Asthma is a chronic lung disease that is characterized by episodes of swelling and contraction of the tubes of the respiratory tract, leading to narrowing of the tubes and difficult breathing. According to the U.S. Centers for Disease Control and Prevention, about 16 million adult Americans are living with asthma.The medications for asthma are organized into two broad classes, the long-term medications and the short-term (quick relief or rescue) medications.
Long-term Medications
These are taken to prevent or minimize the occurrence of asthmatic symptoms. According to the Mayo clinic, they are the most important class of asthma medications.
One major class of drugs in this category is corticosteroids which block the processes that lead to swelling and narrowing of the tubes in the respiratory tract. They are usually inhaled. Corticosteroids in this class are fluticasone (Flovent), budesonide (Pulmicort), triamcinolone (Azmacort), flunisolide (Aerobid), beclomethasone (Qvar, Beclovent, Vanceril), mometasone (Asmanex), ciclesonide (Alvesco).
Another class of drugs in this category is the long acting Beta-2 agonists (LABA). Also called bronchiodilators, these act by making the muscles in the tubes of the respiratory tract relax and dilate, opening them up and easing the effort of breathing. They usually last up to 12 hours. They are recommended for use together with inhaled steroids. Drugs in this category are salmeterol (Serevent Diskus), formoterol (Foradil Aerolizer) and albuterol sulfate (VoSpire ER).
A third class of drugs used in long-term treatment is the immune modulators. These drugs are targeted at reducing the particular immune response that triggers an episode of asthma. They include omalizumab (Xolair) and desensitizing injections.
Leukotriene modifiers are also used for long term treatment. These work on the immune system to reduce the production of certain factors that bring on or worsen the processes involved in an attack of asthma. They include montelukast (Singulair) and zafirlukast (Accolate).
Mast cell stabilizers such as cromolyn and nedocromil (Tilade) and methylxanthines such as theophylline(Theo-24, Theocron, Uniphyl, T-Phyl and Elixophyllin) are also used in long-term asthma therapy.
Combinations of two long-term medications are also available. They include Advair (fluticasone and salmeterol) and Symbicort (budesonide and formoterol).
Short-term medications
Drugs in this category are used mainly in emergency or rescue situations. They usually work for a short time to relieve symptoms of asthma.
Short-acting beta agonists (SABA), a significant class of drugs in this category, are fast acting bronchodilators. They are recommended by the EPR3 as the therapy of choice in emergency asthma care. They include albuterol (AccuNeb, Proventil, Ventolin, Volmax, Asmavent, Salbutamol, Ventodisk), levalbuterol (Xopenex), pirbuterol (Maxair).
Another important class in this category is the anticholinergics. They are usually combined with short acting beta agonists (SABAs) for better effect, but can be used alone in people who cannot tolerate the SABAs. They also relax and dilate the muscles of the tubes in the respiratory tract. In this class are ipatropium (Atrovent) and the combination formulation, Combivent (albuterol and ipatropium).
Systemic corticosteroids are used in combination with SABAs to speed up recovery and reduce recurrence of attacks. They include prednisone, prednisolone (Prelone, Orapred, Pediapred), methylprednisolone (medrol), hydrocortisone (Cortef), dexamethasone and cortisone.
Other medications
Asthma may coexist with other allergic symptoms such as allergic rhinitis and angioedema. A full evaluation by the care giver determines other medications that do not directly treat asthma, but would ease recovery and relieve other respiratory allergy symptoms. These include anti-histamines such as loratadine and diphenhydramine and mucolytics such as acetyl-cysteine and decongestants.
