Cromolyn (Inhalation)

Overview

Cromolyn is a type of mast cell stabilizer, and patients who use it experience fewer breathing complications, enabling them to lead a near-normal life, be it at home, school, or the workplace. People who suffer wheezing, shortness of breath, or any other asthma symptoms at least twice a week usually need to use this medication along with other appropriate prescription drugs.

An individual who is vulnerable to any asthma-like symptoms, including bronchospasm, may benefit from using cromolyn before the potential inhalation of allergens or particles like pollen, pet dander, and aspirin. Inhaling chemicals or dry, cold, or polluted air may also cause breathing difficulties, making it essential for a susceptible individual to use the antiasthma protection before exposure.

Exercise may also cause asthma-like effects that cromolyn can treat. Likewise, the treatment works for coughing, tightness in the chest, and similar symptoms that asthma may trigger.

It is imperative to note that cromolyn does not treat asthma; it just prevents it or controls its symptoms. So once a patient is under such an attack, they cannot turn to the drug for relief. The medication may sometimes be sufficient enough, making it unnecessary for a patient to include other similar medicines in their antiasthma regimen.

Cromolyn is a prescription-only drug that a doctor may prescribe along with other asthma medications, such as bronchodilators. Such drugs work by clearing narrow airways of the lungs so that victims can breathe better. Corticosteroids may also complement the therapeutic action of the treatment.

When in action, cromolyn impedes the activity of particular inflammatory cells in the lungs. In turn, these cells are unable to release specific natural substances in the human body, including histamines, which are often responsible for swollen air pathways and the resultant breathing difficulties.

For the best outcomes in managing asthma symptoms, the patient must use cromolyn regularly in strict adherence to the instructions from their doctor. Although the following content carries critical insights that a patient needs to know while researching viable treatment, only a healthcare professional can provide more precise medical advice and directions based on an individual, actual diagnosis.

Conditions Treated

  • Asthma symptoms
  • Bronchospasm

    Type of medicine

  • Mast cell stabilizer

Side Effects

Also called Intal inhaler, cromolyn may produce undesired outcomes in the patient using it. What the patient does next after experiencing side effects of the antiasthma medication depends on how severe or persistent they are.

A patient should get in touch with their physician right away if they experience rashes, breathing difficulty, itchy skin, wheezing, trouble swallowing, or hives while using cromolyn. The swelling of body parts such as the face, tongue, throat, or lips as an outcome of this treatment warrants immediate medical attention too. These side effects are rare though.

While it is not common for cromolyn to cause low blood pressure, shortness of breath, and tightness in the chest, these treatment complications can occur. Such effects are risky enough to necessitate reporting them to the doctor without delay.

Some of the more common cromolyn side effects are manageable and usually go away without medical intervention as the patient continues to take their antiasthma drug. However, a patient may still choose to see their doctor about currently non-threatening symptoms that are escalating, becoming bothersome, or increasingly interrupting the patient's day-to-day schedule. Such unfavorable but mild conditions include:

  • Coughing
  • Dry, sore throat
  • Stuffy nose
  • Abdominal pain
  • Itchy nasal pathways
  • Sneezing
  • Strange taste in the mouth

Dosage

Cromolyn comes with manufacturer's dosage information for the product. Still, a doctor's prescription may vary from the directions on the product label depending on the treatment needs and circumstances of the patient. Such doctor's instructions are final, and the patient should not alter them on their own accord.

How potent a cromolyn dose is determines the amount a patient should use. Likewise, a patient has to continue taking the medication depending on the nature of the specific condition under treatment. The characteristics of the complication will also help decide the correct per-day dose and the interval of time between each inhalation session.

Before a patient starts to use the cromolyn inhalation, they should read and understand the user instructions that come with the product packaging. It is essential to avoid misuse of the product, and if specific user procedures for the inhaler are confusing, the patient should seek further clarifications from their doctor. The victim may also request that their caregiver keeps monitoring them to ascertain that they are using the antiasthma inhaler correctly.

Typically, the cromolyn dosage is available in four different forms, namely:

  • Aerosol powder
  • Capsule
  • Solution
  • Aerosol liquid

Dosing for cromolyn inhalation aerosol

If an adult or 5-year-old child or older is using the aerosol dosage form to control asthma symptoms, they should take two puffs four times (2 x 4) each day at an interval of four to six hours between inhalation sessions. Children below the age of five should not use the cromolyn inhalation aerosol, whatever their complication is.

