Treatment for Asthma
The two types of asthma medications used to treat asthma include long-term control medication and short-term, quick-relief medication. Though the goal of both medications is to treat asthma symptoms, they are used for different purposes. Long-term control medication is usually taken every day to control asthma symptoms and to prevent the occurrence of asthma attacks. Quick-relief medication is primarily taken to relieve the sudden onset of asthma symptoms (such as during an asthma attack), and in cases in which the asthma symptoms only occur occasionally.
The type of medication prescribed by your physician to treat your asthma symptoms depends on the type and severity of your asthma, as well as your other individual medical needs.
Long-term asthma control medications may include inhaled anti-inflammatory drugs (medications that reduce or prevent the swelling in the airways) and long-acting bronchodilators (medications that open the airways by relaxing muscles around and in the airways that tighten during asthma). The goal of long-term medications is to reduce and prevent swelling in the airways that can trigger asthma attacks. According to the National Heart, Lung, and Blood Institute (NHLBI), long-term control medications may be recommended for people who:
- experience asthma symptoms three or more times a week.
- experience asthma symptoms at night three or more times a month.
When a person first starts taking long-term control medications, it may take a few weeks for the medications to become effective. It is very important that long-term control medication is taken every day, even if the person is feeling well, to continue managing the asthma at an optimal level.
Whether the asthma control medication is inhaled or ingested as a tablet or liquid depends on the type of medication and purpose. For example, for long-term control of asthma, you may be instructed by your physician to take albuterol as an extended-release tablet. However, when using albuterol for short-term, quick relief medication, you may be instructed by your physician to take a form of an inhaled medication. Consult your physician for more information.
Long-term asthma control medication may include:
- inhaled corticosteroids - anti-inflammatory medication that prevents swelling of the airways when exposed to asthma triggers. Steroids, which also reduce mucus in the lungs, are sometimes used to prevent and control mild, moderate, and severe asthma.
- inhaled cromolyn and nedocromil - nonsteroidal, anti-inflammatory medications that are often used to treat children with mild asthma. (Both cromolyn and nedocromil cannot stop symptoms during an asthma attack. They only are used to help prevent an asthma attack from occurring.).
- inhaled long-acting beta2-agonists - mainly used to control moderate-to-severe asthma and to prevent nighttime symptoms, these bronchodilator medications relax muscles around the tightened airways so that the airways reopen. These medications do not reduce swelling, so they are often prescribed along with an anti-inflammatory medication, such as an inhaled steroid.
- sustained-release theophylline or sustained-release beta2-agonist tablets - bronchodilators used to prevent nighttime symptoms. Theophylline needs to build up in the blood stream over time to be effective in treating asthma.
- leukotriene modifiers - these medications block the action of chemicals called leukotrienes, which occur in white blood cells and may cause inflammation and narrowing of the airways. Leukotriene modifiers cannot stop symptoms during an asthma attack. They only are used to prevent an asthma attack from occurring. Leukotriene modifiers seem to be more effective in people with aspirin-sensitive asthma (a type of asthma triggered by an allergic reaction to aspirin or other nonsteroidal anti-inflammatory medications).
Examples of long-term asthma control medication:
||Generic medication examples
||beclomethasone, budesonide, flunisolide, fluticasone, triamcinolone
|inhaled cromolyn and nedocromil
||cromolyn sodium, nedocromil sodium
|leukotriene modifiers (tablets)
||salmeterol (inhaled), albuterol (tablets)
|theophylline (tablets or liquids)
Omalizumab (Xolair®) is a newer long-term asthma control medicine that works by binding to one of the antibodies that trigger allergic asthma attacks. It is an injection administered twice monthly to patients age 12 and older. Because of the potential for a severe allergic reaction (anaphylaxis) to this medication, it should be given only at a physician's office experienced with omalizumab.
Long-term asthma control medication may affect individuals differently. Your physician will prescribe the appropriate asthma control medication based on your individual needs.
Quick-relief asthma medication quickly relaxes the muscles in and around the airways that tighten during an asthma attack. The sooner a person takes quick-relief medication at the onset of asthma symptoms, the faster the asthma will be back under control. Although quick-relief medications may relieve symptoms, the relief may only last about four hours. It is important to note that quick-relief asthma medications do not keep symptoms from recurring. Only long-term asthma control medications can help prevent the recurrence of symptoms. Some people with severe or frequent asthma may use both types of medications to control their asthma (as advised by their physician) - the long-term asthma control medication to keep the inflammation controlled and the quick-relief medication in the event of an asthma attack.
