Medications for Asthma
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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
Talk to your doctor about your treatment goals and preferences and work together to come up with a treatment plan that is right for you.
Prescription Medications
Short-acting rescue medications
- Short acting beta-2-agonists
- Anticholinergics such as Ipratropium bromide (Atrovent)
- Systemic corticosteroids
- Inhaled corticosteroids
- Oral corticosteroids (for severe persistent asthma)
- Mast cell stabilizers such as cromolyn sodium or nedocromil
- Immunodilators such as omalizumab (an anti-IgE monoclonal antibody)
- Leukotriene modifiers such as montelukast and zafirlukast
- Long-acting Beta-2-antagonists such as salmeterol and formoterol
- Methylxanthines such as theophylline
- Combination agents (inhaled corticosteroids and long-acting beta-2-agonist)
Short-acting Rescue Medications
Short-acting rescue medications are used to treat acute asthma symptoms.
Beta-2-agonists (Inhalers):
Asthma Inhaler for a Child
Children will be more likely to benefit from inhaled medications if a spacer is used with metered-dose asthma inhalers . The University of Arizona offers a table that compares the different brands of spacers. A study, though, found that there was no difference in how medicine was delivered with homemade versus store-bought spacers. Talk to your doctor to find our what is right for you or your child.
Common names of beta-2-agonists (inhalers) include:
- Albuterol (Proventil, Ventolin)
- Levalbuterol (Xopenex MDI)
- Pirbuterol (Maxair)
These drugs are bronchodilators, meaning they open the airways by relaxing the muscles around bronchial tubes. This can provide quick relief of acute symptoms. They can also be used as preventive medications prior to exercise. You must be careful not to overuse these drugs and contact your doctor immediately if your symptoms are not controlled.
Common side effects include:
- Fast heartbeat
- Headache
- Nervousness
- Tremor
Ipratropium Bromide (Atrovent)
Ipratropium is a bronchodilator (medicine that opens up narrowed breathing passages and may decrease mucus secretion). It is taken by inhalation to help control the symptoms of lung diseases, such as asthma, chronic bronchitis , and emphysema . Ipratropium helps decrease coughing, wheezing, shortness of breath, and troubled breathing by increasing the flow of air into the lungs.
When ipratropium inhalation is used to treat acute, severe attacks of asthma, bronchitis, or emphysema, it is used only in combination with other bronchodilators.
Common side effects include:
- Cough
- Dryness of mouth
- Unpleasant taste
Corticosteroids (Oral)
Common names include:
- Methylprednisolone (intravenous)
- Prednisone (oral)
- Prednisolone (oral)
These drugs are sometimes used for a short duration to prevent the progression of moderate or severe symptoms, reverse inflammation, speed recovery, and reduce the risk of relapse.
Possible side effects include:
- Indigestion
- Lowered resistance to infections
- Abnormalities in glucose metabolism
- Increased appetite
- Mood alteration
- Fluid retention
Long-term Control Medications
Long-term “control” medications are used to achieve and maintain long-term management of symptoms and reduce inflammation.
Corticosteroids (Inhaler)
Common names include:
- Beclomethasone (Beclovent, Vanceril, Qvar)
- Budesonide (Pulmicort)
- Flunisolide (Aerobid)
- Fluticasone (Flovent)
- Mometasone
- Triamcinolone
These drugs suppress, control, and reverse inflammation. They can reduce the need for oral corticosteroids.
Possible side effects include:
- Oral thrush
- Cough
Corticosteroids (Oral)
Common names include:
- Methylprednisolone (Medrol)
- Prednisolone (Pediapred, Orapred)
- Prednisone (Deltasone, Orasone)
These drugs help reduce inflammation and prevent escalation of symptoms. Oral corticosteroids can produce more side effects than inhaled corticosteroids. Long-term use of oral corticosteroids is not generally recommended. However, your doctor may prescribe oral corticosteroids for long durations only when other treatments have failed to restore normal lung function and the risks of uncontrolled asthma are greater than the side effects of the medication.