In the case of cromolyn aerosol for preventing a bronchospasm attack as a result of exercise or allergen inhalation, adults and 5-year-old-and-above children should take two inhales a minimum of 10 to 15 and maximum of sixty minutes before participating in any exercise or exposure to circumstances that could trigger the complication.

Cromolyn aerosol canisters come in various dosing capacities, from 112 to 200 inhalations, and a patient only uses the size their doctor prescribed. Since it is difficult to tell how much medication is remaining in the canister, a patient should always track and record each puff they make so they may determine the right time to renew or refill their prescription. The water floating test cannot work for this type of canister when it comes to deciding how full it is.

Any new cromolyn inhaler or one that has not been in use for a long while requires priming to get it ready for efficient operation. Testing the inhalation system ensures that it can deliver the appropriate amount of medication when taking a puff for the first time. As such, the user should follow directions from the manufacturer for attaching the canister, which contains the drug, securely into the mouthpiece.

After confirming that the medicine container fits well into the mouthpiece, the user removes the mouthpiece cap before shaking the inhaler a couple of times. To test the pumping mechanism of the system, the user holds the inhaler, stretching their arm out to a safe distance (to avoid accidental inhalation), and pushes the top of the canister. If the system perfectly sprays the drug into the air, it shows that the inhaler is in a great shape to deliver the appropriate treatment doses efficiently.

To use the inhaler, the user should hold it between their thumb and the other fingers (just they would handle an ordinary can of beverage), position it upright, and turn it such that the mouthpiece end is down and points in their direction. Next, they examine the mouthpiece for cleanliness after removing its cap. This cromolyn inhalation system should only be used with its designated mouthpiece.

After shaking the inhaler four or so times in preparation for the administration of cromolyn, the user turns the mouthpiece away from the mouth so they can breathe out slowly and extensively to the limit of an ordinary breath. A doctor may prescribe one of two practical inhalation methods, and the patient should always go with what their caregiver ordered.

In method one, the patient inhales the medication with their mouth open. Firstly, they point the mouthpiece toward their wide-open mouth, just two inches away. The user sprays the medicine directly into the hollow space, avoiding the roof of the mouth and the tongue. They should not hold the inhaler way off the mouth to the extent of including the eye region within the scope of the spray.

The alternative inhalation aerosol technique requires the mouth to be shut. The lips form a secure seal around the mouthpiece, which sits between the teeth, above the tongue. The user should check that no part of their mouth is obstructing the opening through which the inhaler discharges the medication.

With the patient bending their head back a little, they are ready to take their first puff using the cromolyn aerosol technique. The first step is to breathe in bit by bit via the mouth while simultaneously pushing the top of the canister to start spraying and take a single inhalation. The patient has to keep breathing in slowly for around four seconds until they have attained a full, deep breath.

The slow breathing in, while concurrently spraying into the mouth, is critical as it lets the user optimize the amount of the medicine reaching their lungs, the typical location of asthma symptom attacks. A patient may not get this part of the sequence right the first time, but they should keep trying to perfect their inhalation. If a user takes the medication with their mouth shut and their mouth or nose releases a fine mist, they are probably not utilizing the inhaler correctly.

After taking the puff, the patient should hold their breath for up to 10 seconds, allowing the medication to settle into their breathing passages and lungs. Now they can withdraw the mouthpiece and breathe out slowly.

An interval of one minute between each intake is necessary in case the prescription says two or more inhalations per dose (session). When the patient is ready to go for the next puff, they should shake the inhaler again before repeating the specific process for their first inhalation. It is imperative to avoid spraying or inhaling twice at once.

Once the patient is done with a cromolyn inhalation aerosol dose, they should wipe the mouthpiece of their inhaler and put its cap back. They should record each puff every time to keep track of their medicine inventory, and when the number of applications matches the maximum dosage capacity for the specific inhaler, they must dispose of the inhaler.

Some patients are unable to use a regular cromolyn aerosol inhaler correctly, and that denies them the maximum benefits of the therapeutic action of the medication. Incorrect use of this medicine dispenser may result in some of the spray not reaching the lungs, but staying in the throat or even oozing out through the nose or a closed mouth. When a user is consistently unable to use their equipment well, their health remains at risk, so they should consult their doctor, who may recommend a modification that includes a spacer device.

