Asthma

Medications To Prevent Asthma Attacks

Knowing how airway inflammation prompts asthma symptoms, researchers have developed powerful “preventer medicines” for asthma that halt inflammation in a number of ways, including:

• Stopping the production of chemicals in the body that cause inflammation
• Blocking the release of these harmful chemicals from the cells that make them
• Competing with these harmful chemicals so as to prevent them narrowing of the airway

Anti-Inflammatory Medicines

These medications prevent asthma attacks by:

• Reducing the swelling of the lining of the airway
• Reducing the narrowing of airways due to tightening by the surrounding muscle
• Reducing mucus formation in the airways

The main anti-inflammatory preventer drugs are inhaled corticosteroids. Examples of inhaled corticosteroids are:

• AeroBid; Bronalide (flunisolide)
• Advair (fluticasone + salmeterol)
• Azmacort (triamcinolone) (has a built-in spacer device)
• Beclovent; Vanceril (beclomethasone)
• Flovent (fluticasone)
• Pulmicort (budesonide)

(Names under which these drugs are sold – the trade names – are given first, followed by the generic name in parentheses.)

Corticosteroids are the most effective anti-inflammatory drugs for the prevention of asthma symptoms.

• The corticosteroids used in asthma treatment are not the same as the anabolic steroids used by some athletes to build muscle mass and “bulk up.”
• Using a spacer with inhaled steroids reduces the risk for mouth and throat irritation. Gargling and rinsing the mouth with water after using the inhaler also is recommended.

At the usual doses inhaled steroids are well absorbed in the lung and produce few side effects. At higher doses, side effects may include:

• Hoarseness
• Cough
• Thrush (yeast infection in the mouth)

Other Preventer Medications

Sometimes the long-term control and prevention of asthma symptoms requires the use of other medicines in addition to, or in place of, inhaled corticosteroids. Your doctor will tell you exactly what to do if a dose adjustment in your inhaled steroid is required or if other asthma medicines are to be added.

Other preventer drugs that can help control asthma symptoms include:

• Long-acting beta2-bronchodilators
• Theophylline bronchodilators
• Oral corticosteroids
• Nonsteroidal antiallergics
• Leukotriene modifiers

Long-Acting Beta2-Bronchodilators

These medications include Foradil (formoterol) and Serevent (salmeterol). These are inhaled medications that are used in addition to inhaled anti-inflammatory steroids. They should not be used alone.

• The amount of other preventer medicines you take may be adjusted by your doctor after you start taking long-acting bronchodilators. Do not change dosages of any asthma medicines on your own.
• Long-acting beta2-bronchodilators are much more potent than short-acting beta2-bronchodilators such as albuterol. Do not take more than your doctor ordered.
• These very potent and long-acting drugs relieve airway constriction for a long period of time (about 12 hours) but are not indicated for the relief of symptoms during an acute asthma attack.
• If your action plan instructs you to take a short-acting reliever drug such as albuterol during an asthma attack, continue using your long-acting medication as directed.

Theophylline Bronchodilators

These include Theo-Dur, Theolair (theophylline). They are oral bronchodilator drugs (tablet or syrup) that work in a different way than the beta2-bronchodilators to relieve muscle spasm of the airways.

• Long acting and useful for nighttime asthma symptoms.
• Effectiveness in controlling asthma symptoms is related to the amount of drug in the bloodstream.
• Regular blood tests to determine the blood level of theophylline are required.
• The blood level of theophylline can be increased by many different drugs such as erythromycin (an antibiotic) and conditions such as cirrhosis of the liver. The blood level of theophylline can be decreased by other drugs such as benzodiazepine (a tranquilizer) and factors such as cigarette smoking.
• At higher doses, side effects may include nausea and vomiting, headache and dizziness, nervousness and irritability, and insomnia.
• When theophylline is used properly and monitored under a doctor’s care, it is a safe and useful drug in the management of asthma symptoms.

Oral Corticosteroids

These include:

• Delta-Cortef (prednisolone)
• Deltasone (prednisone)
• Medrol; Solu-Medrol (methylprednisolone)

These steroids are related to cortisone produced in our bodies. They are sometimes required to control more severe episodes of asthma.

• If used for more than a few weeks, the dose must be gradually reduced if the drugs need to be withdrawn
• Long-term use of oral steroids can produce significant side effects such as high blood sugar, weight gain, fluid retention, high blood pressure, muscle weakness, and slow wound healing.
• Your doctor may try to minimize these side effects by prescribing a very low dose of oral steroids, having you take the medicine every other day, or some combination of instructions.

Nonsteroidal Antiallergics

These include Intal (cromolyn) and Tilade (nedocromil). Cromolyn andnedocromil are not related to the corticosteroids.

• These drugs work by blocking the release of inflammatory chemicals from certain cells in the body.
• They are useful in protecting the airways from exposure to allergens or to the irritating effect of exercise or cold air.
• They may reduce the need for inhaled corticosteroids and bronchodilators.
• The nonsteroidal antiallergics must be taken continually for maximum protection.

Leukotriene Modifiers

These include:

• Accolate (zafirlukast)
• Singulair (montelukast)
• Zyflo (zileuton)

Leukotriene modifiers (or antileukotrienes) are the first new class of prescription asthma medication to be introduced in 20 years. The drugs control leukotrienes, which are inflammatory chemicals released by cells in the lung during an attack.

Leukotrienes cause lung tissue to become inflamed, mucus to be secreted, and smooth muscle around the airways to contract. These changes lead to asthma symptoms such as wheezing and shortness of breath.

• Zafirlukast and montelukast control asthma symptoms by blocking the action of leukotrienes on the airways. Zileuton blocks the actual production of leukotrienes.
• When used in combination with inhaled corticosteroids, the leukotriene modifiers may be helpful in preventing more attacks.
• All of the leukotriene modifier drugs are oral medications, making them easier to take than most other asthma medicines that are taken into the lungs by inhaler.
• Side effects may include headache and nausea, and the drugs may interfere with the action of blood thinners.