Asthma Treatment

[William Mahaffy]

There are numerous medications available for the treatment of asthma. Some are in pill form, some newer medications can be taken nasally, but the majority are taken by inhalation commonly called inhalers, puffers or atomizers.

These inhalers generally fall into two categories. Short-acting medications are used in the setting of an acute attack and are taken when the symptoms begin to occur. The long-acting types are more prophylactic (preventative), are taken on a regular schedule and are not for use in the acute setting.

The short-acting inhalers are collectively known as bronchodilators, sympathomimetics or Beta-2 agonists. They selectively dilate the bronchial airways allowing for improved air movement. The long-acting inhalation medications have several mechanisms of action. Glucocorticoids (steroids) are not bronchodilators but are used in asthma to reduce airway inflammation-a major contributor to asthma attacks.

Other prophylactic medications are known as mast cell stabilizers. Mast cells, when stimulated, release chemicals into the bloodstream that will cause airway constriction. These mast cells have other important functions in the body but when these chemicals are released, an asthma attack can result. Stabilizing agents are not bronchodilators but are used to prevent or limit the release of these chemicals. These inhalers are also very effective in limiting antigen; industrial chemical or exercise-induced asthma attacks.

 Anticholinergicshave limited use in asthma treatment because of their significant side effects. However, there are specific preparations that are virtually free of untoward effects and are particularly useful in patients with coexisting heart disease.

Finally, methylxanthines are medium-potency bronchodilators whose mechanism of action is not fully understood. These medications are not currently available as inhalers and are used orally for long-term control or can be given intravenously for acute attacks in which other therapies have failed.

Another important consideration when using inhaler therapy is how to actually use the device. The inhaler must be triggered at a specific point of the inhalation cycle to get maximum benefit from the medication. Many patients have trouble coordinating the use of the device especially during an acute attack. An attachment known as an aerochamber can be fitted to the end of the inhaler and increases the amount of medication delivered to the lungs regardless of when the drug is released.

I have included a table of the more common medications used for treatment of asthma. The trade names are listed with the generic names in parenthesis. An [n] indicates nasally administered medication. An [o] indicates oral. All others are inhalers.

Sympathomimetics

 Alupent(Metaproterenol)

 Brethine(Terbutaline)

 Bronkosol(Isoetharine)

 Maxair(Pirbuterol)

Proventil, Ventolin (Albuterol) (This is probably the most common drug in this category)

 Serevent(Salmeterol)

Steroidal Anti-inflammatory

 Aerobid(Flunisolide)

Azmacort, Nasacort [n] (Triamcinolone) (The first is an inhaler, the second is nasal)

Beclovent, Beconase [n], Vanceril, Vancenase [n] (Beclomethasone)

 Dexacort(Dexamethasone)

Flovent, Flonase [n] (Fluticasone)

 Pulmicort(Budesonide)

Mast Cell Stabilizers

 Intal(Cromolyn)

 Tilade(Nedocromil)

 ZyloFilmtabs [o] (Zileuton)

Methylxanthines

Respbid, Slo-Bid, Theo-Dur (Theophylline) (all oral)

Anticholinergics

 Atrovent(Ipratropium) (This is also a very common medication and can be used in combination with Albuterol. An inhaler called Combivent includes both medications in one inhaler.)