Adding a spacer to an inhaler increases the efficiency of the medicine-discharging system, ensuring that the maximum amount of cromolyn reaches the lungs with each puff to deliver treatment. For a patient to use the alternative spraying method, they should first read, understand, and follow the directions from the manufacturer for attaching the spacer to the inhaler. Such modifications are available in various designs, but most of them support a common breathing method.

Here are the steps for using an inhaler with a spacer:

  • After securing the spacer on to the inhaler, the patient shakes them both slightly.
  • With the mouthpiece of the spacer turned away from the mouth, the patient breathes out slowly until they cannot expel air anymore.
  • With the mouth-closed method, the user inserts the mouthpiece of the spacer into their mouth just like they would use a regular cromolyn aerosol inhaler, with their lips creating a seal around it.
  • Next, the patient discharges a single inhalation of the medication into the spacer by pressing the top of the canister once. In about two seconds, they start taking a deep, slow breath through the mouth that lasts around 10 seconds. While breathing in, the patient could count down to one from 10, albeit slowly.
  • While counting toward to 10, the user should try to hold their breath for as long as possible before breathing out slowly.
  • A one-minute break is necessary between any two puffs if the doctor ordered multiple inhalations per dose or session. Next, the patient shakes the entire inhalation system again before going for their second inhaling. The steps for this are the same as those for the first exercise. At no time should a user discharge more than one inhalation dosage into the spacer for a single puff.
  • After a successful inhalation session, the user detaches the spacer from the inhaler and puts the mouthpiece cap back on.

It is imperative to clean the entire medication apparatus a minimum of once every week. The canister, which contains the actual cromolyn drug, should not get into contact with water under any circumstances. So a patient must first separate the medicine container from the inhaler before cleaning can begin.

Typically, a warm solution of water and detergent are ideal for cleaning the cap, spacer, and mouthpiece. The patient then uses warm tap water to rinse the items. They should get rid of any water that remains in any of the inhaler components, exposing them to air so they can dry thoroughly. Afterward, it is safe to re-assemble the parts.

Dosing for the cromolyn inhalation capsule

Cromolyn is also available in the form of capsules. These capsules are for inhaling, not swallowing like tablets. The medication targets the lungs and ingesting it does not deliver treatment where it is needed. Below is a detailed description of the right dosage for both kids and adults.

If an adult or 2-year-old child or older is using the inhalation capsule method to control asthma symptoms, they should take a 20-mg capsule via an inhaler four times each day at an interval of four to six hours between inhalation sessions. Children below the age two should not use the cromolyn inhalation capsule, whatever their complication is.

In the case of cromolyn inhalation capsule for preventing a bronchospasm attack as a result of exercise or allergen inhalation, adults and 2-year-old-and-above children should use a 20-mg capsule via an inhaler a minimum of 10 to 15 and maximum of 60 minutes before participating in any exercise or exposure to circumstances that could trigger the complication.

Healthcare professionals recommend one of two particular inhaler devices for delivering the cromolyn capsule treatment into the lungs of a patient. These are the Spinhaler or the Halermatic. There are manufacturer instructions for using either of the devices, and the patient should read and understand them before beginning the medication. They should also refer to their doctor for precise answers regarding the appropriate use of their inhaler.

Any consistently incorrect application of the medication system makes it harder for the patient to benefit fully from the treatment, compromising their health. So, a patient should consider regular checkups by their caregiver to assess whether they are using the apparatus as the doctor ordered.

A patient inhaling cromolyn capsules through the Spinhaler must begin by loading the device. The first step toward that involves cleaning and drying their hands. Just when the patient is ready to take the drug, they put one capsule into the inhaler. With the mouthpiece facing down, they hold the device in an upright position. Next, they detach the inhaler from its mouthpiece.

The system operates by way of a spinning propeller, so this part of the setup should be ready for use. At this point, the propeller is secure on the spindle, and the mouthpiece is still facing downward. The cromolyn capsule has a foil that the user takes away before putting the colored part of the drug tightly into the cup of the propeller.

While setting up the medication system, the patient should avoid all unnecessary contact with the capsule. Their hands or fingers may have wetness, including from sweating, which could render the capsule fragile.

The user may push the propeller a little with their finger to confirm that it spins without resistance. Next, they attach the rest of the inhaler system into the mouthpiece. They should screw it extremely tight to make for a reliable medical apparatus.

