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 National Heart, Lung, and Blood Institute asthma treatment guidelines recommend ongoing adjustment of medication doses or medication types as your health needs change. The type of medication prescribed by your doctor to treat your asthma symptoms depends on the type and severity of your asthma, as well as your other individual medical needs.
The goal of long-term medications is to reduce and prevent swelling in the airways that can trigger asthma attacks. 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 doctor to take albuterol as an extended-release tablet. However, when using albuterol for short-term, quick relief medication, you may be instructed by your doctor to take a form of an inhaled medication. Consult your doctor for more information.
Long-term asthma control medication may include:
- Anti-inflammatory drugs.These medications reduce or prevent swelling in the airways and may include:
- Inhaled corticosteroids. These anti-inflammatory medications prevent 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. These are nonsteroidal, anti-inflammatory medications that are often used to treat children with mild asthma. Cromolyn and nedocromil cannot stop symptoms during an asthma attack. They are only used to help prevent an asthma attack from occurring.
- Bronchodilators.These long-acting medications, which open the airways by relaxing muscles around and in the airways that tighten during asthma, may include:
- 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. These bronchodilators are used to prevent nighttime symptoms. Theophylline needs to build up in the bloodstream 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).
- Anti-IgE (omalizumab).These medications are most useful for patients with moderate to severe persistent allergic asthma. They reduce allergic reactions by causing free IgE to disappear from the body and preventing it from attaching to allergens.
Examples of long-term asthma control medication:
|Category||Generic medication examples|
|Inhaled corticosteroids||Beclomethasone, budesonide, flunisolide, fluticasone, triamcinolone|
|Inhaled cromolyn and nedocromil||Cromolyn sodium, nedocromil sodium|
|Leukotriene modifiers (tablets)||Zafirlukast, zileuton|
|Long-acting beta2-agonists||Salmeterol (inhaled), albuterol (tablets)|
|Theophylline (tablets or liquids)||Theophylline|
Omalizumab (Xolair) is a 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 doctor's office experienced with omalizumab.
Long-term asthma control medication may affect individuals differently. Your doctor 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 two to three 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 doctors)--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 doctor.
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:
|Category||Generic medication examples|
|Inhaled short-acting beta2-agonists||Albuterol, pirbuterol, terbutaline|
|Inhaled anticholinergics||Ipratropium bromide|
Your doctor 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 doctor 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 doctor 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, uses a chemical propellant (hydrofluoroalkane or HFA) to emit the medication out of the inhaler.
A metered-dose inhaler is held in front of or inserted into the mouth as the medication is released in puffs. Consult your doctor for specific instructions on how to properly use a metered-dose inhaler.
As of December 31, 2011, MDIs sold in the United States may no longer use ozone-depleting chlorofluorocarbons (CFCs) to propel the medication.
- Nebulizer. 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 people who cannot use a metered-dose inhaler, such as infants and young children, and people with severe asthma). A mouthpiece is connected to a machine via plastic tubing to deliver medication to the patient. Consult your doctor for specific instructions on how to properly use a nebulizer.
- Dry powder or rotary inhaler. A breath-activated, nonpressurized dry powder inhaler that may be used for children and adults, this type of inhaler does not use CFCs to propel the medication out of the device. Consult your doctor for specific instructions on how to properly use a dry powder or rotary inhaler.
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