Possible side effects include:
- Indigestion, nausea, and possibly bleeding in the stomach
- Lowered resistance to infections
- Growth suppression (in children)
- Obesity
- Diabetes mellitus
- Hypertension (high blood pressure)
- Osteoporosis (thinning of the bones)
- Cataracts
- Adrenal suppression
- Muscle weakness
Nonsteroidal Anti-inflammatory Inhalers
Common names include:
- Cromolyn sodium (Intal)
- Nedocromil (Tilade)
These drugs are used for long-term prevention of symptoms. They may modify inflammation and can be used as preventive treatment prior to exercise.
Possible side effects include:
- Unpleasant taste
- Cough
Long-acting Beta-2-agonists
Common names include:
- Salmeterol (Serevent)
- Formoterol (Foradil)
These drugs provide long-term prevention of symptoms, especially nighttime symptoms and are often added to anti-inflammatory therapy. They may also be used as preventive treatment prior to exercise or contact with a known allergen. However, they should not be used during an acute attack.
Possible side effects include:
- Rapid heart beat
- Tremor
- Difficulty sleeping, nervousness
Long-acting inhalers, like salmeterol, may increase the risk of asthma-related death, intubation (putting a tube in the windpipe to breathe), and hospitalization. Note: If you have any concerns, talk to your doctor.
Methylxanthines
Common names include:
- Theophylline (Theo-Dur, Uniphyl, Slo-bid)
This type of drug provides long-term control and prevention of symptoms, especially nighttime symptoms. It works by opening the airways and relaxing the muscles around the bronchial tubes. It also increases the ability to clear mucus out of the airway.
Possible side effects include:
- Headache
- Fast heartbeat
- Difficulty with urination
- Nervousness
- Trouble sleeping
- Upset stomach
Immunomodulators
Common names include:
- Zafirlukast (Accolate)
- Montelukast (Singulair)
- Zileuton —used for long term control and prevention in mild persistent asthma. Blocks the production of leukotrienes. Possible side effects include elevation of liver enzymes and interactions with other medicines
- Omalizumab —used for long term control and prevention of moderate or persistent allergic asthma. Binds to IgE. This medicine is injected. Pain and bruising at the injection site may occur. Anaphylaxis has been reported.
These drugs provide long-term control and prevention of symptoms in mild, persistent asthma. They work by blocking the action of leukotrienes—chemicals that play a role in inflammation and allergic reactions.
Combination Drugs
Common names include:
- Fluticasone and salmeterol (Advair)
These drugs provide long-term control and prevention of symptoms by combining the effects of a long-acting beta-2-agonist and inhaled steroid. Therefore, its effects are similar to both agents used alone combined in one convenient formulation.
The side effects of Advair are similar to those described above for both fluticasone and salmeterol.
Special Considerations
Whenever you are taking a prescription medication, take the following precautions:
- Take your medication as directed. Do not change the amount or the schedule.
- Do not stop taking them without talking to your doctor.
- Do not share them.
- Know what results and side effects to look for. Report them to your doctor.
- Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
- Plan ahead for refills so you don’t run out.
References:
American Academy of Allergy, Asthma, & Immunology website. Available at: http://www.aaaai.org/ . Accessed July, 2008.
Mosby's 2001-2002 Medical Drug Reference . Mosby-Year Book; 2001.
National Asthma Education and Prevention Program website. Available at: http://www.nhlbi.nih.gov/about/naepp/ . Accessed July, 2008.
National asthma education and prevention program expert panel, report 3; Guidelines for the diagnosis and management of asthma 2007. National heart, lung, and blood institute. http://www.nhlbi.nih.gov/guidelines/asthma/ . Accessed July, 2008.
1/6/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Levenson M. Long-acting beta-agonists and adverse asthma events meta-analysis. Joint Meeting of the Pulmonary-Allergy Drugs Advisory Committee, Drug Safety and Risk Management Advisory Committee and Pediatric Advisory Committee. December 10-11, 2008.
2/24/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Rodriguez-Martinez C, Sossa M, Lozano J. Commercial versus home-made spacers in delivering bronchodilator therapy for acute therapy in children. Cochrane Database Syst Rev. 2009;(1):CD005536.
5/21/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Wilson SR, Strub P, Buist AS, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med. 2010;181(6):566-577.
Last reviewed September 2009 by Christine Colpitts, CRT, MA
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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