A number of medications exist for asthma, and many are used in combination with others. Your doctor can help you decide which option is best for you based on your age and the severity of your symptoms. In general, the main types of asthma medications are:
- Long-term-control medications. These are used on a regular basis to control chronic symptoms and prevent attacks.
- Quick-relief medications. Also called rescue medications, you use these as needed for rapid, short-term relief of symptoms during an asthma attack.
- Medications for allergy-induced asthma. These decrease your body’s sensitivity to a particular allergen and prevent your immune system from reacting to allergens.
These medications are taken every day, usually on a long-term basis, to control persistent asthma.
- Inhaled corticosteroids. These anti-inflammatory drugs are the most effective medications for asthma. They’re different from anabolic steroids, which some athletes abuse. Corticosteroids reduce inflammation in your airways.
Corticosteroids help decrease the frequency of your attacks and reduce the need for other medications you may use to control your symptoms. Because inhaled corticosteroids control most forms of asthma by delivering medication directly to your airways, they have a low risk of side effects. When used as directed, inhaled corticosteroids can minimize your need for oral corticosteroids, which have a higher risk of side effects. Inhaled corticosteroids include fluticasone (Flovent), budesonide (Pulmicort), triamcinolone (Azmacort), flunisolide (Aerobid) and beclomethasone (Qvar). Advair Diskus is a combination inhaler containing fluticasone and salmeterol.
Inhaled corticosteroids may affect some children’s growth. If your child is taking these medications, have his or her growth rate regularly monitored. Long-term use of inhaled corticosteroids may slightly increase the risk of skin thinning and bruising.
If you’re using a metered dose inhaler form of corticosteroid, be sure to use a spacer and gargle with water afterward. It’s important to spit out this water. This reduces the amount of drug that can be swallowed and absorbed into your body by way of your stomach. It also reduces side effects, such as mouth and throat irritation and oral yeast infections (thrush).
- Long-acting beta-2 agonists (LABAs). These medications are part of a group of medications called bronchodilators, which open up constricted airways. Long-acting beta-2 agonists, such as salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer) last at least 12 hours. They’re used to control moderate and severe asthma and to prevent nighttime symptoms. Salmeterol or formoterol should always be combined on a regular schedule with inhaled corticosteroids and should not be used as the main treatment for asthma.
On Nov. 18, 2005, the Food and Drug Administration (FDA) issued a public health advisory for three LABA medications, warning that the medications may increase the risk of severe asthma episodes and possibly death if a severe asthma episode occurs. The three asthma medications included in the advisory are:
- Advair Diskus
- Foradil Aerolizer
- Serevent Diskus
The FDA has asked the manufacturers of the three medications to update their product labels with the new health warning. If you experience asthma attacks and you’re taking one of these medications, you’ll need to talk with your doctor to determine the best course of action.
- Leukotriene modifiers. These drugs reduce the production or block the action of leukotrienes — substances released by cells in your lungs during an asthma attack. Leukotrienes cause the lining of your airways to become inflamed, which in turn leads to wheezing, shortness of breath and mucus production. Leukotriene modifiers include montelukast (Singulair) and zafirlukast (Accolate).
Used in conjunction with other medications — such as inhaled corticosteroids — leukotriene modifiers may help prevent more attacks. Although generally not as effective as inhaled corticosteroids, leukotriene modifiers are an option if you have mild asthma and want to avoid corticosteroids.
- Cromolyn and nedocromil. Although they’re not effective for everyone, daily use of inhaled cromolyn (Intal) or nedocromil (Tilade) may help prevent mild to moderate asthma attacks. In some cases, they may also help prevent asthma triggered by exercise if you take them an hour before any vigorous activity.
- Theophylline. You take this bronchodilator in pill form every day. It may be helpful for relieving your nighttime symptoms of asthma. But theophylline may cause side effects, such as nausea and vomiting, severe abdominal pain, diarrhea, acid reflux, confusion, fast or irregular heartbeat, and nervousness. If you’re taking theophylline, get regular blood tests to make sure you’re getting the correct dosage.
