During asthma, a breathing disorder, airways become swollen, tight and irritated, which makes breathing difficult. Classic symptoms associated with asthma include wheezing as air moves through narrowed passages, a sensation of chest tightness and difficulty breathing or talking. Asthma may occur alone or in combination with allergic diseases; although asthma is among the most common of childhood disorders, it is chronic in nature, so adults who have asthma often must continue to use control and rescue medications.
Beta-Agonists
Beta-agonist drugs are inhaled medicines that improve asthma symptoms through multiple actions. Beta-agonists relax airway muscles tightened by the disease, and they reduce allergic responses like histamine and mast cell activity in the lungs and surrounding tissues. Short-term beta-agonists, like albuterol, are used as rescue medications for asthma; two puffs of inhaled albuterol work on airways in minutes and can be repeated up to every four hours for asthma attacks. Long-acting beta agonists, such as salmeterol or formoterol, have similar activity but last up to 12 hours to control asthma symptoms. Since long-acting beta agonists can actually cause an asthma attack if used alone, they are only used with other inhaled treatments that control asthma, like corticosteroids.
Corticosteroids
Inhaled corticosteroid drugs are the most common treatment option for long-term control of asthma symptoms and prevention of acute asthma attacks. Corticosteroids reduce swelling of the airways and block prolonged allergic and immune responses by the body at the lungs and surrounding tissue. Some examples include fluticasone (Flovent) and triamcinolone (Azmacort). Corticosteroids combined with long-acting beta agonists may be used when asthma symptoms continue (i.e., is uncontrolled) despite treatment with one drug. For example, Advair Diskus inhaler combines fluticasone and salmeterol.
Leukotriene Modifiers
Leukotriene is a body chemical that increases allergic, inflammatory and tissue constriction activity in the body. Oral medications that block leukotriene levels or effect, called leukotriene modifiers, are approved for people 12 years of age or older to control and prevent asthma symptoms. Singulair, which directly blocks leukotriene at body receptors, and Zyflo, which blocks formation of leukotrienes in the body, are two examples. These and other leukotriene modifiers are taken only once daily and are effective for even severe persistent asthma. In adults who took Singulair to control asthma during premarketing studies, headache was the most common side effect, which occurred in nearly 20 percent of patients.
Xolair
Omalizumab, marketed as Xolair injection, is a type of immunotherapy treatment for adults who have asthma and allergic disorders. Xolair given every two to four weeks minimizes the body's overreaction to allergic substances, such as dust or animal dander, which can also trigger asthma attacks or make it harder to control asthma symptoms. In an August 2009 update to the EXCELS safety review of Xolair, greater heart and blood vessel side effects (heart failure, blood clotting events) were seen with Xolair use; however, Xolair use according to the prescribing label is still considered acceptable, pending final review results in 2012.
