Asthma medicines are used to control symptoms, reduce the occurrence and severity of attacks and improve quality of life. Two types of asthma medicines exist: quick-relief and long-term control medicines. Long-term control medicines work slowly to help to prevent asthma symptoms and episodes by stopping the swelling in the airways. Quick relief medicines help to stop an asthma attack once it has started by relieving the tightness and opening up the airways to allow airflow.
Long-term control medicines: Corticosteroids
According to the NIH Expert Panel, corticosteroids are the most potent and effective asthma medicines currently available. Inhaled corticosteroids are used for long-term asthma control. A Journal of the American Medical Association-published study reported that inhaled corticosteroids are the most effective therapy for adult patients with asthma. Oral corticosteroids are taken for a short time to control asthma after a serious attack or when starting long-term treatment. They may also be used long-term for severe persistent asthma.
Long-term control medicines: Cromolyn sodium and nedocromil
The NIH Expert Panel Report 3 states that Cromolyn sodium and nedocromil are alternative medicines for treating mild, persistent asthma and useful for preventing asthma symptoms triggered by exercise, cold air and allergies. They are inhaled medicines and more commonly prescribed for children. National Jewish Health reports that these medicines are not quick-relief medicines and should not be taken to relieve symptoms, as they are less effective than inhaled steroids and leukotriene modifiers.
Long-term control medicines: long-acting beta2-agonists, or LABAs
LABAs open the airways and their effects last 12 or more hours after one dose. The NIH Expert Panel recommends that these medicines only be used in combination with inhaled corticosteroids for long-term control of moderate or severe persistent asthma when symptoms persist despite treatment with inhaled corticosteroids. The use of LABAs is not currently recommended by the NIH Expert Panel for acute symptoms or asthma attacks.
Long-term control medicines: Leukotriene modifiers
These medicines are recommended to be given along with inhaled corticosteroids to control mild persistent and moderate persistent asthma symptoms. They may be especially helpful for people whose asthma is triggered by exercise, aspirin or allergies. The NIH Expert Panel recommends these medicines as an alternative treatment to inhaled corticosteroids with or without long-acting beta2-agonists for mild or persistent asthma. Checking liver function is necessary when taking leukotriene modifiers.
Long-term control medicines: Methylxanthines
According to the NIH Expert Panel, Methylxanthines have mild to moderate bronchodilator effects and are useful as alternative combination therapy with inhaled corticosteroids, particularly for night-time asthma symptoms. The Global Initiative for Asthma states that theophylline, the most frequently used methylxanthine, is less effective as add-on treatment than inhaled long-acting inhaled beta2-agonists. Theophylline requires regular testing to check blood levels for proper dosing. Alternative safer and more effective medicines include inhaled corticosteroids and leukotriene modifiers.
Quick-relief medicines: Anticholinergics
Anticholinergics relax the airways and prevent narrowing. They are slower-acting than the short-acting beta-agonists, or SABAs, which precludes them from being used as rapid-acting quick relief medicines. The NIH Expert Panel recommends that anticholinergics not be used alone to treat asthma, but they may be useful following an inhaled beta-agonist to achieve a longer-lasting effect, especially during an acute attack. They may be used as an alternative bronchodilator for patients who do not tolerate SABAs.
Quick-relief medicines: Short acting beta agonists, or SABAs
SABAs act to relax lung muscles and help them to open. Their effects are immediate and remain for about six hours. They are called rescue medicines because they can improve worsening symptoms or stop an asthma attack. The NIH Expert Panel Report 3 recommends inhaled SABAs as the medicine of choice for treating acute asthma symptoms and prevention of exercise induced asthma. They are used with long-term control medicines for treating persistent asthma.
References
- National Institutes of Health: National Asthma Education and Prevention Program Expert Panel Report 3-Guidelines for the Diagnosis and Management of Asthma
- Global Initiative for Asthma: Global Strategy for Asthma Management and Prevention
- "Journal of the American Medical Association"; Anti-IgE Therapies in Adults: Pharmacological Management to Reduce Exacerbations in Adults with Asthma- A Systematic Review and Meta-analysis; Don D. Sin, MD, MPH, et al; July 2004
- National Jewish Health: Cromolyn Sodium and Nedocromil
