My son has a moderate allergy condition. His doctor has given him two inhalers to use. The first is called Intal and he is to use it three times daily. The other is Proventil. I believe that this is to be used on an as needed basis. However, there is some confusion within the family as to when this medication should be used. I have found that on occasion, the Proventil has been used when it may not have been needed. Is the Proventil dangerous when used in this manner? Thank you in advance.

Asthma is one of the most common disorders affecting children. As many as 10% of children have some degree of asthma, and the number has been rising steadily since about 1980. Thankfully, advances in the diagnosis and treatment of asthma have dramatically improved life for these children. Today most children with properly managed asthma can lead a life unhindered by their disease. It shouldn't hold them back from even the highest levels of athletic competition, as recent Olympic Gold Medals have shown.

Having said that, the death rate from asthma increased 46% in the last decade in spite of these treatment advances. A major cause of this increase in mortality is improper use of inhalers. Often children are handed several inhalers and never really understand the different functions and uses of each one.

Asthma is a chronic lung disease characterized by tight airways -- a result of airway hyper-responsiveness. Our airways are designed to be responsive to harmful substances in the air. If we walk through clouds of smoke, our airways will shrink, protecting our delicate lung tissues from the noxious ingredients in the smoke. They should return to normal when we begin to breathe fresh air. People with asthma have an exaggerated tightening response.

Different people with asthma respond to different "triggers," such as smoke, allergens, air pollution, irritating fumes, viral infections, or cold air. When we exercise, we breathe rapidly and are unable to bring air temperature all the way up to 98.6 degrees -- particularly if we breathe through the mouth. Thus asthmatics who are sensitive to cold air will often wheeze with exercise. (Wheezing, the classic asthma symptom, is the noise made by air moving through these tight airways.) Because asthmatics respond differently to different triggers, their airways are tighter at some times than at others. Reducing exposure to triggers can be a powerful way to improve asthma and reduce the need for medications.

Hyper-responsive airways tighten in three ways in response to triggers. First and most immediately, smooth muscle surrounding the airways constricts, narrowing the caliber of the airways. Second, the airways are narrowed by inflammation and swelling of the airway lining. This leads to the third component of airway narrowing, which is the accumulation of mucus and other fluids, which can plug the airways.

The goal of asthma therapy is for children to maintain their normal activity levels while free from symptoms such as wheezing, coughing, or breathlessness. The different inhalers that you mentioned, albuterol (Proventil or Ventolin) and cromolyn (Intal) belong to two different classes of asthma medications which work entirely differently. Albuterol (Ventolin or Proventil) works almost instantly to relax the smooth muscles surrounding the airways. It quickly opens the airways and reduces symptoms.

Unfortunately, its success is its greatest danger.