Asthma

Treatment

Successfully controlling asthma means achieving several fundamental treatment goals. These include:

• Normal (or near normal) lung function
• Unrestricted participation in physical and recreational activities
• Uninterrupted sleep
• No missed days from school or work
• No need for urgent medical care because of an asthma attack

To reach these goals:

• Learn about your asthma, including what it is, what medications to take, when to take them, and why you take them.
• Follow your asthma action plan and take your daily control medications faithfully.
• Know your triggers and avoid them whenever possible. If you cannot avoid them, take quick relief medications before coming in contact with these triggers.
• Treat symptoms, even if they are mild, to prevent them from becoming worse.
• Get a flu shot in the fall since influenza can cause an asthma flare-up.

This section includes more on:

• Asthma medications
• Guidelines for using medications
• Alternative Therapy
• Treatment during pregnancy

Medications

Medications are used to prevent and control asthma symptoms, to reduce the number and severity of asthma episodes, and to improve airflow. There are two main types of asthma medications:

• Anti-inflammatories: These are the most important class of therapy for people with asthma. Anti-inflammatory medications reduce swelling and mucus production in the airways. As a result, airways are less sensitive and less likely to react to triggers.
• Bronchodilators: These medications relax the muscle bands that tighten around the airways. This action rapidly opens the airways, letting more air in and out of the lungs and improving breathing. Bronchodilators also help clear mucus from the lungs; as the airways open, mucus moves more freely and can be coughed out more easily. In short-acting forms, bronchodilators relieve or stop asthma symptoms and are very helpful in treating symptoms during an asthma episode. In long-acting forms, bronchodilators provide control of asthma symptoms and prevent asthma episodes. All but the people with the mildest cases of asthma will need both types of medication.

This section includes more on:

• Anti-inflammatories
• Bronchodilators
• Combination inhalers

Anti-inflammatories

Anti-inflammatory medications are important treatment options for people with asthma. They work by reducing swelling and mucus production in the airways, so airways are less sensitive and less likely to react to asthma triggers. These medications need to be taken daily. Anti-inflammatories lead to fewer asthma symptoms, better airflow, less-sensitive airways, less airway damage, and fewer asthma episodes. If taken every day, they control or prevent asthma symptoms.

This section on anti-inflammatory medications includes more on:

• Corticosteroids (inhaled and oral)
• Mast-cell stabilizers
• Leukotriene modifiers

Anti-inflammatories: corticosteroids

Inhaled corticosteroids

Inhaled corticosteroids are the most effective medications at reducing airway inflammation and mucus production. The use of these medicines leads to better asthma control, with fewer symptoms and flare-ups and less need for hospitalization. Inhaled steroids prevent symptoms; they do not relieve symptoms. They need to be taken every day for best results. Some results are seen in one to three weeks, with the best results after three months of daily use. Inhaled corticosteroids include Advair (a combination medication that includes a corticosteroid plus a long-acting bronchodilator), Aerobid, Azmacort, Flovent, Pulmicort, and Qvar.

Inhaled corticosteroids come in three forms: metered-dose inhaler (MDI), dry-powder inhaler (DPI), and nebulizer solutions. The MDI form works best when used with a valved holding chamber or a spacer, which ensures that an adequate amount of the medication reaches the lungs.

Inhaled corticosteroids have very few side effects, especially at lower doses. At higher doses, thrush, a yeast infection in the mouth, and hoarseness can occur but are rare. Rinsing the mouth, gargling after each use, and using a spacer device with metered dose inhalers will help prevent these side effects. Thrush is easily treated with an anti-fungal mouthwash.

Many parents are concerned about giving their children "steroids." These steroids are not the same as anabolic steroids that some athletes take to build muscle and, so, do not have the same side effects.

Systemic corticosteroids (oral and intravenous)

Systemic corticosteroids are used for short periods of time to treat asthma that is not responding to quick-relief medications. They can also be used for long-term severe asthma that is difficult to control.

