Asthma inhalers bring tremendous relief to wheezing patients, and advances in recent decades have made them more effective. But they're also more complicated, requiring careful use.

Here's what you need to know about this chronic lung disease:





Some people simply stick an inhaler in their mouth, trigger it and breathe. But they won't get much benefit if the medicated spray doesn't get to their lungs, cautioned Dr. Michael Niederman, chairman of the department of medicine at Winthrop-University Hospital in Mineola.

"Ideally, you want them to exhale fully, start to breathe in a stream of air" and then trigger the inhaler, he said. Then, they should hold their breath as long as they can.

Plastic "spacer" devices, which are available by prescription, can be attached to an inhaler and allow the spray to more effectively reach the lungs, he said. If you'd like to use one, ask your doctor.

If you're using an inhaled steroid, such as Flovent or Pulmicort, or a combination drug like Advair that includes an inhaled steroid, it's important to rinse out your mouth and gargle after each use. That's because use of the drugs can lead to thrush, a yeast infection in the mouth.





For people with breathing issues, a visit to the doctor often includes a lung-function test to determine how much air they're taking in and exhaling. You can do this at home, too, with the help of an inexpensive device known as a peak-flow meter.

By breathing into the device, patients can measure their own airflow and determine if their airways are congested, said Dr. Benjamin Leeman, a pulmonologist in Valley Stream. The devices help people with asthma understand their typical level of breathing power and detect if it changes, he said. If the numbers are low for that patient on a particular day, that could be a sign that the person should launch a "pre-emptive strike," Leeman said, and use an inhaler on a preventive basis.





Some inhalers come with counters that keep track of the number of doses that have been used. These can be useful, Leeman said, because they allow the physician to track how often the patient needs to use the inhaler.

"If they get a prescription and come back within a week or two, I can see how much they used," he said. "If they're using them at full throttle, or close to that, they're not well controlled." That could be an indication the patient should be using a different type of inhaler, he said.

According to Leeman, it's fine to ask your pulmonologist if an inhaler with a counter is available.





Some people feel reassured when they use a nebulizer, which creates mist as it delivers asthma medication to the lungs. But "studies have shown that most of that mist that's being propagated is just going into the room," Leeman said. That means it's not going into your lungs.

Nonetheless, Leeman said he does recommend nebulizers for some patients, such as the elderly and disabled, but most people "really benefit from the inhaler" instead.





Inhalers can cause side effects, including some that appear in people with chronic symptoms who use them over the long term -- which Niederman described as anything more than four weeks.

Possible side effects of inhaled corticosteroids (like Flovent and Pulmicort), which often are used over the long term, include a cough, hoarseness and thrush in the mouth.

Leukotriene modifiers (like Singulair), which also are used long-term, sometimes cause flu-like symptoms.

Federal health officials have warned about the use of a type of bronchodilator medication known as long-acting beta-agonists (LABAs), which often are found in combination drugs that also include inhaled corticosteroids (such as Advair and Symbicort). The U.S. Food and Drug Administration requires warning labels on LABAs because they may boost the risk for a worsening of symptoms that can lead to hospitalization and even death.

Niederman said it's "not clear" why these drugs have this effect, adding that some people "may use them instead of seeking medical help when they get sick, masking symptoms and delaying appropriate care." He also noted that "the risk is lower if the long-acting beta-agonists are used with inhaled steroids and not alone," which is in line with the FDA warning that LABAs should never be used alone.

What to do? "You've got to assess the risks relative to the benefits and get on the lowest dose that's still effective," Niederman said. "For patients who really need this, the benefits have been generally tremendous." That means asthma control -- "fewer attacks, less wheezing, less shortness of breath and better quality of life," he said. "There is also better exercise tolerance."



Pulmonary specialists



Dr. Daniel Baram

70 North Country Rd., Ste. 101

Port Jefferson; 631-473-0037

Dr. Dennis L. Bernardini

175 E. Main St.

Huntington; 631-424-3787

Dr. Alan I. Blum

444 Merrick Rd.

Fl. Lower Level 1

Lynbrook; 516-593-9500

Dr. David M. Breidbart

LSQ Medical Bldg.

6 Ohio Dr., Ste. 201

Lake Success; 516-328-8700

Dr. Michael L. Cohen

N. Shore Internal Med. Assocs.

560 Northern Blvd., Ste. 203

Great Neck; 516-482-0600

Dr. Alan Fein

2800 Marcus Ave.

Dept. Pulmonary Med.

Fl. 2, Ste. 202

Lake Success; 516-608-2890

Dr. Morton L. Glaser

60 North Country Rd., Ste. 203

Port Jefferson; 631-509-1888

Dr. Richard E. Gordon

Island Pulmonary Associates

4271 Hempstead Tpke., Ste. 1

Bethpage; 516-796-3700

Dr. Harly Greenberg

North Shore LIJ

Sleep Disorders Ctr.

410 Lakeville Rd., Ste. 107

New Hyde Park


Dr. Benjamin J. Leeman

20 W. Lincoln Ave., Ste. 306

Valley Stream; 516-599-8787

Dr. Steve A. Mermelstein

444 Merrick Rd.

Lower Level 1

Lynbrook; 516-593-9500

Dr. Alan S. Multz

2201 Hemptstead Tpke.

East Meadow; 516-486-6862

Dr. Ian H. Newmark

8 Greenfield Rd.

Syosset; 516-496-3001

Dr. Michael S. Niederman

222 Station Plaza N.

Ste. 400

Mineola; 516-663-2834

Dr. Mark J. Rosen

410 Lakeville Rd., Ste. 107

New Hyde Park; 516-465-5400

Dr. Rita B. Schulster

442 E. Waukena Ave.

Oceanside; 516-599-8234

Dr. Howard Sklarek

325 Meeting House Lane

Bldg. 1, Ste. K

Southampton; 631-283-8008

Dr. Harry Steinberg

410 Lakeville Rd.

Ste. 107

New Hyde Park


Dr. Lawrence A. Walser

185 Old Country Rd.

Ste. 3



Dr. Gary Wohlberg

370 E. Main St., Ste. 5

Bay Shore


Dr. Perry A. Wyner

2 Lincoln Ave., Ste. 201

Rockville Centre


Dr. Henry Zupnick

158 Hempstead Ave.





How they were picked


Castle Connolly Medical Ltd. is a health-care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and top hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of top doctors and the medical leadership of leading hospitals.

Castle Connolly's physician-led team of researchers follows a rigorous screening process to select top doctors on both the national and regional levels. Its online nominations process -- located at nominations -- is open to all licensed physicians in America who are able to nominate physicians in any medical specialty and in any part of the country, as well as indicate whether the nominated physician is, in their opinion, among the best in their region in their medical specialty or among the best in the nation in their medical specialty.

Careful screening of doctors' educational and professional experience is essential before final selection is made among those physicians most highly regarded by their peers. The result -- Castle Connolly identifies the top doctors in America and provides the consumer with detailed information about their education, training and special expertise in their paperback guides, national and regional magazine "Top Doctors" features and online directories. Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors. (Newsday is not part of the selection process.)

Physicians selected for inclusion in this "Top Doctors" feature may also appear as Regional Top Doctors online at, or in one of Castle Connolly's Top Doctors guides, such as America's Top Doctors® or America's Top Doctors® for Cancer.



To see the whole list . . .


Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to, or call 800-399-DOCS.

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