There are two categories of asthma medications; quick-relief
medicines and controller
medicines. Quick-relief medicines are taken when
the symptoms of an asthma episode occurs. Controller medicines
prevent asthma episodes and must be taken regularly, even when
no symptoms are occurring.
Just as each person’s asthma triggers are different,
each person’s asthma medication treatment will be different.
Asthma symptoms can change over time and asthma medications
will change too. It is important for you to work very closely
with your or your child’s doctor to determine the best
current medications for your asthma condition
Quick-relief medicines
Quick-relief medicines treat the symptoms
of an asthma episode. These inhaled
medicines are fast acting. They provide relief from wheezing,
shortness of breath, tightness in the chest and trouble breathing
by relaxing the muscles around the airways. Relief usually comes
in minutes and can last for four to six hours. (For relaxation
techniques to help ease anxiety of an asthma episode see relaxation
and controlled breathing techniques.) There are few mild
side-effects which can include increased heart
rate and generalized stimulation. Inhaled medications should
always be used with a spacer. Some of the common brand
names of these medicines are Proventil, Ventolin,
Alupent, ProAire, Xopenenx and Brethaire.
These medications are also prescribed for use before exercise
for those individuals who experience exercise induced asthma.
Another medication, taken orally, also causes the smooth muscles
around the airways to relax. The medicine is called Theophylline.
Because it is taken orally, it enters the entire body. There
are more side-effects including upset stomach,
rapid heart beat, headaches, nervousness and difficulty concentrating.
Remember, these medications are for the relief of asthma episode
symptoms. They do not treat the inflammation that causes asthma
episodes. If you need to use your quick-relief medicine more
that two times per week for an asthma episode, you should contact
your doctor. (Note: this does not include use of quick-relief
medicine before exercise.)
Oral steroid medication is an additional form of quick-relief
medicine. Please see discussion below
regarding oral steroid medicine.
Controller medicines
Controller medicines treat and prevent the inflammation that
causes asthma episodes. This group of medicine is called anti-inflammatory
medication. They are not fast acting. Over the course of time
they will prevent inflammation and excess mucous production.
- a) Inhaled corticosteroids
- Inhaled corticosteroids are one of the most effective anti-inflammatory
medications for the treatment of asthma. In addition to reducing
and preventing inflammation, they decrease the airway sensitivity
and improve lung function. Some of the common brand names
of inhaled corticosteroids are AeroBid, Azmacort, Vanceril,
Flovent, Beclovent and Pulmicort. Two common side effects
of using inhaled corticosteroids are sore throat and sometimes
a yeast infection in the mouth. To lower the possibility of
these effects, a spacer, where appropriate, should always
be used and you should always rinse your mouth after using
these medications.
Many people are frightened by the word corticosteroid. They
confuse this natural substance with anabolic steroids which
are a synthetic substance related to the male sex hormone,
testosterone. Inhaled Corticosteroids fight respiratory inflammation.
Anabolic steroids are used illegally by body builders and
athletes to increase muscle. Another concern parents have
with inhaled corticosteroids is that it can cause an effect
on growth in young people. While studies show that a slight
decrease in growth rate may occur at first, they also have
shown that there is not a long-term effect on growth rate.
A final concern is that the use of inhaled corticosteroids
may increase the risk of bone loss in premenopausal women.
This concern should be discussed with your doctor.
- b) Cromolyn and Nedrocromil
- Cromolyn and Nedrocromil are also controller
medicines. They work as an anti-inflammatory agent to prevent
swelling and mucous production. Unlike the inhaled corticosteroids,
they can not reduce swelling that has already occurred. These
medicines must be taken regularly to prevent asthma symptoms.
They are long-acting and their benefits increase over weeks
and months of use. There can be a side effect of a dry cough.
Using a spacer where appropriate and rinsing your mouth after
use is also advised with these medicines.
- c) Leukotriene Modifiers
- The newest group of controller anti-inflammatory medicines
is called Leukotriene Modifiers. Leukotrienes are chemicals
that occur naturally in the body. These are chemicals in the
airway that cause inflammation and airway muscle constriction.
The Leukotriene Modifiers block the formation or action of
these chemicals. These medications are taken by mouth and
may take days to a week to be effective. Three Leukotriene
Modifiers are currently available. Their brand names are Singulair,
Accolate and Zyflo. Each of these medications can cause side
effects when taken with other specific medications. It is
essential that your doctor know every medication you are taking
before prescribing Leukotriene Modifiers.
- d) Long-acting beta-agonist
- Another controller medication is a long-acting beta-agonist.
This medication opens the airways. Common names of these medications
are Serovent, Proventil Repetabs and Volmex. These medications
can reduce the dose of inhaled steroid medication.
- e) Combination
- An additional form of controller medication is available
as an inhaled corticosteroid in combination with a long-acting
bronchodilator. These two medications are Advair and Symbicort.
Oral steroids
Oral steroids can be an asthma control medication
and/or a quick-relief medicine that is used with an acute asthma
episode. They act quickly to reduce severe inflammation of the
airways and reduce mucous production.
Oral steroids are most often prescribed in a short
burst, usually one to two weeks. Used in this manner,
oral steroids can shorten a severe asthma episode and reduce
the risk of hospitalization or death. Because oral steroids
can stop the production of the body’s natural steroids,
the dose is usually tapered down over several days to a week.
Long-term use of high dose oral steroids has
many serious side-effects. These can include
thinning of the skin, weight gain, fluid retention, increased
blood pressure, headache, mood changes, and bone loss, slowed
growth in children, increased risk of cataracts and glaucoma,
and fatigue. (The short bursts of oral steroids do not carry
a significant risk of these side effects.) Because of these
risks, long-term use of oral steroids is only used for patients
with very difficult to control asthma. It is essential that
these patients work very closely with their physician to monitor
their health.
There are a few additional medications that are rarely used
for very difficult to control asthma. If your doctor prescribes
one of these rare medications, you should consult your physician
and pharmacist for information regarding the medicine.
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