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Asthma Medications

Overview

The first step in managing your asthma symptoms is to know and avoid your personal asthma triggers. Still, avoidance only goes so far, so you may need an asthma drug to help control your symptoms.

The right medication will depend on a range of factors, including your age, symptoms, triggers, and response to the drugs. Effective asthma medications, including those recommended by the American Lung Association, aren’t available over the counter (OTC). In fact, OTC asthma medications are generally discouraged. Your doctor can prescribe the medication that’s best for you.

Knowing what medications are available can help you work with your doctor to create your treatment plan. Read on to learn about the types of asthma drugs available today, what they treat, and what side effects they may cause.

Inhalers and nebulizers

Asthma medication comes in various forms, including tablets, liquids, injections, and inhalers. Many medications come as sprays or powders that need to be inhaled deep into your lungs. You can take these using either an inhaler or a nebulizer. Both can deliver fast-acting or long-term medicines. The device you use won’t change the effectiveness of the drug. It’s a matter of personal preference, and there are pros and cons to each method.

Inhalers

These handheld devices are used to pump medicine into your lungs. They require some coordination on the user’s part, because you have to press the apparatus and then inhale the medication. Inhalers are small, light, and portable, but that means they can also be easy to lose. If you or your child uses an inhaler, be sure to have backups. You don’t want to discover you’ve lost the inhaler when you’re having a flare-up.

Inhalers come in two types: metered dose inhaler (MDI) and dry powder inhaler (DPI).

An MDI delivers a measured spritz of medicine when you press the inhaler. Some MDI inhalers count the doses used, so you know when the medicine is about to run out. You can also use a spacer with an MDI inhaler to make it easier to use. A spacer attaches to the inhaler and “holds” the medicine in a small chamber, so you can inhale it when you’re ready. This works well for young kids and babies. You can attach either a mouthpiece or a facemask to the spacer for easy inhalation.

A dry powder inhaler releases medicine in powder form. To use it, you inhale powder forcibly out of the inhaler. This method requires a bit more work on the user’s part, and generally isn’t the best choice for young kids.

Nebulizers

Nebulizers are plug-in or battery-powered devices that turn liquid asthma medicines into a mist that’s easy to inhale. They’re especially good for kids, because they’re automatic. To receive the medicine, you wear the nebulizer’s mouthpiece or facemask, and then breathe in the mist slowly. It usually takes between 5 and 10 minutes to breathe in the medicine from the nebulizer. The downside is that the machines need a power source and are less portable than inhalers. They can be bulky and loud.

Bronchodilators and anti-inflammatories

Asthma medications typically fall into two groups: bronchodilators and anti-inflammatories. They work by targeting the two main symptoms of asthma.

Bronchodilators target the tightened muscles in your lungs that are restricting your airways. These drugs help relax the lung muscles. This widens your airways and makes it easier for you to breathe. Bronchodilators are used for quick relief from asthma symptoms.

Anti-inflammatory agents target inflammation in your lungs. They reduce lung swelling and irritation, which helps improve your breathing. Anti-inflammatory drugs are used for daily maintenance to help prevent asthma symptoms.

Quick-relief medications

Asthma drugs are further divided between quick-relief and long-term medications. All quick-relief medications are bronchodilators.

Quick-relief medications are also called rescue therapy. They’re used to provide rapid relief from asthma flare-ups or more serious attacks.

Short-acting beta agonists

These inhaled medications provide near-instant relief during an asthma attack, and the relief can last for several hours. Short-acting beta agonists are the drugs of choice for treating exercise-induced attacks. Examples include:

  • albuterol (ProAir HFA, Ventolin HFA)
  • levalbuterol (Xopenex HFA)

The more common side effects of these drugs include:

  • shakiness
  • excitability
  • headache
  • throat irritation
  • fast heart rate

In rare and serious cases, these drugs may cause heart arrhythmias.

Anticholinergics

Anticholinergics are another class of fast-acting, inhalable bronchodilators that can provide quick relief from an asthma attack. One example is ipratropium bromide (Atrovent HFA).

The more common side effects of anticholinergics include:

  • trouble breathing
  • nosebleed
  • nasal dryness
  • nasal irritation
  • dry mouth

Rare but serious side effects include bronchospasms, which are muscle spasms in the lungs which narrow your airways. Rare side effects also include worsening of pre-existing heart arrhythmias.

