Asthma medications are divided into two types—quick-relief and long-term control. Quick-relief medicines are used to control the immediate symptoms of an asthma episode. Long-term control medicines do not provide relief right away, but help to lessen the frequency and severity of episodes over time.
- Long-term control medications. These drugs are usually taken daily to control persistent asthma. The most effective long-term control medications reduce the inflammation of your airways. The inflammation may be present even when you feel fine. Inhaled steroids are powerful anti-inflammatory medications and provide effective long-term asthma control.
- Quick-relief medications. These drugs provide prompt treatment for asthma attacks, which occur when your airways narrow and cause coughing, chest tightness, shortness of breath and wheezing.
Long-term control medications
Long-term control medications are usually taken daily on a long-term basis to achieve and maintain control of persistent asthma. Regular use of inhaled corticosteroids can suppress inflammation, decrease bronchial sensitivity and decrease symptoms in patients with persistent asthma.
Corticosteroids: Inhaled and oral steroids
1. Inhaled Steroids
- Most effective single long-term control therapy available for patients with persistent asthma
- Most potent anti-inflammatory medication currently available
- Have been shown to decrease the use of quick-relief medications
- Not the same as anabolic steroids, which are used by athletes to increase muscle mass
- Dosage form: inhaled through metered dose inhaler (MDI) or dry powder inhaler (DPI)
Potential Adverse Effects
- A possible life threatening condition called adrenal insufficiency may happen if you switch from a corticosteroid taken by mouth to an inhaled corticosteroid. This condition interferes with the body's ability to cope with medical emergencies of trauma, surgery, and infection (particularly gastroenteritis). Your body may need time to adjust. Follow your doctor's direction carefully.
- Systemic adverse effects with inhaled steroids are less than oral at the dose ranges currently used. Local side effects include candidiasis (thrush), dysphonia, hoarseness, dry mouth, and coughing.
2. Oral Steroids
- Can be used chronically for the most severe, difficult-to-control asthma
- Usually administered as a short-course "burst" to gain quick control of persistent asthma
- Dosage forms: tablets and/or tabs
Potential Adverse Effects
- With short-term use, systemic steroids may cause increased appetite, fluid retention, weight gain and mood alteration
- Long-term use carries a much greater risk of adverse effects, including growth suppression, osteoporosis, dermal thinning, cataracts, and muscle weakness
Mast Cell Stabilizers: Cromolyn Sodium and Nedocromil:
- Can be used as an alternative choice for for mild persistent asthma in children
- May also be used as preventive treatment prior to exercise or unavoidable exposure to known allergens
- Strong safety profile
- Dosage form: inhaled through metered dose inhaler (MDI) or nebulizer
Potential Adverse Effects
- The most common are throat irritation or dryness, bad taste, and cough.
Long-acting Beta2-Agonists (LABA)
- Effective for long term prevention of asthma symptoms, added to inhaled corticosteroids (ICS)
- Prevents exercise-induced bronchospasm
- Not to be used to treat acute symptoms or exacerbations
- Dosage form: inhaled or orally as tablets
Potential Adverse Effects
- The NAEPP Expert Panel Report 3, 2007, recommends that the established, beneficial effects of LABA for the majority of patients whose asthma is not well controlled with ICS alone should be weighed against the increased risk for severe exacerbations, although uncommon, associated with the daily us of LABA
- Principal adverse effects of this drug class are tachycardia, palpitations, tremor, nervousness, and insomnia
Methylxanthines
- The main use of theophylline, the principally used methylxanthine, is as adjunctive therapy to ICS.
- An alternative — but not preferred — alternative for mild persistent asthma
- Dosage form: liquids, tablets and capsules
Potential Adverse Effects
- Side effects at usual therapeutic doses include insomnia, gastric upset, aggravation of ulcer or reflux, and difficulty in urination in males with prostatism
- Dose-related acute toxicities include tachycardia, nausea and vomiting, central nervous system stimulation, headache, seizures, hematemesis, hyperglycemia, and hypokalemia
Leukotriene Modifiers
- Alternative--not preferred--treatment option for mild persistent asthma
- Can be used as adjunct therapy with ICS, but for youths over 12 and adults they are not the preferred, adjunct therapy compared to the addition of LABAs
- Dosage form: tablets, granules
Potential Adverse Effects
- Well tolerated with few side effects. Case studies have suggested zafirlukast and zileuton affect theophylline and warfarin levels requiring frequent monitoring of theophylline level and prothrombin time in those individuals taking these medications Elevated liver transaminases have also been noted in individuals on montelukast, zileuton, and zafirlukast, and the FDA advises that liver function be tested monthly for 3 months, then quarterly for the next year, followed by intermittent testing.
Quick-relief medications
Quick-relief medications provide prompt relief of asthma attack symptoms: chest tightness, wheezing and coughing.
- Inhaled Short-acting Beta2-Agonists
- Anticholinergics
- Systemic Corticosteroids
Inhaled Short-acting Beta2-Agonists
- Most effective medication for treating acute asthma symptoms
- Relax airway smooth muscle and cause a prompt (within 3-5 minutes) increase in airflow
- Preventative treatment prior to exercise for exercise-induced symptoms
- Often overused. May actually exacerbate asthma when misused
- Dosage form: inhaled
Potential Adverse Effects
- Principal adverse effects of this drug are tachycardia, palpitations, tremor, nervousness, headache, and insomnia
- The drugs mays cause adverse cardiovascular reactions in patients with cardiovascular disease, especially elderly patients
Anticholinergics
- Alternative for patients with intolerance to Beta2-agonists
- Treatment of choice for bronchospasm due to beta-blocker medication
- May provide additive effect with multiple doses to Beta2-Agonists, in emergency departments for moderate to severe exacerbations
- Dosage form: inhaled
Potential Adverse Effects
- The most common adverse effects are headache, dry mouth, and cough
- Ipratropium is contraindicated in patients with hypersensitivity to atropine and should be used with caution in patients with glaucoma or bladder neck obstruction, since use may exacerbate these problems
Systemic Corticosteroids
- For moderate to severe exacerbations
- Prevents progression of exacerbation, reverses inflammation, speeds recovery and reduces rate of relapse
- Dosage forms: ingested tablets, liquids or injections
Potential Adverse Effects
- With short-term use, systemic steroids may cause increased appetite, fluid retention, weight gain, and mood alteration.
- Long-term use carries a much greater risk of adverse effects including growth suppression, osteoporosis, dermal thinning, elevated blood sugars, cataracts, and muscle weakness
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