Systemic steroids take three hours to begin working and work best after six to 12 hours. Sometimes corticosteroids are taken in high doses for a few days (a "steroid burst"). They may also be given in a low dose daily or every other day for long-term control. Systemic steroids include Medrol, Solu-Medrol (methylprednisolone), Deltasone (prednisone), Prelone, Pediapred, and Orapred (prednisolone).

Side effects of systemic steroids tend to occur after extended use and include acne, weight gain, mood or behavior changes, upset stomach, bone loss, eye changes, and slowing of growth in children. These side effects rarely occur with short-term use, such as to treat an acute asthma episode.

Anti-inflammatories: mast cell stabilizers

Intal and Tilad are inhaled asthma medications that work by preventing the release of histamine and other inflammatory substances from immune cells called mast cells. They effectively prevent asthma symptoms, especially in children with allergies and asthma and in people with exercise-induced asthma. These medications need to be taken two to four times a day, and take three to four weeks to start working.

These medications are very safe and have few side effects. Tilade can cause dry throat and can have a bad taste.

Anti-inflammatories: leukotriene modifiers

Leukotriene modifiers are a newer type of asthma medicine. Leukotrienes are chemicals that occur naturally in our bodies and cause tightening of airway muscles and production of mucus. These medicines work by blocking the normal actions of leukotrienes. Studies show that these medications help improve airflow and reduce asthma symptoms when used in conjunction with other asthma medications.

The medicine is taken in pill form one to four times a day and may decrease the need for other asthma medications. Leukotriene modifiers include Accolate and Singulair.

The most common side effects of leukotriene modifiers are headache and nausea. Leukotriene modifiers may interfere with the proper action of some other medications (for example, theophylline and the blood thinner warfarin). Make sure you inform your doctor of all the medications you take.

Medications: bronchodilators

There are two main types of bronchodilators:

• Beta 2-agonists (short- and long-acting forms)
• Anticholinergics
• Theophylline is another type of bronchodilator that is used to control asthma.

Bronchodilators: beta 2-agonists

Short-acting, inhaled forms

Short-acting beta 2-agonists are also called "quick acting" or "rescue" medications because they relieve asthma symptoms very quickly by opening the airways. These inhalers are the best for treating sudden and severe or new asthma symptoms. They work within 20 minutes, and the effects last four to six hours. Used 15-20 minutes before exercise, beta 2-agonists can prevent exercise-induced asthma symptoms. These drugs include albuterol (Proventil HFA, Ventolin HFA, Accuneb), Alupent, Combivent (combines a beta 2-agonist and an anticholinergic), Duoneb (combines a beta 2-agonist and an anticholinergic), Maxair, and Xoponex.

Overuse of short-acting beta 2-agonists is a sign of unstable asthma. If you need to use your short-acting beta 2-agonists more than twice per week, talk to your doctor about increasing the amounts of long-term-control medications you take, such as inhaled steroids and long-acting beta 2-agonists (see below).

Long-acting forms

The long-acting forms of beta 2-agonists are used to provide control--not quick relief --of asthma. These drugs take longer to begin working than the short forms, but they last up to 12 hours. They are used twice a day to maintain open airways for long-term control. They also help treat exercise-induced asthma. They include Serevent and Foradil, which are available in dry-powder inhaler (DPI) form. Serevent is also available in Advair, as a combination medication along with an inhaled corticosteroid.

Side effects of beta 2-agonists include nervous or shaky feelings, overexcitement or hyperactivity, increased heart rate, upset stomach, and trouble sleeping. Oral forms of beta 2-agonists--pills or syrups--tend to have more side effects because they are in higher doses and are absorbed through the bloodstream to get to the lungs. Inhaled forms are deposited directly in the lungs and, therefore, have fewer side effects.

Bronchodilators: anticholinergic drugs

Atrovent is a type of bronchodilator known as an anticholinergic drug. It is available in both a metered-dose inhaler and nebulizer solution. For asthma, it works best when used with a short-acting beta 2-agonist inhaler. It is not a quick-relief medication because it takes about 60 minutes before it begins to work. It isn't commonly used to treat asthma. Side effects are minor; dry throat is the most common one. If the medication gets in the eyes, it may cause blurred vision for a short period of time.

