Asthma is a lung condition caused by inflammatory processes resulting in difficulty breathing. Common symptoms include shortness of breath, wheezing, tightness of the chest and coughing. A sudden asthma attack may be treated with rescue medications, while preventative medications may prevent future attacks of asthma.
Short-acting Beta-2 Agonists
An acute asthma attack may be treated with bronchodilators that affect the beta-2 receptors in the muscles surrounding the airways. Short-acting beta-2 agonists (SABAs) work to relax the muscles, allowing for easier breathing within a few minutes and lasting up to four hours. They are used to treat intermittent flare-ups and exercise-induced asthma but should not be used for long-term treatment. Most commonly, SABAs such as albuterol, levalbuterol and pirbuterol are given by inhaler or nebulizer, but proventil is also available in both pill and syrup form. Common side effects include nervousness and increased heart rate.
Ipratropium
Ipratropium may also be used for occasional asthma attacks but is more commonly used for emphysema or chronic bronchitis. Ipratropium works by stopping spasms of the bronchial muscles through anti-cholinergic activity. It may be used alone or in combination with a SABA. It may cause side effects such as dry mouth or nose, nervousness, headache, and sore throat. It is given by inhaler or nebulizer.
Corticosteroids
Corticosteroids in pill or injectable form may be used for a severe, acute asthma attack. They will not immediately relieve breathing but will begin to reduce inflammation. Prednisone, prednisolone, dexamethasone and methylprednisolone may be used in oral form while dexamethasone, methylprednisolone and hydrocortisone may be given by injection.
Corticosteroids in inhalation form include medications such as fluticasone, budesonide, mometasone and triamcinolone which may be used in the treatment of chronic asthma. They appear to be the most effective medications for long-term control and work by reducing inflammatory processes within the lungs. Side effects may include an increased risk for the development of thrush or yeast infection of the throat and mouth. To reduce the risk of thrush, a spacer should be used with the inhaler and the mouth should be thoroughly rinsed with water after each use.
Long-acting Beta-2 Agonists
Long-acting beta-2 agonists (LABAs) such as salmeterol and formoterol, work in the same manner as the SABAs; however they are not useful as treatment for acute asthma attacks as they may take longer to begin working. Effects may last 12 to 24 hours and are used to control chronic asthma and prevent nighttime asthma attacks. They are most commonly used with inhaled corticosteroids to prevent inflammation. Some patients may experience nervousness; however, most become used to this with continued use.
Leukotriene Modulators
Leukotriene modulators work to decrease the activity of inflammatory chemicals in the airways known as leukotrienes. Montelukast and zafirlukast are available in oral formulations and are approved for the prevention of asthma attacks in those with mild, chronic asthma. They may be used in combination with other asthma treatments such as inhaled corticosteroids.
Mast Cell Stabilizers
Mast cell stabilizers such as cromolyn and nedocromil work by preventing the release of histamine from inflammatory cells known as mast cells. Histamine is responsible for the allergic response and prevention of its release may help to prevent an asthma attack. They are used as inhalation treatments to prevent asthma attacks but do not work to treat an acute attack. The inhalation treatments generally must be taken three to four times daily, making them less convenient than other treatments.
Theophylline
Theophylline is a direct bronchodilator that relaxes bronchial muscles. It is a member of the same medication class as caffeine and may cause insomnia, nervousness and increased heart rate. It may also cause more serious side effects, including cardiac and central nervous system effects. Its use may require periodic laboratory testing of the blood to avoid toxicity. Because of these risks, theophylline is not as commonly used as it once was but is still highly effective for some people.