These medications — medically known as short-acting bronchodilators — are sometimes called “rescue” medications because they can stop the symptoms of an asthma attack. These medications are taken as needed when you first begin to feel asthma signs and symptoms, such as coughing, wheezing, chest tightness or shortness of breath. Short-acting bronchodilators are also effective if taken before you feel any signs or symptoms, such as when your peak flow meter shows readings lower than normal. A peak flow meter is a device you can use at home to help detect subtle increases in your airway obstruction. A low reading may be a sign that your asthma is about to flare up. Your doctor can give you instructions on how to deal with low readings.
- Short-acting beta-2 agonists. These bronchodilators begin working within minutes and last four to six hours. But they can’t keep symptoms from coming back. The most commonly used short-acting bronchodilator for asthma is albuterol.
- Ipratropium (Atrovent). Your doctor may prescribe this medication for the immediate relief of your asthma symptoms.
- Oral and intravenous corticosteroids for asthma attacks. These corticosteroids — including prednisone, methylprednisolone, hydrocortisone and others — may be taken to treat acute asthma attacks or very severe asthma. 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, loss of bone mineral (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. If you have allergic asthma that can’t be easily controlled by avoiding triggers and using medication, allergy desensitization shots (immunotherapy) may help you. You’ll begin with skin tests to determine the allergens that cause you the most trouble, followed by a series of 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 the allergens. Immunotherapy isn’t for everyone, though. You’re most likely to benefit if it’s clear you have allergic asthma. In addition, immunotherapy carries the risk of an allergic reaction to the shot. Life-threatening reactions are rare but possible.
- Anti-IgE monoclonal antibodies. If you have allergies, your immune system produces allergy-causing IgE antibodies to attack substances that generally cause no harm, such as pollen, dust mites and pet dander. If you have allergic asthma that’s difficult to control, omalizumab (Xolair) may reduce the number of asthma attacks you experience by blocking the action of these antibodies. That way your immune system isn’t prompted to react and cause the inflammation that makes breathing difficult.
Your doctor may recommend Xolair if you have moderate to severe asthma caused by an allergy, if all other treatments have failed and if you’re at least 12 years old.
Xolair is delivered by injection every two to four weeks. Risks include the possibility of a severe reaction within two hours of receiving the shot, blood-clotting problems and a possible link to cancer. That link is currently being studied. Also, if you’re pregnant or breast-feeding, tell your doctor beforehand.
Treatment by severity for better control
Treatment based on asthma severity can help you control your asthma. According to guidelines from the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology, asthma therapy should be flexible and based on changes in symptoms, which should be assessed thoroughly each time you see your doctor. Then, treatment can be adjusted accordingly.
For example, if your asthma is well controlled, you may be able to take less medicine. On the other hand, if your asthma is uncontrolled or worsening, an increase in medication and more frequent visits with your doctor may be required.
The best way to prevent asthma attacks is to identify and avoid indoor and outdoor allergens and irritants. That’s easier said than done because thousands of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution — can trigger your attacks. A number of indoor allergens, including dust mites, cockroaches, pet dander and mold, can do the same. A common asthma irritant is tobacco smoke.
Even if you reduce indoor and outdoor allergens and irritants, managing asthma can be challenging. It often takes ongoing communication and teamwork with your doctor. But by working together, you and your doctor can design a step-by-step plan for living with your condition. In addition to knowing and avoiding your triggers, adopt the following behaviors:
- Develop an action plan. With your doctor and health care team, write a detailed plan for taking maintenance medications and managing an acute attack. Then be sure to follow your plan. Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life in general.
- Monitor your breathing. Like many people, you may recognize your own signs of an impending attack, such as slight coughing, wheezing or shortness of breath. But because your lung function may decrease before you notice any signs or symptoms, regularly measure your peak airflow with a home peak flow meter.
- Treat attacks early. If you act quickly, you’re less likely to have a severe attack. You also won’t need as much medication to control your symptoms. When your peak flow measurements decrease and alert you to an impending attack, take your medication as instructed and immediately stop any activity that may have triggered the attack. If your symptoms don’t improve, get medical help as directed in your action plan.
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