When someone is diagnosed with asthma it is customary for the doctor and patient to put an action plan into place to eliminate triggers, prescribe treatment and ultimately control asthma symptoms. Being able to control asthma will prevent chronic symptoms of asthma such as coughing and wheezing, reduce the occurrence and frequency of attacks and maintain normal activity levels in daily life. Because there is no cure for asthma and in some instances of asthma there is no identified cause, medication is necessary to treat, prevent and control the symptoms of the disease. The type of medication is determined upon the patient’s age, symptoms, triggers, and what makes the asthma better. Not all medications work on every individual especially since more than a quarter of people who suffer with asthma are children. Therefore determining the right type of prescription will be a task that both the doctor and patient will have to develop together.
There are two types of medications that doctors prescribe to asthma patients, long-term control medications and quick relief or rescue medications. Long-term control medications are the most effective way to reduce inflammation in the airway. Long-term treatments are normally taken on a daily basis to prevent symptoms. Quick relief medications are used in flare up situations to quickly open up swollen airways. Asthma patients most commonly use inhalers because the medication goes directly to the lungs however; pill and liquid forms of asthma medications are available as well.
Long-term control medications include inhaled corticosteroids, leukotriene modifiers, long-acting beta agonists, combination inhalers, theophylline, and methylxanthines. Quick relief medications include short-acting bronchodilator inhalers, anticholinergics, and oral and intravenous corticosteroids. With extrinsic asthma, allergies are a possible trigger, which is why allergy medication is used to treat allergy-induced asthma. Allergy medications include immunotherapy allergy shots, oral and nasal spray antihistamines, decongestants, and corticosteroid nasal sprays. Bronchial thermoplasty is another treatment that is used in cases where asthma is severe and traditional medications are ineffective. Lastly in cases where patients have difficulty with inhalers, an asthma nebulizer should be used.
LONG-TERM CONTROL MEDICATIONS
Inhaled corticosteroids-Inhaled corticosteroids are the preferred long-term control medication for people who suffer with asthma. They are most effective at relieving airway inflammation and swelling. By reducing the inflammation in the lungs it prevents the chain reaction that causes all the symptoms of an asthma attack. Taking inhaled corticosteroids daily can greatly reduce the severity of asthma, frequency and occurrence of asthma attacks. Inhaled corticosteroids are generally safe and are not habit forming. They have a lower risk of side effects than oral corticosteroids in pill or liquid form. Examples of inhaled corticosteroids include Flovent Diskus, Flovent HFA, Pulmicort Flexhaler, Asmanex, Aerobid, Qvar, Vancenase, Beclovent, Nasacort, and Atolone.
Leukotriene modifiers- Leukotriene modifiers inhibit leukotriene, a chemical that promotes the body’s inflammatory response. By blocking these chemicals, leukotriene inhibitors reduce inflammation within the airways. Therefore eliminating the chain reaction, which causes asthma symptoms. Some side effects linked to leukotriene inhibitors include agitation, aggression, hallucinations, depression and suicidal thinking. Examples of leukotriene inhibitors include Singulair, Accolate, Zyflo, and Zyflo CR.
Long-acting beta agonists-Long-acting beta agonists are chemically related to adrenaline and are used to open up the airways. They keep the airways open for 12 hours or longer. However, long-acting beta agonists should not be used along. They should be used in combination with a low dose inhaled corticosteroid. Side effects include rapid heartbeat and shakiness Examples of inhaled medications include Serevent, and Foradil,
Combination inhalers-Combination inhalers include an inhaled steroid with a long-acting bronchodilator. Examples of combination inhalers include Advair Diskus and Symbicort.
Methylxanthines- Methylxanthines is a group of controller medications that is chemically related to caffeine and opens up the airways. Methylxanthines work as long-acting bronchodilators. Theophylline and aminophylline are examples of methylxanthines.
QUICK RELIEF MEDICATIONS
Short-acting beta agonists- Also known as short-acting bronchodilator inhalers, this medication is used for quick relief of coughing, wheezing, chest tightness, and shortness of breathe. These medications dilate the airways to lessen the asthma symptoms. Examples of short acting beta agonists include Albuterol, Levalbuterol, and pirbuterol.
Anticholinergics- Anticholinergics open up the airways by blocking the neurotransmitter acetylcholine within the central and peripheral nervous system. This is similar to the action of beta-agonists however; anticholinergics take slightly longer to take effect but last longer overall. In some instances anticholinergics and beta-agonists will be used together to produce a greater effect. The anticholinergics used for rescue asthma medication is Ipratropium bromide (Atrovent).
Oral and Intravenous Corticosteroids-Corticosteroids should be taken for short-term use only due to the increased side effects. Corticosteroids are an effective anti-inflammatory, and side effects are temporary when taken for two weeks or less otherwise they can be permanent. Prednisone and methylprednisolone are two examples of oral corticosteroids.
ALLERGY INDUCED MEDICATION
Immunotherapy- Immunotherapy is used to alter the immune system in patients who have an elevated level of immunoglobulin E, an allergy antibody. Allergy shots are generally given once a week for a few months, and then once a month after that. Omalizumab (Xolair) is one kind of immunotherapy injection.
Allergy Medication- Allergy medications include oral and nasal sprays, antihistamines, and decongestants. They work by preventing asthma related inflammation in the airways.
Cromolyn and Ipratropium are two forms of nasal sprays used as asthma medication. Cromolyn can prevent the development of an asthma attack if taken regularly however it does not help once an attack has started.
Bronchial thermoplasty- When inhaled corticosteroids don’t improve asthma symptoms, especially in severe cases, bronchial thermoplasty may be the next best option. Bronchial thermoplasty uses an electrode to warm the inside of the airways, which calms the smooth muscle within the lungs. This helps to inhibit inflammation in the airways, which causes asthma symptoms. Bronchial thermoplasty is not widely available since more research is needed to determine the benefits and possible side effects.
Asthma Nebulizer- An asthma nebulizer is also known as a breathing machine. They are generally used in cases where there is difficulty using an inhaler. Asthma nebulizers use a mask that covers the mouth and nose. It changes the medication from a liquid into a mist making it more accessible to be inhaled into the lungs. Unlike an inhaler, a nebulizer requires several minutes for treatment.