soccer, basketball, baseball and street hockey in addition to enjoying in-line skating and bicycling.

"They have not been raised to let asthma be a definition of who they are," Mrs. Finkel says. "Adam, for instance, is not a sick kid he is a healthy kid with asthma. You can never let it slide, though. There is no playing catch-up with asthma."

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