Understanding Asthma Diagnosis & Treatment
There are two general types of asthma medications:
Anti-inflammatory drugs are taken daily to control asthma and prevent asthma attacks. Inhaled corticosteroids are the most popular and most likely to be effective anti-inflammatory medications for most people suffering from asthma. They reduce swelling and mucus production in the airways, making them less likely to react to triggers. Inhaled corticosteroids include beclomethasone (QVAR), budesonide (Pulmicort), fluticasone (Flovent), flunisolide (Aerobid, Aerospan), and ciclesonide (Alvesco) all of which are usually taken twice-a-day, and mometasone (Asmanex) and fluticasone furoate (Arnuity Ellipta), which may control asthma in some patients when taken just once-a-day.
Two other popular types of anti-inflammatory medications include the leukotriene modifier pills monteleukast (Singulair), which can be taken just once a day, zafirlukast (Accolate) taken twice a day, and zileutin (Zyflo) taken four times a day. The third type of anti-inflammatory drug is the inhaled cromones: cromolyn (Intal) and nedocromil (Tilade).
The biologic mepolizumab (Nucala) is a once a month injection that targets blood cells which trigger asthma attacks. It keeps interleukin 5 (IL-5) from binding with those cells and in doing so lowers the number of severe asthma incidents. It can also help a patient reduce the amount of their other asthma medications, but it is only recommended for patients 12 and older.
An anti-IgE drug, omalizumab (Xolair), is an injection usually taken once every two to four weeks and works by inhibiting the allergic inflammation that often causes constriction of the airways. Because of its high cost, Xolair is usually reserved for patients with difficult-to-control allergic asthma.
Bronchodilators relieve the symptoms of asthma by temporarily relaxing the muscle bands that tighten around the airways. As a result, breathing improves for about four hours for the short-acting bronchodilators and for about 12 hours for the long-acting inhaled bronchodilators. Short-acting inhaled bronchodilators include the highly popular rescue inhaler albuterol (Ventolin, Proventil, ProAir, and a generic, called salbutamol in Europe) and the new Levalbuterol (Xopenex) with the potential advantage of fewer side-effects for some patients. Long-acting inhaled bronchodilators include salmeterol (Serevent) and formoterol (Foradil or Oxis). When an inhaled corticosteroid is not adequately controlling asthma, a long-acting bronchodilator is often added. According to the FDA, for safety reasons, these long-acting medications should only be used in combination with another controller medication and only for as long as necessary to regain control. Three inhalers combine these two types of asthma controller medications: Advair Diskus (fluticasone in one of three doses, plus salmeterol), Symbicort (budesonide plus formoterol), and Dulera Inhalation Aerosol (mometasone plus formoterol).
WARNING: Bronchodilators are potent drugs. If overused, they can cause dangerous side effects such as high blood pressure and fast or irregular heart beats (arrhythmias). If you are using a short-acting rescue bronchodilator more than twice a week because of asthma symptoms, talk to your doctor. Your asthma needs to be controlled better, possibly with anti-inflammatory drugs like corticosteroids.
There are also some over-the-counter (OTC) drugs purported to treat asthma including Bronkaid Mist (epinephrine) and Asthmanefrin. These drugs are very short-acting bronchodilators, relaxing the muscles around the airways. They provide relief of symptoms for up to an hour, but they don't prevent asthma attacks and are much more likely to cause side effects (including dangerous abnormal heart rhythms) when compared to prescription bronchodilators. They aren't recommended for people with chronic asthma. OTC medications for asthma are generally discouraged and you should talk to a doctor about your asthma symptoms.these over-the-counter medications for asthma are generally discouraged and you should talk to a doctor about your asthma symptoms.