Long-term asthma control medications

Long-term asthma control medications are taken daily. They’re used to prevent asthma symptoms rather than treat sudden asthma attacks. For long-term treatment, your doctor may prescribe an anti-inflammatory drug, a bronchodilator, or a combination of the two.

Long-term asthma control medications are divided into the following groups.

Inhalable corticosteroids

These anti-inflammatory drugs are the strongest and most commonly prescribed long-term asthma drugs. Examples of these drugs include:

  • beclomethasone (QVAR)
  • budesonide (Pulmicort Flexhaler)
  • flunisolide (Aerospan)
  • fluticasone (Flovent Diskus, Flovent HFA)
  • mometasone (Asmanex)

The more common side effects of inhalable corticosteroids include:

  • throat irritation
  • nosebleed
  • headache
  • nose irritation

Rare but serious side effects can include:

  • bronchospasm
  • vision problems
  • increased blood pressure in the eyes
  • decreased growth in children

Oral corticosteroids

Corticosteroids are systemic drugs, which means they affect your entire body. They can be used to treat severe asthma symptoms. These drugs are anti-inflammatories, and they work by relieving swelling and inflammation in your airways. Oral corticosteroids are taken by mouth.

Examples of these drugs include:

  • prednisone
  • methylprednisolone
  • hydrocortisone

The more common side effects of these drugs include:

  • weight gain
  • high blood sugar levels
  • trouble sleeping
  • slow wound healing

Long-term use of corticosteroids can cause side effects that may be serious. Therefore, these drugs should only be used for short-term treatment. Examples of serious side effects include:

  • peptic ulcers
  • osteoporosis
  • glucose intolerance
  • weight gain

Long-acting beta antagonists

Long-acting beta antagonists (LABAs) are bronchodilators. They’re used to help prevent asthma attacks and are typically taken twice per day using an inhaler. They're always used along with an inhalable corticosteroid. These drugs are fast-acting and can provide relief for up to 12 hours.

Examples of these drugs include:

  • formoterol (Perforomist)
  • salmeterol (Serevent Diskus)

The more common side effects of these drugs include headache and muscle pain. Rare but serious side effects can include bronchospasm and throat spasm.

Combination inhalers

Combination inhalers are common prescriptions for asthma. They include a combination of a corticosteroid and a LABA. Combinations available in the United States include:

  • budesonide and formoterol (Symbicort)
  • fluticasone and salmeterol (Advair Diskus)

The more common side effects of these drugs include headache and throat infection. Rare but serious side effects can include heart arrhythmias, increased blood pressure, and bronchospasm.

Leukotriene modifiers

Leukotriene modifiers are considered anti-inflammatory drugs, but they work differently from corticosteroids. They come in tablet form and work by blocking the action of leukotrienes. Leukotrienes are substances in your lungs that cause the air passages to constrict. They also cause your lungs to make excess mucus.

Examples of leukotriene modifiers include:

  • montelukast (Singulair)
  • zafirlukast (Accolate)
  • zileuton (Zyflo, Zyflo CR)

The more common side effects of these drugs include headache, stomach pain, and muscle pain. More serious side effects can include liver damage, blood disorders, and seizures.

Methylxanthines

Methylxanthines are bronchodilators that are also thought to have some anti-inflammatory effects. These drugs come as pills. One example of a methylxanthine is theophylline (Theochron, Theo-24, Elixophyllin).

These drugs are rarely prescribed. This is because they require close monitoring to make sure that the amount of drug in your body stays within a narrow range. If the amount goes above that range, it puts you at risk of serious side effects such as heart arrhythmias and seizures.

The more common side effects of these drugs include:

  • headache
  • trouble sleeping
  • nausea
  • vomiting

Immunomodulators

Immunomodulators are also called biologics. They affect your immune system, blocking substances that cause asthma attacks. These drugs are typically only prescribed for people who can’t control their asthma symptoms with other types of asthma medications. Examples of these drugs include:

Each of these drugs can cause different side effects, but the common ones include:

  • headache
  • tiredness
  • injection site reactions
  • muscle and joint pain
  • infections

More serious side effects can include:

  • hypersensitivity reactions, which can include anaphylaxis
  • bronchospasm
  • heart attack
  • stroke

Outlook

There are many medication options for treating your asthma symptoms. The type of medication you take, and how you take it, depends on factors such as your age, the severity of your symptoms, your triggers, and your lifestyle.

Keeping up to date on the medications available will help you best manage your asthma. Talk to your doctor regularly about your symptoms and how each medication is working for you. They can continue to help you tailor your treatment plan.

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