Medication is the cornerstone of asthma treatment and the main way asthma is controlled. Asthma medications can be divided into two basic categories:
Anti-inflammatory medications, also called long-term controller medications,
Work slowly and last a long time.
Reduce the inflammation that makes the bronchial tubes overly sensitive.
Must be used on a regular basis to be effective. Those with persistent asthma will need to take anti-inflammatory medication daily.
Are considered a first line of preventive care because they help to prevent asthma attacks from starting. However, they do not immediately stop asthma attacks once they've begun.
Bronchodilators, also called quick-reliever (rescue) medications:
Work quickly and last for varying periods of time
Open narrowed airways and relieve bronchoconstriction (spasms of the airways)
Do little to reduce the chronic inflammation that makes bronchial tubes overly sensitive
Help stop asthma attacks once they've begun, and are often used on an "as-needed" basis
Your doctor will determine the type of medication that you will use based on your asthma classification. Generally, if you have intermittent asthma, you are only given quick-relief medication. If you have persistent asthma, your doctor will probably want you to use both long-term controller and quick-relief medications. People with exercise-induced asthma (EIA) may be told by their doctor to take either long-term controller or quick-relief medication right before they exercise to prevent symptoms.
Asthma medications come in all sorts of forms -- sprays, pills, powders, liquids and shots -- and are sold under many brand names. New medications frequently come on the market. So, if you have been on the same medications for five or more years, particularly if you do not have good control (frequent symptoms, nighttime asthma), check with your doctor to see if another type of medication might be better for you.
Medications that are swallowed in pill or liquid form usually have systemic, or total body, side effects. Inhaled medications go primarily to the lungs, decreasing the overall side effects. Medications vary as to "onset of action," or the amount of time it takes to feel the results. Another variable is when the peak, or maximal effect, occurs. If you are taking medication to prevent problems with nighttime asthma or with exercise-induced symptoms, you will want to coordinate the drug's effects with the timing of these activities. Unwanted side effects and cost are two other important factors in choosing which medications would be best for you.
Control medications (anti-inflammatory medications)
Once asthma has been diagnosed, many patients start on controller medicine, also called long-term preventative medication or maintenance medication. These medications are taken daily on an ongoing basis to calm the airways and control symptoms. The different types of medication in this category work by reducing inflammation, thereby opening the airways, and improving breathing ability.
Types of long-term control medications include inhaled corticosteroids, cromolyn sodium and nedocromil sodium, and long-acting beta-agonists (beta-adrenergic agonists).
Inhaled corticosteroids are the most effective medications to prevent swelling and irritation in the lining of inflamed airways. Dry powder or aerosol are the commonly prescribed forms.
Inhaled corticosteroids are used as daily controller medications in those with persistent asthma. They are a type of steroid medication that is related to cortisone, a hormone produced naturally by the adrenal glands. They block the chemicals in your body that cause inflammation and can take a week or more to start working fully. However, inhaled corticosteroids are not the same as anabolic steroids used illegally by some athletes. They are safe for long-term use since they are targeted directly at the lungs and do not affect the liver or cause sterility, as do the illegal anabolic steroids.
All corticosteroids can be used either as a short-term medication in severe, persistent asthma. They are effective in reducing bronchial inflammation and have minimal side effects when used for short periods of time. Patients switching from an oral steroid like prednisone, to an inhaled steroid need to be careful. While adjusting to the switch, one may not be able to handle major stress such as surgery or severe infection or trauma without additional systemic steroid. Discuss with your health care provider.
If taken as directed, inhaled corticosteroids do not cause the potentially serious side effects that can occur with the regular use of oral corticosteroids. Still, inhaled corticosteroids do have side effects (as does any medication): hoarseness can occur with increasing dosages and vocal stress; thrush (a yeast infection in the mouth) and mouth irritations are the most common. Use of a spacer (an attachment on the inhaler), and rinsing with water and spitting out after inhaling a dose can minimize the side effects. Some studies have suggested an increased risk of cataracts.
Women who take large doses of inhaled corticosteroids because of severe asthma may experience bone density loss after menopause. In the New England Journal of Medicine, researchers reported an increased risk of glaucoma formation with older adults using inhaled corticosteroids.
In addition, there has been some concern regarding possible growth retardation in children, which appeared to be dose related: The longer corticosteroids are used and the higher the dosage, the more likely growth stunting is to occur. However, results from two studies appearing in the New England Journal of Medicine independently concluded that inhaled corticosteroid use in children has no long-term impact on growth and that the potential risks were balanced by the benefits of improved asthma control.
Cromolyn and nedocromil
These medicines reduce inflammation by preventing the activation of messages in your body that tell the immune system to start acting up. They are less effective than inhaled steroids.
Cromolyn sodium and nedocromil are typically used as daily controller medications, but can also be used before exercise or exposure to an allergic asthma trigger. Cromolyn sodium is often the drug of choice for children because of minimal chance of side effects and its effectiveness for allergy-related asthma.
Long-acting beta-agonist inhaler (beta-adrenergic agonist)
This medication prevents constriction by stimulating the messages to the smooth muscles in the airways that help relax the bronchial tubes. Long-acting beta-agonists are often used as a long-term control medication in moderate persistent or severe persistent asthma, particularly to prevent symptoms for those with nighttime symptoms and/or exercise-induced asthma. They are effective for up to 12 hours and are not for use as quick-relief medication.
