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Asthma (cont.)

Medications

Controller medicines help minimize the inflammation that causes an acute asthma attack.

Long-acting beta-agonists: This class of drugs is chemically related to adrenaline, a hormone produced by the adrenal glands. Inhaled long-acting beta-agonists work to keep breathing passages open for 12 hours or longer. They relax the muscles of the breathing passages, dilating the passages and decreasing the resistance to exhaled airflow, making it easier to breathe. They may also help to reduce inflammation, but they have no effect on the underlying cause of the asthma attack. Side effects include rapid heartbeat and shakiness. Salmeterol (Serevent) and formoterol (Foradil) are long-acting beta-agonists.

Inhaled corticosteroids are the main class of medications in this group. The inhaled steroids act locally by concentrating their effects directly within the breathing passages, with very few side effects outside of the lungs. Beclomethasone (Vancenase, Beclovent) and triamcinolone (Nasacort, Atolone) are examples of inhaled corticosteroids.

Leukotriene inhibitors are another group of controller medications. Leukotrienes are powerful chemical substances that promote the inflammatory response seen during an acute asthma attack. By blocking these chemicals, leukotriene inhibitors reduce inflammation. The leukotriene inhibitors are considered a second line of defense against asthma and usually are used for asthma that is not severe enough to require oral corticosteroids.

Zileuton (Zyflo), zafirlukast (Accolate), and montelukast (Singulair) are examples of leukotriene inhibitors.

Methylxanthines are another group of controller medications useful in the treatment of asthma. This group of medications is chemically related to caffeine. Methylxanthines work as long-acting bronchodilators. At one time, methylxanthines were commonly used to treat asthma. Today, because of significant caffeine-like side effects, they are being used less frequently in the routine management of asthma. Theophylline and aminophylline are examples of methylxanthine medications.

Cromolyn sodium is another medication that can prevent the release of chemicals that cause asthma-related inflammation. This drug is especially useful for people who develop asthma attacks in response to certain types of allergic exposures. When taken regularly prior to an exposure, cromolyn sodium can prevent the development of an asthma attack. However, this medicine is of no use once an asthma attack has begun.

Omalizumab belongs to a newer class of agents that works with the body's immune system. In people with asthma who have an elevated level of Immunoglobulin E (Ig E), an allergy antibody, this drug given by injection may be helpful with symptoms that are more difficult to control. This agent inhibits IgE binding to cells that release chemicals that worsen asthma symptoms. This binding prevents release of these mediators, thereby helping in controlling the disease.

Rescue medications are taken after an asthma attack has already begun. These do not take the place of controller drugs. Do not stop taking your controller drug(s) during an asthma attack.

Short-acting beta-agonists are the most commonly used rescue medications. Inhaled short-acting beta-agonists work rapidly, within minutes, to open the breathing passages, and the effects usually last four hours. Albuterol (Proventil, Ventolin) is the most frequently used short-acting beta-agonist medication.

Anticholinergics are another class of drugs useful as rescue medications during asthma attacks. Inhaled anticholinergic drugs open the breathing passages, similar to the action of the beta-agonists. Inhaled anticholinergics take slightly longer than beta-agonists to achieve their effect, but they last longer than the beta-agonists. An anticholinergic drug is often used together with a beta-agonist drug to produce a greater effect than either drug can achieve by itself. Ipratropium bromide (Atrovent) is the inhaled anticholinergic drug currently used as a rescue asthma medication.