Dr. Donald Levy, Allergy, Asthma, and Immunology, Orange County Ca


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Related Articles

Beta2-Agonists
Theophylline
Cromolyn
Nedocromil
Leukotriene Modifiers
Corticosteroids
Anti-IgE Medications
Commonly Prescribed Asthma Medications

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Office Location
:
705 W. La Veta Ave.
Suite 101
Orange, CA 92868
(714) 639-7847

 


Asthma Medications Review

Beta2-Agonists

Action
Beta2-agonists are bronchodilator medications that open airways by relaxing the muscles in and around the airways that tighten during an asthma episode.

How They Are Prescribed
Beta2-agonists come in inhaled and oral forms. Inhaled preparations are the preferred way of taking these medications.

Inhaled beta2-agonist preparations are available as:

  • Metered-dose inhalers
  • Solutions for nebulizers
  • Powder-filled capsules that are inhaled using a device called a dry-powder
    inhaler

Inhaled short-acting beta2-agonists quickly stop symptoms of asthma episodes and prevent symptoms that can be brought on by exercise. They are sometimes used in
small doses (no more than three or four times a day) to treat daily asthma symptoms. Long-acting inhaled salmeterol or formoterol is used as a controller medication in conjunction with inhaled corticosteroids to prevent symptoms.
These long-acting drugs cannot be used to relieve acute asthma episodes.
Oral preparations are available in liquid or tablet form.

Side Effects
The side effects of beta2-agonists include rapid heartbeat, tremors, anxiety and nausea. These side effects tend to go away as the body adjusts to the medication.
Serious side effects are rare, but may include chest pain, fast or irregular heartbeat, severe headache or dizziness, or severe nausea or vomiting. Call your doctor right
away if you have any of these symptoms.

Notes
Inhaled bronchodilators are the first choice for asthma treatment. They begin to work within five minutes and have fewer side effects than the oral preparations and they go directly to the lungs, not to the rest of the body.

Liquids or tablets begin to work within 30 minutes and last as long as four to six hours.
A child as young as 5 can use the metered-dose inhaler. A holding chamber called a spacer device can be attached to the inhaler to make it easier to use, even for children younger than 5.

Using a nebulizer to take the medicine works the same way as using an inhaler.
A nebulizer is easier to use than an inhaler and is recommended for children under the age of 5, people who have trouble using an inhaler, or for people who have severe asthma episodes.

Remember
Beta2-agonists relieve symptoms, but they cannot reduce or prevent the swelling that causes the symptoms. When you have to use a beta2-agonist frequently, it may be a
sign that the swelling in your airways is getting worse. If you use a beta2-agonist to relieve symptoms every day or if you use it more than three or four times in a single
day, your asthma may be getting much worse and you may need a controller medicine. Discuss your symptoms and medication use with your doctor right away.

Theophylline

Action
Theophylline is a bronchodilator medication that opens airways by relaxing the muscles in and around the airways that tighten during an asthma episode.

How It Is Prescribed
Theophylline comes in an oral sustained-release form in tablets or capsules.
Do not chew theophylline if you take it in tablet or capsule form, because it is designed for sustained release and too much of the medication will be released all at once.

Do not mix theophylline with hot food. Heat will dissolve the medication and release too much into the body at one time.

Take theophylline with food rather than on an empty stomach. If you forget to take your theophylline on time, do not take twice as much the next time. Take the normal amount as soon as you remember. Call your doctor about how to get back on schedule.

Side Effects
Side effects from theophylline may include nausea, vomiting, stomach cramps, diarrhea, headache, muscle cramps, irregular heartbeat, or feeling shaky or restless. Call your physician if you have any of these side effects. It may mean that the amount of
medication you are taking should be changed. Mild side effects often go away after a
few days. More serious side effects can occur if the amount of theophylline in your
blood gets very high.

Notes
Theophylline may be prescribed to be taken every eight or 12 hours. This makes it an easy medication to use.

It takes some time for theophylline to build up in the bloodstream, where it must stay
at a steady level to have a lasting effect. This means that it is important for you to take it at the times and in the amount your doctor prescribes.

Your doctor will periodically do a simple blood test to determine if the medication is at the right level.

If your child has a fever or a virus (such as chickenpox), or if your child starts taking an antibiotic, call your doctor right away. Other medications may interact with theophylline. Make sure any doctor who prescribes a new medication knows your child is taking theophylline. If you have any concern that a medication may interact with theophylline, check with your doctor before giving the new medication to your child. The usual dose may be too strong for your child during this time and your child may experience the side effects listed above from the theophylline.

Cromolyn

Action
Cromolyn is an anti-inflammatory medication that prevents airways from swelling when they come in contact with an asthma trigger.

How It Is Prescribed
Cromolyn comes in two forms for inhalation:

  • A metered-dose inhaler
  • Solution for use in a nebulizer

Cromolyn can be used in two ways:

  • To prevent symptoms of persistent asthma, it should be taken every day.
  • To prevent symptoms of asthma that occur with exercise or contact with an asthma trigger (such as an animal), it can be taken five to 60 minutes before contact. The effects of the medicine last for three or four hours.
Side Effects
Cromolyn is safe to use in the treatment of asthma. The most frequent side effect of cromolyn administered by metered-dose inhaler is irritation of the throat, bad taste in
the mouth, cough, wheezing and nausea.

