In today’s discussion, I’m going to describe some of the more traditional treatments for asthma, and then discuss some new medications. This week I’ll be discussing treatment methods which are used, as well as some of the newer medications which are becoming available. The first type of medication I would like to discuss is the Controller Medication. These medications are designed to relieve the underlying inflammation associated with asthma, thus preventing or reducing the risk of an asthma attack. They include beclomethasone, triamcinolone, flunisolide, fluticasone, and budesonide. These drugs are very effective in the routine management for those with moderate persistent and severe persistent asthma, however they may need days or weeks of consistent use to become fully effective.
Oral steroids such as methyl prednisone, prednisone, and prednisolone, which are taken in pill form, are used when inhaled corticosteroids are not effective, such as in people who have severe persistent asthma. Possible side effects include an increased risk of diabetes, cataracts, osteoporosis, high blood pressure, skin problems, headaches, growth problems, fluid retention and weight gain.
Cromolyn and Nedocromil are also controller medications, but they are less effective than the inhaled corticosteroids. They are very safe, though, and are often used when the stronger drugs are not needed.
Leukotriene modifiers are some of the newest controller drugs available. They can be very effective in treating asthma, but in general are not considered as effective as inhaled corticosteroids. These drugs, zafirlukast, zileuton, and montelukast, work by blocking the action of leukotrienes, chemicals that are produced by the immune system in response to allergens, and which cause inflammation and other problems. Leukotriene modifiers are generally safe with few side effects. However, patients who take zileuton need to have their liver function monitored.
Long-acting bronchodilators, often referred to as long-acting Beta2-agonists, treat asthma by relaxing the muscles around the airways, keeping the airways open. These may work for 12 hours or so and must be used in addition to other controller drugs, particularly for nighttime control of symptoms. They include the drugs salmeterol and sustained-release albuterol. Recent studies have found that salmeterol may also be useful in preventing exercise-induced asthma, but its effectiveness after a month or so of use may fall to less than 10 hours. Possible side effects include the “jitters” and rapid heart rate. These drugs should not be confused with the short-acting bronchodilators, which are used as rescue medications. These inhaled drugs act within 5 to 15 minutes to relax the muscles surrounding the airways, allowing the airways to expand and air to pass through more easily. They include albuterol, include bitolterol, and pirbuterol. Effects last 4 to 6 hours.