Asthma Medications
Goals of therapy
There is no cure for asthma but proper use of appropriate medications can control symptoms for the majority of people with asthma, enabling them to lead normal, active lives with minimal or no asthma symptoms and exacerbations.
There are two main classes of asthma medicines: bronchodilators (also known as quick relievers or rescue medicines) and anti-inflammatories, which are for long-term control (also known as controllers). Persons with intermittent symptoms usually need only the bronchodilators. Persons with persistent asthma require both bronchodilators (relievers) and anti-inflammatories (controllers).
Bronchodilators vs. anti-inflammatories
The key to understanding the different medications is to focus on what they do in the lungs. Bronchodilators open up the airways that get narrow due to an asthma episode/attack. The narrowed airways lead to feelings of chest tightness, and symptoms such as wheeze, cough and shortness of breath.
Bronchodilators (relievers)
The most important use of bronchodilators is to relieve chest tightness, shortness of breath, wheeze or cough. The person uses an broncholdilator inhaler as soon as symptoms begin to appear, or shortly before they are anticipated, for example just before exercise.
Examples of bronchodilators include:
- Albuterol (albuterol HFA, Proventil HFA, Ventolin, Ventolin HFA, Volmax, Vospire ER)
- Levalbuterol (Xopenex, Xopenex HFA)
- Metaproterenol (Alupent),
- Pirbuterol (Maxair)
- Terbutaline (Brethine)
You may also hear about long acting bronchodilators that are for long-term control of bronchospasm; and are not anti-inflammatories. Examples of long acting bronchodilators include:
- Formoterol (Foradil)
- Salmeterol (Serevent)
Theophylline is sometimes used as an additional therapy and, when it is used at all, is generally given for control of night-time symptoms in persons with severe asthma
Anti-inflammatories / Corticosteroids (Controllers)
The anti-inflammatory drugs have been called “long-term controllers” – and they are. They are long-term controllers of inflammation that occurs in the airway in asthma.
It is widely recognized that corticosteroids are the most effective long-term control medication for asthma. In general, corticosteroids are still underused in asthma although their use is increasing. Many Americans have a “steroid phobia.” This may result from confusing inhaled corticosteroids with anabolic steroids, which are used illegally by some athletes as performance- enhancing drugs.
Inhaled corticosteroids are purely preventive agents. They have little immediate effect on asthma symptoms, but if taken twice daily every day for three to seven days they begin to prevent asthma symptoms from occurring. Use of an inhaled corticosteroids is usually considered for a person who is using a bronchodilator (rescue medication) more than twice a week, or who is awakening with nocturnal asthma symptoms more than twice a month.
Examples of corticosteroids include:
- Budesonide (Pulmicort)
- Fluticasone and servent combination (Advair)
- Budesonide and formoterol combination (Symbicort)
- Mometasone (Asmanex)
- Fluticasone (Flovent)
- Beclomethasone dipropionate (QVAR)
- Flunisolide (Aerobid)
- Trimacinolone (Azmacort)
Oral corticosteroids in acute asthma
In a person having an acute asthma exacerbation, oral corticosteroids are to gain control of the exacerbation. It is important to start the oral corticosteroid (usually prednisone) as soon as a significant acute exacerbation is diagnosed. This is because it will take the medicine 6-8 hours to start being effective.
Leukotriene receptor antagonists (LTRA)
Leukotrienes are naturally occurring chemical in our bodies. In the airways of an asthmatic person, leukotrienes have been shown to be associated with bronchoconstriction (airway narrowing).
Two medications in this group are in common use. They block tissue receptors for leukotrienes.
- Montelukast (Singulair)
- Zafirlukast (Accolate)
A related medicine called zileuton (Zyflo) blocks production of leukotrienes.
Cromones
Cromolyn sodium (Intal) has been largely replaced by the much more effective inhaled corticosteroids. Cromolyn can also be given to prevent exercise-induced asthma with a dose 30 minutes before exercise.
Nedocromil (Tilade) is a related drug also intended for prevention, rather than for relief of symptoms. It has been found to be more effective than cromolyn against allergic, exercise-induced and cold air-induced asthma symptoms. Nedocromil should be given 2-4 times a day. As with cromolyn, nedocromil is not widely used.
New therapies
Omalizumab (Xolair) is a new approach to the treatment of allergic asthma and has been shown to decrease asthma symptoms including nighttime awakenings, exacerbations, and use of daily inhaled corticosteroids. It is not a rescue medicine and involves injections once or twice a month based on your IgE level and weight.
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