This type of oral medication is a bronchodilator. Theophylline is rarely used in asthma treatment today and is noted for significant side effects, including nervousness, hyperactivity, upset stomach, and headaches. Tell your doctor if you are taking any other medicine with theophylline because side effects may occur.
Antileukotrienes, also known as leukotriene inhibitors or modifiers, are among the newest oral anti-inflammatory medications. The body processes leukotrienes, chemicals that cause inflammation, as part of the reaction to an allergen. They may be useful as a primary treatment to control mild persistent asthma or as add-on therapy with moderate or severe persistent asthma. Two of these drugs, zafirlukast and montelukast, block the action of leukotrienes in your lungs, while a third medication in this class, inhibits their production. All three drugs block the recognition of allergens, thereby avoiding the usual cascade of symptoms. The result is a decrease in the frequency of asthma flare-ups and a decreased need for quick-relief medications. These medications do not benefit every asthmatic. Side effects include headache and nausea, and the medications may interact negatively with other drugs, such as blood thinners.
Called quick-relievers or rescue medicine, this type of medication works quickly to relieve flare-ups of asthma symptoms. They can "rescue" you and keep symptoms from getting worse. Most of this type of medicine comes in a canister and is inhaled.
Relievers work by opening airways and increasing airflow. They will stop the coughing, chest tightness, shortness of breath and wheezing associated with an asthma attack within 30 minutes.
Quick-relief medication is not meant to be used daily. Relievers are used at the moment you are having a flare-up of symptoms. No matter how light or severe your asthma is, your doctor will make sure that you have a reliever medication available. If you are using more than one canister of this medicine each month for relief, it may indicate that your long-term control medication needs to be adjusted. The two types, or classifications, of quick-relief medication are anticholinergics and short-acting beta-agonists.
Anticholinergics relax muscles around the airways to reverse airway narrowing and stop spasms in the bronchial muscles. Inhaled anticholinergics are generally not used as a first-line reliever medication for most patients with asthma as they may take several hours to take effect. They use a different mechanism than short-acting beta-agonists to make it easier to breathe and are usually used as an adjunct to inhaled Beta2-agonists (also known as B2-agonists) in patients who have severe asthma episodes. There is now an anticholinergic and short-acting beta-agonists combination available.
Beta2-agonists, or short-acting beta-agonists, are the most effective bronchodilators. When bronchial muscles tighten, the airway is narrowed and asthma symptoms occur. B2-agonists work rapidly and selectively on the B2 receptors in the muscles that surround the bronchial tubes to open the airways and improve breathing by reversing bronchoconstriction, allowing the muscles to relax. They also slow the release of histamines (part of the body's reaction to an allergen) and increase the body's ability to clear mucus from the airways. Their duration is about four hours. However, brands differ in potency, onset of action, and peak effective time.
B2-agonists are generally used on an as-needed basis during an asthma episode or prior to exercise for EIA. They are not intended for use every day, more than three times in any given day, or in excess of one canister per month. Excessive use indicates poor control and the need to add or increase long-term control medications. It could also mean that the inhaler isn't being used properly and the patient is not getting the proper dosage. Possible side effects are shakiness, jitteriness or rapid heartbeat, which should wear off after several weeks as the body adjusts to the medicine.
The first combination anti-inflammatory and bronchodilator, fluticasone propionate and salmeterol inhalation powder, became available in the United States in 2001. The drug does not replace fast-acting inhalers for sudden symptoms. This medication is a controller medication or preventative medication and like Serevent or Foradil is not to be used as a reliever medication. While adjusting to the switch, one is not as able to heal after surgery, infection or serious injury.
Allergy desensitization shots
Certain sufferers of allergic asthma cannot easily control symptoms by avoiding triggers and using medication. In these cases, immunotherapy (allergy desensitization shots) may offer relief and even help prevent development of airway inflammation, resulting in chronic airway sensitivity.
According to the American Academy of Allergy, Asthma and Immunology (AAAAI), allergen immunotherapy works like a vaccination. Through exposure to small, injected amounts of a particular allergen, in gradually increasing doses, your body builds up immunity to the allergen(s) triggering an allergic reaction. This means that when you encounter these allergens in the future, you will have a reduced or very minor allergic response and fewer symptoms.
Immunotherapy appears to work best for allergies to pollen, mold, cat dander, insect stings, and dust mites. Potential side effects during treatment, according to the AAAAI, may include swelling at the site of the injection, and in rare instances, a more serious allergic reaction, resulting in asthma symptoms or an anaphylactic reaction. Asthma symptoms include cough, wheezing and shortness of breath. Symptoms of an anaphylactic reaction can include hives, sneezing, watery nasal discharge, itchy eyes, swelling in the throat, wheezing or a sensation of tightness in the chest, nausea, dizziness or other symptoms.
Omalizumab is the first biotechnology product to treat patients with a type of asthma that is related to allergies. The drug, a monoclonal antibody, has been shown to be safe and effective to treat people 12 years of age and older with moderate to severe allergy-related asthma that is not well controlled with inhaled steroid treatments. In these patients, omalizumab decreases the number of asthma episodes of airway narrowing that result in wheezing, breathlessness and cough. The product is given as an injection under the skin.