Asthma Medications and Ways to Prevent Asthma
Medications used to treat asthma work to relieve and prevent symptoms by decreasing inflammation (swelling) and bronchospasm (tightening of muscles that surround the airways). Treatment is based on how severe your asthma is and can be adjusted if your asthma becomes well controlled. Your asthma is well controlled when:
- You can run and exercise.
- You don’t miss school or work or activities
- You can’t remember the last time you had an urgent visit to the Emergency Room or Urgent Care.
- You don’t have asthma symptoms (cough, wheeze or shortness of breath) more than 2 days a week
- You don’t need your albuterol (rescue medication) more than 2 times a week to relieve symptoms
- You don’t wake up in the night with asthma symptoms more than 2 times a month
- You don’t use more than 2 albuterol inhalers in a year
There are three main types of asthma medications and they are often used together:
- Long-term-control medications: These are used on a daily basis to control symptoms and to prevent future attacks
- Quick-relief or rescue medications: You can use these medications as needed for rapid relief of symptoms during an asthma attack
- Medications for allergy-induced asthma: These decrease your body’s sensitivity to a particular allergen. This will hopefully prevent you from having an asthma attack if you come in contact with the allergen.
These medications are taken every day, usually on a long term basis. They will help to prevent future attacks from occurring. It is very important to not skip doses of these medications and keep in mind that it usually takes up to two weeks from starting these medications to recognize any relief of symptoms.
Inhaled Corticosteroids: These medications help to reduce inflammation (swelling) inside the airways. They are the most effective medications for asthma. They are completely different from anabolic steroids. There is a low risk of side effects with inhaled corticosteroids. When used as directed, inhaled corticosteroids can minimize your need for oral steroids, which have a higher risk of side effects. Examples of inhaled corticosteroids include Arnuity, Flovent, QVAR, Alvesco, Asmanex, Pulmicort and Aerospan.
There are also inhaled corticosteroids that are combined with a long acting albuterol-like medication which serves the dual function of reducing inflammation and relaxing the smooth muscles around the airways. Examples of these combination drugs include Advair, Symbicort and Dulera.
Your doctor may recommend using your medication with a spacer. For any inhaled corticosteroid, be sure to gargle with water and spit it out afterwards. This will help to reduce mouth and throat irritation and oral yeast infections (thrush).
Leukotriene Modifiers: These drugs reduce the production or block the action of leukotrienes. Leukotrienes are released by cells in your lungs during an asthma attack. Leukotrienes cause the linings of your airways to become inflamed, which in turn leads to wheezing, shortness of breath and mucus production. Leukotriene modifiers can be used with inhaled corticosteroids to help prevent asthma attacks. Examples of leukotriene modifiers include Singulair (montelukast).
These medications are often called “rescue” medications because they can quickly stop the symptoms of an asthma attack. These medications are taken as needed when you first begin to feel symptoms of asthma including coughing, wheezing, chest tightness and difficulty breathing.
Short-acting beta-2 agonists: Bronchodilators (Albuterol, Xopenex) are quick relief medications that relax the muscles around the airways. They are inhaled into the airways directly and should relieve symptoms within 15-20 minutes. If you feel like your asthma symptoms get worse with exercise, try using albuterol or xopenex fifteen minutes prior to exercise to help prevent symptoms.
Ipratropium (Atrovent): This is another medication that may provide immediate relief of your asthma symptoms. It can be used by itself or it is also commonly combined with Albuterol (Duoneb or Combivent).
Oral and intravenous corticosteroids for asthma attacks: These may be used for severe asthma symptoms that have not responded to albuterol given every 4 hours for 1-2 days. They may take a few hours or a few days to be fully effective. Long-term use of these medications can cause serious side effects, including cataracts, mood and appetite changes, weight gain, osteoporosis, muscle weakness, decreased resistance to infection, high blood pressure and thinning of the skin.
Medications for allergy-induced asthma
Other medications focus on treating allergy triggers for asthma. These include:
Immunotherapy: This can be very helpful for patients with severe allergies who haven’t responded well to medications. You will receive a skin test to determine the allergens that cause you the most trouble. You will then receive therapeutic injections containing small doses of those allergens. You generally receive injections once a week for a few months, then once a month for a period of three to five years. Over time, you should lose your sensitivity to your allergens. Hopefully exposure to these allergens won’t cause you to have an asthma attack anymore. Life-threatening allergic reactions to the injections are a rare but possible complication of immunotherapy.
Anti-IgE monoclonal antibodies (Xolair): People with allergies have IgE antibodies that circulate in their bloodstream attacking substances that are normally harmless such as pollen, dust mites and pet dander. The immune system reacts by causing inflammation which makes breathing difficult. Xolair works by blocking the action of these IgE antibodies. Xolair is indicated for groups of people over the age of 12 with moderate to severe asthma. It is delivered by injection every two to four weeks. Risks include the possibility of a severe reaction within two hours of receiving the shot.
The best way to prevent asthma attacks is to identify and avoid indoor and outdoor allergens and irritants. The following section includes strategies to help you deal with common triggers for asthma.
Smoke: Smoke exposure increases the risk of having an asthma attack. If possible, quit smoking. Contact 1-800-QUIT-NOW for resources. Never smoke in the home or in your car and wear a “smoking jacket” when you smoke outside. Make sure to leave this jacket outside. Avoid using a wood burning stove and avoid campfires.
Air Pollution: Stay indoors when the pollution count is high
Strong Smells: Avoid strong smells found in air fresheners, perfume, cologne, room spray and hair spray. Use unscented household cleaning products.
Illness: Get medical treatment right away for any cold symptoms or respiratory illness. Stay away from other people who are sick and get an annual flu vaccine. Wash your hands several times a day.
Cold Air: Cover your nose and mouth with a scarf on cold or windy days
Pollen and Outdoor Mold: Keep your windows closed during allergy season and use central air conditioning or fans when available. Mow the lawn frequently to limit the amount of pollen released. Change your clothes and shower after being outside during high-pollen season. Use saline nasal rinses and speak with your provider about medications that you can take. Skin testing can determine what pollens or animal danders may be causing you to have allergic, asthmatic symptoms.
Indoor Mold: Keep bathrooms and kitchens well ventilated and clean. Use a bleach solution (1 part bleach to 10 part water) to clean mold. Reduce indoor humidity to less than 50% and fix all water leaks and remove standing water. Have heating, ventilation and air conditioning systems cleaned and serviced regularly.
House Dust: Consider using a True HEPA filter and remove drapes and blinds when possible. Bare floors are best; if you have carpet, vacuum frequently. Wrap your mattress and box spring with allergen proof coverings and wash stuffed toys and bedding in hot water (130 degrees) weekly. Forced air furnaces should have a dust filter installed. Replace these filters every 2 weeks during heating season.
Animals: All furry or feathered animals have the potential to cause allergic reactions. If you have pets, make sure to keep them out of your bedroom and if possible, keep them outdoors. Wash your hands after playing with the pet. Brush your pet daily and give them a bath weekly. If asthma if not well controlled, consider relocating the pet.
Cockroach: Avoid leaving food and garbage out and use insect spray as needed.
Exercise Induced Asthma: Pretreat with Albuterol (or Xopenex) 10-15 minutes before an activity
Strong Emotions: Strong emotions like laughing or crying can trigger an asthma attack. Try to practice calming/relaxation techniques such as deep breathing, yoga, visualization, meditation or guided imagery.
Sulfites in foods and beverages: Do not drink beer or wine or eat dried fruit, processed potatoes or shrimp if they cause asthma symptoms.