The next step involves puncturing the cromolyn capsule. To do this, the user holds the fully-assembled inhalation system upright with its mouthpiece facing downward. The system has an exterior sheath that the user glides downward steadily until it cannot move anymore, at which point it pierces the capsule. They may now slide the sheath back up as far as practical. If not convinced that piercing has occurred, the patient may repeat the process once more.

Provided that the mouthpiece connects to the inhaler securely, the Spinhaler is ready for use at this juncture. The user picks up the system and turns it away from the mouth so they may breathe out slowly and extensively until they cannot reasonably expel more air. In this case, the mouthpiece goes into the mouth, with the lips sealing around it. The user must check that the opening of the inhaler can release the medication without obstruction from the tongue or teeth.

Next, the patient inclines their head back before breathing in deeply and fast. The motions of a spinning propeller are detectable with the inhaler in the mouth and the user taking a deep breath. The system is simultaneously dispensing the cromolyn medication for propagation into the lungs during this step.

The user may then withdraw the inhaler from their mouth before holding their breath for as long as manageable. With the Spinhaler far from their mouth to avoid breaking it, the patient breathes out slowly and extensively for as long as an ordinary breath permits.

The cromolyn capsule is now used and up for disposal. Then, the user stores the inhaler in its appropriate container, sealing it safe with the right lid.

The Spinhaler requires regular cleaning too. A minimum of once each week, the patient may use a brush to get rid of any chemical dust on the propeller from all previous application. Next, they disassemble the apparatus and wash each inhaler component with a solution of warm water and soap.

The interior of the propeller shaft also needs cleaning by immersion in water and sliding the propeller on and off its steel spindle. To release any excess wetness, the user shakes the Spinhaler after washing it. All the components must dry completely before the next setup. This type of inhaler requires replacement after every six months.

In the case of the Halermatic inhaler for capsules, the user first washes and dries their hands before setting it up. When they are just about to administer the medication, they slot the cromolyn capsule cartridge into the inhaler. The system includes a mouthpiece with a cover that the user must take away. The next step is to detach the mouthpiece and then press the cartridge forcefully down until it cannot move further.

The mouthpiece is a critical part of the inhalation system, so the user must slide it back on. This component is also essential to the capsule cartridge-piercing operation before elevating it to the spinning chamber. To achieve that, the user has to push the mouthpiece down steadily until it cannot move any further. Piercing the medication cartridge is a one-off step that requires no revisiting.

Now the Halermatic is ready for medical deployment, which begins with the user positioning it away from their mouth as they breathe out slowly to the limits of an ordinary breathing exercise. They then insert the mouthpiece in the mouth, sealing their lips around it, and tilting their head back. Again, the effectiveness of this system requires the elimination of any obstruction to the discharge of cromolyn, be it with the tongue or teeth.

With the mouthpiece in, the user takes a deep and steadily breathes in. The processes releases and disperses cromolyn into the lungs and its airways. Before withdrawing the inhaler, the user holds their breath for 10 seconds or so, allowing the medication to stay in for as long as it takes and have the maximum impact possible.

Having removed the inhaler from the mouth to avoid compromising its function, the user may exhale to the extent of an ordinary breath. The patient should not stop taking puffs of this medication until they have exhausted all the capsule powder. It is acceptable for a properly working Halermatic to have remnants of powder dust after use. The disposal of an empty cromolyn capsule cartridge is necessary, right away.

These are the steps for cleaning and maintaining the Halermatic:

  • Using a brush to get rid of cromolyn powder dust every day.
  • Using a slightly wet piece of cloth to clear powder dust that accumulates with time.
  • Pulling off the mouthpiece to wash it separately when need be. The inhaler comes with a blue-based body that should never come into contact with water. So, the mouthpiece has to dry before reattachment to the Halermatic.
  • Replacing the inhaler every six months.

Dosage for patients using the cromolyn inhalation solution:

If an adult or 2-year-old child or older is using the inhalation solution method to control asthma symptoms, they should take a 20-mg ampul via a nebulizer four times each day at an interval of four to six hours between inhalation sessions. The patient should use a new ampul solution with each dose. Children below the age two should not use the cromolyn inhalation solution, no matter their condition.