When using more and more of the quick-relief asthma medications to obtain relief, the asthma may become uncontrolled and an adjustment of the long-term asthma control medication may be necessary. Always consult your physician.
Quick-relief medications may include:
- inhaled short-acting beta2-agonists - short-acting beta2-agonists are bronchodilator medications to help relax muscles in and around the tightened airways so that the airways reopen.
- inhaled anticholinergics - medications that block a chemical called acetylcholine. Acetylcholine can stimulate muscle contractions, increase mouth and lung secretions, and slow the heartbeat, resulting in an asthma attack.
Examples of quick-relief asthma medication:
||Generic medication examples
|inhaled short-acting beta2-agonists
||albuterol, bitolterol, pirbuterol, terbutaline
Your physician may also prescribe short course of oral corticosteroids (in tablet or liquid form) during periods of flare-ups with your asthma. Oral corticosteroids are anti-inflammatory medications that may prevent swelling of the airways and reduce mucus in the lungs. Oral corticosteroids do not give immediate relief, but are often used together with your quick-relief inhaled medications to provide better asthma control.
Short-term, quick-relief asthma medication may affect individuals differently. Your physician will prescribe the appropriate asthma control medication based on your individual needs.
In most cases, inhaled medications are preferable to oral medications, because they tend to have fewer side effects. When medicine is inhaled, less is needed because it goes directly to the target: the lungs. In addition, inhaled medications take a shorter amount of time to become effective (minutes instead of hours).
One 2002 study also stated that regular use of inhaled corticosteroids in people with asthma can reduce their hospital admissions for severe attacks by almost one-third (31 percent). Other studies in the past have focused on the short-term results from the use of inhalers to prevent asthma attacks. After examining health insurance records for more than 30,000 people with asthma collected over 22 years, the researchers found that on average, 42 in every 1,000 study participants were admitted to the hospital each year. However, regular use of inhaled corticosteroids reduced overall hospital admission rates by 31 percent and re-admission rates by 39 percent.
Always consult your physician for more information.
Several types of inhalation devices are used in the treatment of asthma or other chronic obstructive pulmonary diseases, such as emphysema. Inhalers are often effective in delivering medication directly to the lungs, with fewer side effects than medications taken by mouth or injection. There are several types of inhalation devices. The type of inhalation device will vary, depending on your medical history, preference, and severity and frequency of the symptoms. Inhalers can contain anti-inflammatory medications or bronchodilator medications. The most common types of inhalation devices including the following:
- metered-dose inhaler (MDI)
The most common type of inhaler, the metered-dose inhaler, in most cases, uses a chemical propellant (chlorofluorocarbons, or CFCs) to emit the medication out of the inhaler. There are now some MDIs that do not use CFCs to propel the medication. Many new types of delivery systems are being developed.
A metered-dose inhaler is held in front of or inserted into the mouth as the medication is released in puffs. Consult your physician for specific instructions on how to properly use a metered-dose inhaler.
As of December 31, 2008, albuterol inhalers containing CFCs will no longer be available. Albuterol inhalers will contain hydrofluoroalkane (HFA) propellant instead. This change is being made because CFCs affect the earth’s ozone layer, contributing to its depletion.
According to the US Food and Drug Administration (FDA), HFA inhalers may taste and feel different than a CFC inhaler. However, the medication itself will be the same. The American Academy of Allergy, Asthma, and Immunology lists the following as differences that may be experienced using an HFA inhaler:
- slight difference in smell and taste
- a mist that is less forceful and feels warmer
- inhaler may need to be cleaned and cared for in a different manner
A nebulizer is a type of inhaler that sprays a fine, liquid mist of medication. This is done through a mask, using oxygen or air under pressure, or an ultrasonic machine (often used by persons who cannot use a metered-dose inhaler, such as infants and young children, and persons with severe asthma). A mouth piece is connected to a machine via plastic tubing to deliver medication to the patient. Consult your physician for specific instructions on how to properly use a nebulizer.
- dry powder or rotary inhaler
A breath-activated, non-pressurized dry powder inhaler that may be used for children and adults, this type of inhaler does not use chlorofluorocarbon (CFC) to propel the medication out of the device. Consult your physician for specific instructions on how to properly use a dry powder or rotary inhaler.
Although many metered-dose inhalers still use chlorofluorocarbon (CFC) to propel the medication out, more and more inhalers are being replaced with devices that do not use CFC. CFC, although safe for the person to inhale, is known to damage the earth's ozone layer - a shield that protects the earth against harmful sun rays. Other devices that previously used CFC, such as air conditioners and refrigerators, have already been changed to non-CFC alternatives.
Talk with your physician for more information before taking any asthma medications.
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