Bronchodilators: theophylline

Theophylline is sold under the brand names Uniphyl, Theo-Dur, Slo-Bid, and Theo-24 and is available as a pill or as an intravenous drug. It is long acting and prevents asthma attacks. Theophylline is used to treat difficult-to-control or severe asthma and must be taken daily.

Side effects include nausea and/or vomiting, diarrhea, stomachache, headache, rapid or irregular heartbeat, muscle cramps, jittery or nervous feelings, and hyperactivity. These symptoms may be a sign of too much medication. Your doctor will check your blood levels to make sure you're receiving the proper amount.

Always tell your doctor if you take theophylline for asthma because certain medications, such as antibiotics containing erythromycin or seizure and ulcer medicine, can interfere with the way theophylline works. In addition, viral illnesses can change how your body responds to theophylline. Since cigarette smoke can interfere with the body's response to the drug, it is best to avoid smoke when possible.

Combination inhalers

Some inhalers contain a combination of two different medications, shortening treatment times and decreasing the number of inhalers a patient needs. Advair, a combination of fluticasone (Flovent) and salmeterol (Serevent) is one such product. Another medication is Combivent, a combination of albuterol (Proventil, Ventolin) and ipratropium bromide (Atrovent). Although Advair is commonly prescribed in asthma treatment, Combivent is more frequently used in the treatment of other lung diseases.

Expect to see other medications combined in this way in the future. If your physician prescribes one of these medications, refer to the section on each individual medication to review its purpose, action, and expected effects.

Guidelines for using medications

Refer to your asthma action plan when deciding how or when to use medications. Make sure you understand and can follow the plan. Here's some general advice:

• Wash your hands prior to preparing or taking medications.
• Take your time. Double-check the name and dosage of your medications before using them.
• Keep medications stored according to the instructions that come with the prescription.
• Check liquid medications often. If they have changed color or formed crystals, throw them away and get new ones.
• Call the pharmacy or doctor's office at least 48 hours before running out of medicine. Know your pharmacy phone number, prescription and identification numbers, and medication name and dose so you can easily call for refills.
• Inform your doctor about any other medications you are taking. Medications can work differently when taken together.
• Asthma medications are very safe. However, side effects can occur and vary depending on the medication and dose. Ask your doctor to describe medication side effects. Report any unusual or severe side effects.

A warning about herbal and dietary supplements

Many people turn to alternative and complementary treatments when they have a chronic illness as well as for general health. If you are considering taking herbal or dietary supplements it is important to remember that most of these have not been thoroughly tested for purity and accurate dosing. Further, the FDA does not regulate them.

It is essential that you talk to your doctor before taking herbal or dietary supplements. Some herbs may worsen your asthma or other medical conditions, or they may interfere with prescribed medicines you are taking. If you experience side effects while taking supplements, such as nausea, vomiting, rapid heartbeat, anxiety, insomnia, diarrhea, or skin rashes, stop taking the product and notify your doctor. Be wary of commercial claims about what herbal products can accomplish. Look for scientific-based sources of information and then discuss them with your doctor.

Treatment during pregnancy

Approximately 1 out of every 15 pregnant women has asthma. During pregnancy, it is especially important that asthma be kept under control. Uncontrolled asthma puts both mother and child at risk and can result in lower birth weights. When asthma flares out of control, oxygen supply will be decreased in the maternal blood and therefore to the fetus as well. Since the fetus requires a constant supply of oxygen and nutrition to properly develop, this can result in slowed growth and development.

Communicating with your "asthma" physician is extremely important. Most inhaled medications are very safe to use during pregnancy. Oral medications (pills) may be avoided unless deemed necessary, depending on the medicaton. Generally the treatment of asthma during pregnancy is the same as your usual treatment--you should avoid triggers, monitor symptoms and airflows, and continue medications as prescribed.

Remember, the risks of not controlling asthma are greater than the risks, if any, involved with medication use. Your doctor will work with you to keep both you and your baby safe and healthy.

If you are allergic and receive allergy injections, they are safe to continue during pregnancy. Your doctor will most likely continue at your current dose and not increase it during the pregnancy. You should not start allergy injections for the first time if you are pregnant.