In the case of cromolyn inhalation solution for preventing a bronchospasm episode as a result of exercise or allergen inhalation, adults and 2-year-old-and-above children should use a 20-mg ampul via a nebulizer a minimum of ten to fifteen and maximum of sixty minutes before participating in any exercise or exposure to circumstances that could trigger an attack.

This inhalation solution is available in an ampul (a little glass container). There are proper guidelines that a patient should follow to break the ampul softly and release the cromolyn medication it contains. A doctor can explain any confusing aspects regarding using this treatment.

The use of the solution begins with the breaking of the ampul to free its contents. The user can break by hand any fragile end of the glass container. While dismantling it, the ampul should not be near the nebulizer or the face of the patient.

  • User holds and tilts the ampul before breaking off the lower side cautiously. The solution stays inside.
  • User flips the container over and uses their forefinger to delicately seal the already broken end, which is now facing up.
  • With their finger steadily in position, the user breaks off the other end that is facing down.
  • Holding the glass container over the bowl of the nebulizer component, they lift their forefinger, emptying the solution.
  • User inhales the solution and discards any medication remnants in the nebulizer.

A battery-powered nebulizer with an excellent flow rate is best for taking this medicine. It should also come with either a facemask or mouthpiece. If a cromolyn oral inhalation prescription requires regular use, such as daily, it is useful only when the patient adheres to their dosage schedule strictly, including the time interval between doses.

It is in the best interest of each patient to make up for a missed dose as soon as they find time for it. However, they should avoid taking a double dose or overdosing. In case a patient has not inhaled a missed dose while the time is almost up for the next, they should just forgo the skipped inhalation and revert to their usual dosage schedule.

Major drug interactions

Considering the likelihood of an adverse interaction between cromolyn and other drugs, the patient should always let their doctor know about any other medication they are taking. A healthcare practitioner may have to change the dose or take other necessary precautions upon learning that the patient they are about to give a cromolyn prescription is using other drugs, including over-the-counter medication.

It is also imperative that a patient undergoing treatment for bronchospasm or asthma symptoms discusses proper diet and lifestyle adjustments. Foods, alcohol, and tobacco may be up for such discussions. Likewise, an individual suffering from heart disease or irregular heartbeat and using the aerosol inhaler should be wary of the possibility that the propellants that propagate the cromolyn into the lungs may escalate their disorder.

Warnings

  • Four weeks into using cromolyn, the patient should be noticing improvements. Any escalation or lack of recovery calls for medical attention.
  • If a corticosteroid or bronchodilator is also part of the patient's asthma regimen, only a doctor may recommend quitting these medicines, even if recovery is already evident.
  • Using cromolyn may cause a dry mouth or throat or a sore throat. A patient may relieve these side effects by gaggling and rinsing their mouth after every inhalation session.
  • A patient should never use a cromolyn inhalation solution that is cloudy or has debris in it.

Storage

  • A sealed container at room temperature is the ideal storage for cromolyn.
  • Freezing, heat, water, and direct light are all inappropriate conditions for storing the drug.
  • Any outdated drugs or medication no longer in use requires immediate disposal
  • Cromolyn storage is out of bounds for minors.
  • Keep away from sources of extreme temperatures, such as inside a car. It is dangerous to expose the inhaler canister to fire or poke holes in it.

Summary

Cromolyn is one of the most effective medications for treating asthma symptoms or breathing difficulty due to exercise or exposure to air with impurities, such as pet dander, pollen, and other particles. It is a preventive treatment, meaning that it will not help after the onset of asthma attacks. The medication is available in four primary forms of inhalation namely solution, aerosol liquid, aerosol powder, and capsule.

Successful use of inhalation cromolyn should help clear any obstructions in the lungs and air passages, enabling the patient to breathe better. The medication can help prevent shortness of breath, wheezing, coughing, and even tightness in the chest in patients that are vulnerable to asthma attacks or bronchospasm.

Typically, it takes up to four months for the full therapeutic effects of cromolyn inhalation to materialize. However, the patient has to learn how to use their prescribed inhaler system well to get the best out of this medication. The doctor usually determines which technique of application is most efficient for the patient. In case the user is confused about how to use their antiasthma medication equipment, they should always go back to their caregiver for accurate and safe directions.

Cromolyn may be sufficient to prevent potential bouts of asthma symptoms or bronchospasm, although the doctor may include other medications, such as corticosteroids, in a prescription. The patient should always continue using their full dosage as prescribed, no matter the treatment outcomes unless their doctor suggests otherwise.