There are two main categories of asthma drugs: short-term, quick-relief medications that relieve asthma symptoms, and long-term controller medications that are used every day by people with persistent asthma, even when they feel fine.
| Asthma Medication
If you take your quick-relief inhaler more than two times a week, if you wake up with asthma more than two times a month, or if you refill your quick-relief inhaler more than two times a year, the group recommends that two medicines for asthma are needed and that you should talk with your doctor about a long-term controller.
Short-term reliever medication refers to short-acting inhaled beta-2 agonists such as albuterol and pirbuterol. Beta-2 agonists, also known as bronchodilators, relax the muscles surrounding the airways.
In addition, systemic corticosteroids, such as prednisone and prednisolone, are drugs that help relieve the inflammation or swelling in the airway. Taken in tablet or syrup form, they are often used to treat severe asthma attacks.
As for long-term controller medication, inhaled corticosteroids are the most consistently effective. |
Other long-term controller medications include long-acting beta-agonists, which are used in addition to inhaled steroids. Examples of long-acting beta-agonists are salmeterol and formoterol. Cromolyn sodium, nedocromil, and methylxanthines are also in the controller anti-inflammatory category. A newer class of long-term controller drugs is called anti-leukotriene medication, and examples include Singulair (montelukast), Accolate (zafirlukast) and Zyflo (zileuton). These drugs block the action of chemicals called leukotrienes, which are involved in the development of asthma.
National guidelines on managing asthma now recommend that inhaled corticosteroids are the preferred first-line treatment for people of all ages with persistent asthma. Developed by an expert panel of the National Asthma Education and Prevention Program (NAEPP), the guidelines also recommend that if inhaled corticosteroids are not achieving optimal control, dual-control therapy should be used. "We're advising doctors that if inhaled corticosteroids are not proving effective, before increasing the dose, add a long-acting beta-2 agonist," says James Kiley, Ph.D., director of the Division of Lung Diseases at the NHLBI.
Badrul Chowdhury, M.D., Ph.D., acting director of the FDA's Division of Pulmonary and Allergy Drug Products, says significant advances in asthma drugs include the approval of Advair (fluticasone and salmeterol) in 2000. "This drug might improve adherence because you don't have to go between two drugs," Chowdhury says. It's the first drug approved by the FDA that combines an inhaled corticosteroid and a long-acting bronchodilator in one device, which has a built-in counter that tracks the number of doses. Chowdhury says also significant is the recent FDA approval of the inhaled corticosteroid Pulmicort (budesonide) for children as young as 1.
Monitoring Asthma Symptoms, Using Medicine
Thomas says he felt lucky to survive his bad asthma attack in New York, but the experience was so traumatic that he took a month off work and went back home to his parents' house to recover. "I had panic attacks and a lot of anxiety about having another attack," he says. His anxiety level eased as he got a better handle on monitoring and preventing symptoms and using medicine.
Thomas has gone for 10 years without a major asthma attack, and he attributes that to several factors. He uses a daily long-term inhaled corticosteroid called Azmacort (triamcinolone acetonide) to relieve the inflammation that can cause an asthma attack, and he uses a Ventolin (albuterol) inhaler as needed for short-term quick relief of acute symptoms. He says that in the weeks before his bad asthma attack, he was using a quick-relief inhaler several times a day, even sometimes several times in the same hour. He now recognizes such use as a sign of trouble.
Thomas avoids known triggers and monitors his breathing with a peak flow meter. "As a kid, I just dealt with the asthma attacks as they happened," he says. "Now, I pay attention to what's going on before it gets bad."
According to the NAEPP Expert Panel Report, peak flow meters may be most helpful for people with moderate or severe asthma. A meter reading will tell you your peak flow zones, which are based on the colors of a traffic light. The green zone signals that your asthma is in good control, the yellow zone signals caution and is a sign to use quick-relief medicine to relieve symptoms, and the red zone signals a medical alert that means you should contact a doctor. Written plans can be useful for telling you what kind of medicine to take and how much to take when you're in each zone.
Inhaled asthma medications are delivered through many different devices, including metered dose inhalers, dry powder inhalers, and nebulizers. It's important to get instructions on how to use each medicine you take, and to have your doctor or nurse check your technique. To improve effective use of medication for kids or adults, plastic devices called spacers are often used with inhalers. Spacers create a space between the inhaler and the person's mouth to help more medicine get into the lungs. A nebulizer, which delivers medicine in a fine mist, also is useful for young children.
The issue of using asthma medications in school remains a challenging area for children and parents. To date, 18 states have laws or policies allowing children to carry inhalers in schools, according to AANMA. Many schools require an inhaler to be kept in the nurse's office because it's a drug. "But if a child is in gym class and the nurse is three buildings away, that could be a problem," says Sheerin, the asthma specialist in Atlanta. Experts say the two best things we can do for children with asthma are to teach them how to manage their asthma as they grow up, and to share a written plan from your doctor with the school.
Fusco-Walker, who now works with AANMA as an educator, points to the American Lung Association's asthma camp program as a good support system for parents of children with asthma. "It's a great place for children to learn how to manage their asthma, and parents can enjoy peace of mind while their children experience summer camp," she says. Kids participate in regular camp activities like swimming and biking, and there are trained medical personnel who teach the kids proper use of medication and other aspects of asthma management.
Sheerin says all kids should be able to sleep, play and learn. "If parents are up at night, if kids can't play, or if they are missing a lot of school because of asthma, then the asthma management plan is not right." |
