Asthma treatment requires a comprehensive multi-disciplinary approach using various preventative and treatment methods. Asthma can be complex requiring thorough evaluation by your asthma specialist There are two aspects of medical treatment for asthma: asthma control therapy and asthma reliever therapy. Asthma control therapy uses a whole array of medications that focus on controlling allergic inflammation and preventing patients from having asthma attacks. Asthma relievers are medications that help treat an actual asthma attack by reversing bronchospasm or bronchoconstriction that restricts air from getting into the lungs.
Short-acting beta agonists (SABA) or bronchodilators are used primarily for asthma rescue or reliever therapy. They are available as oral preparations in tablet or liquid forms, as inhalers or solutions for inhalation, or as injections. Short-acting bronchodilators inhalers conveniently allow asthmatics to participate in activities that may be limited by their asthma but more importantly the inhalers are life-saving especially in treating an asthma attack. They work quickly and open the bronchial airways thus allowing more air into the lungs.
The SABAs that can be used for the treatment of an acute asthma flare-up or prophylactically for exercised-induced asthma include the following:
- Albuterol HFA oral inhaler
- Albuterol oral solution for nebulization
- Levalbuterol HFA oral inhaler
- Levabuterol oral solution for nebulization
- Pirbuterol Autohaler oral inhaler
- Albuterol-Iprotropium HFA inhaler
Inhaled steroids are the preferred medication for long term asthma treatment. Inhaled corticosteroids are used as first-line therapy for asthma control because of their proven safety and effectiveness. This class of asthma medications keep asthma under control by keeping multiple aspects of bronchial allergic inflammation at bay. These medications are taken as an inhaler. This allows dosing a concentrated amount of steroid into to the lungs with very little absorption and distribution into the body. In patients with persistent or chronic asthma, inhaled steroids are extremely important in keeping them out of the emergency room, avoiding asthma attacks, and preventing long-term complications from asthma. Thus, inhaled steroids should be taken as maintenance asthma treatment.
Steroids approved for maintenance asthma treatment available as inhalers or solutions in the United States are listed below:
- Beclomethasone Dipropionate HFA oral inhaler
- Budesonide Dry powder inhaler
- Budesonide Oral inhalation solution
- Ciclesonide HFA oral inhaler
- Fluticasone Dipropionate HFA inhaler
- Fluticasone Diproprionate diskus inhaler
- Mometasone furoate dry powder inhaler
- Flunisolide oral inhaler
Leukotrienes are chemicals produced by our body during an allergic reaction, and causes unique effects in the lung seen in asthma patients. There are several medications available in the US called anti-leukotiene agents or leukotriene modifying agents. These medications either block the production of leukotrienes or prevent leukotrienes from binding with leukotriene receptors thus preventing the chemical from contributing to the allergic reaction. Leukotriene modifying agents can be obtained by prescription from your allergy doctor and should be taken as a maintenance drug.
Leukotriene modifying agents approved for use in asthma treatment in the US include Zileuton, a 5-lipooxygenase inhibitor, that blocks the enzyme responsible for synthesizing leukotrienes; and Montelukast and Zafirlukast, both leukotriene antagonists, which prevent leukotrienes from binding their receptors thus preventing it from contributing to allergic inflammation and asthmatic bronchospasm.
Long-acting bronchodilators ( LABAs) are used in asthma treatment as an add-on medication for patients not doing well on inhaled steroids alone. They work in the same way as short-acting dilators by opening the bronchial airways but the duration of action of these medications are much longer. They last for about 12 hours.
A note of caution. Long-acting bronchodilators should not be used without inhaled steroids. If not used as directed by your physician, LABAs may worsen asthma or cause asthma deaths It should always be used with an inhaled steroid.
In the United States, there are two long-acting bronchodilators available for use with steroid inhalers: Salmeterol and Formoterol. They are available as dry-powder inhalers but for safety reasons are never used alone for asthma treatment. They are now used more as combination drugs called “ICS-LABAs” or “inhaled corticosteroid-long acting beta agonist” combination inhalers. The ICS-LABAs approved for asthma treatment in the USA are:
- Budesonide-Formoterol HFA oral inhaler
- Fluticasone-Salmeterol(available in dry powder and HFA oral inhaler)
- Mometasone-Formoterol HFA oral inhaler
Systemic steroids are used in the more severe asthma patients who are poorly controlled with standard preventive asthma treatment regimens. It is also used primarily in patients who are having an asthma attack. Systemic steroids can be given orally or by injection. Most physicians try to reserve these drugs for the more severe asthma patients since they may cause serious long-term side effects. Some known undesirable side-effects of systemic steroids include mood swings, irritability, weight gain, obesity, water retention, edema, diabetes, osteoporosis, or cataracts. Systemic steroids should be given under the supervision of your physician.