Asthma is a chronic obstructive airway disease in which patients experience bronchospasm and difficulty breathing in response to certain triggers, including cold air, allergens or pollutants. A number of inhaled medications are available to treat acute attacks and help asthmatics control symptoms. While some of these medications are considered quite safe though many carry warnings of one kind or another. Use of those that carry risks may be warranted given the significant risk of mortality associated with an uncontrolled asthma attack
Albuterol
Perhaps the most ubiquitous and well known of asthma inhalers is albuterol, also sometimes called the “rescue inhaler.” Albuterol is a short-acting beta agonist, meaning that while it can’t be used to control asthma symptoms in the long term, it works immediately to reduce bronchospasm and open airways in the case of an asthma attack. In 2008, however, the “New York Times” reported that there were some dangers associated with albuterol. It appeared to make patients who used it routinely more susceptible to asthma attack. For this reason, many physicians emphasize that albuterol should not be used routinely, is inappropriate for day-to-day asthma control and should be used only in the case of an emergency.
Fluticasone
Unlike albuterol, fluticasone is prescribed for day-to-day maintenance and reduction of asthma symptoms. It’s an inhaled corticosteroid, meaning that it works to reduce inflammation in the lungs and helps prevent symptoms of asthma. Notes the website RxList, fluticasone can’t help resolve an asthma attack once it starts—it’s not a rescue inhaler. Other warnings associated with fluticasone include that as an inhaled corticosteroid, it puts patients at increased risk for osteoporosis. Long-term use of corticosteroids is associated with reduced uptake and utilization of calcium, notes Asthma World, which can lead to loss of bone density. Patients on fluticasone are advised to take supplemental calcium and vitamin D.
Salmeterol
The mechanism of action of salmeterol is similar to that of albuterol—like albuterol, it’s a beta agonist that helps to reduce inflammation and bronchospasm. Unlike albuterol, however, salmeterol is long-acting, meaning that it can be used for day-to-day asthma maintenance. The Food and Drug Administration has issued a Black Box warning regarding salmeterol in response to several asthma-related deaths in patients for whom the drug was prescribed. It seems, notes RxList, that salmeterol can increase a patient’s risk of a serious or life-threatening asthma attack. Physicians working with patients can help individuals assess whether the risk posed by salmeterol is greater than or warranted by the risk posed by their asthma.