Notes

  • Cromolyn is generally not used by itself as a controller medication in the
    treatment of asthma.
  • Cromolyn cannot be used to stop an asthma episode once it has started.
  • Cromolyn can only be used to prevent an episode from starting.
  • Cromolyn does not work for every person. It may take up to six weeks for the medicine to take effect.
  • If you are taking an inhaled beta2-agonist and cromolyn together, take the
    beta2-agonist first.
  • If you forget to take your cromolyn on time, take it as soon as you remember. Talk to your doctor about how to get back to your normal schedule.

Nedocromil

Action
Nedocromil is an anti-inflammatory medication that prevents airways from swelling when they come in contact with an asthma trigger.

How It Is Prescribed
Nedocromil comes as a metered-dose inhaler.

Nedocromil can be used in two ways:

  • To prevent symptoms of persistent asthma, it should be taken every day.
  • To prevent symptoms of asthma that occur with exercise or contact with an asthma trigger (such as an animal), it can be taken five to 60 minutes before contact. The effects of the medicine last for three or four hours.
Side Effects
Nedocromil is safe to use in the treatment of asthma. Side effects include a dry cough and a bad taste in the mouth. These side effects can be reduced by rinsing your mouth and drinking a few sips of water after taking it.

Notes

  • Nedocromil generally is not used by itself as a controller medication in the treatment of asthma.
  • Nedocromil cannot be used to stop an asthma episode once it has started. Nedocromil can only be used to prevent an episode from starting.
  • Nedocromil does not work for every patient. It may take up to six weeks for
    the medicine to take effect.
  • If you use an inhaled beta2-agonist and cromolyn together, take the
    beta2-agonist first.
  • If you forget to take your nedocromil on time, take it as soon as you remember. Talk to your doctor about how to get back on your normal schedule.

Leukotriene Modifiers

Action
Leukotriene modifiers block the action of chemicals called leukotrienes, which produce both inflammation and narrowing of the airways.

How They Are Prescribed
Leukotriene modifiers, sometimes called leukotriene receptor antagonists (including zileuton, montelukast and zafirlukast), come in oral tablets.

Leukotriene modifiers are used to prevent symptoms of asthma and should be taken every day.

Side Effects
Leukotriene modifiers are safe to use in the treatment of asthma. They may cause stomach upset. Your doctor may want to monitor how well your liver is working while you are taking zileuton.

Notes

  • Leukotriene modifiers cannot be used to stop an asthma episode once it has started.
  • Leukotriene modifiers may be particularly effective in people with
    aspirin-sensitive asthma.
  • They can be used as the initial controller medication for mild, persistent asthma.
  • Some leukotriene agents can interact with other medications.
    Make sure you talk to your doctor before starting any new medication.

Corticosteroids

Action
Corticosteroids are anti-inflammatory medications that prevent and reduce swelling inside the airways and decrease the amount of mucus in the lungs.

How They Are Prescribed
Corticosteroids comes in two forms:

  • A metered-dose inhaler
  • Liquids or tablets to be swallowed (called oral corticosteroids)

Inhaled corticosteroids are taken with a metered-dose inhaler or with a dry-powder inhaler. When taken at the proper doses, they are safe medications that work well for people with moderate or severe, persistent asthma. They reduce the sensitivity of the airways to asthma triggers, prevent swelling of the airways and allow inhaled bronchodilators to work better. Inhaled corticosteroids are very safe for long-term use (years and decades).

Liquid and tablet oral corticosteroids are used during severe asthma episodes to
quickly reduce swelling of the airways and prevent the episode from getting worse.
For people with moderate asthma, oral corticosteroids are sometimes used for three to seven days and then stopped. People with very severe asthma may need to take oral corticosteroids every other day or even daily.

Side Effects
Inhaled corticosteroids can cause yeast infections in the mouth or irritate the upper airways and cause coughing. Occasionally, inhaled corticosteroids may cause
hoarseness and loss of voice. There are two things you can do to prevent these side effects: Use a spacer device (an attachment on the inhaler) and rinse out your mouth
after you take the medicine. Using oral corticosteroids for a short time may cause different side effects such as increased appetite, fluid retention, weight gain, elevated blood sugar, rounding of the face, changes in mood and high blood pressure.
These side effects will stop when you stop taking the medication, but do not stop
taking it without first talking to your doctor Oral corticosteroids used for a long time
can cause serious side effects such as high blood pressure, high blood sugar, thinning
of the bones, cataracts, muscle weakness and slow growth in children. Because of
these side effects, your physician may prescribe long-term use of oral corticosteroids only if your asthma is severe and cannot be controlled without these drugs.

Certain infections (such as chickenpox, measles and tuberculosis) can be worsened
by oral corticosteroids. Check with your doctor before starting to take oral corticosteroids if you think you may have an infection.

Notes

  • Corticosteroids are not the same as the steroids used by some athletes. Inhaled corticosteroids and oral corticosteroids taken for a short time do not damage the liver and do not cause other long-lasting changes in the body.
  • Children as young as 3 years of age can use inhaled corticosteroids if a holding chamber or spacer device is attached to the metered-dose inhaler. Ask your child's doctor about using a spacer.
  • Before stopping or changing your inhaled corticosteroids, always talk with your doctor. The side effects from inhaled corticosteroids can often be managed.
    If you stop your inhaled corticosteroid without a plan, your asthma could get worse.
  • The use of inhaled corticosteroids on a long-term basis (for years and years) is safe and will not harm your body. Many people with asthma have used these drugs for 25 years or more without side effects.
  • When oral corticosteroids are used to treat serious asthma episodes, they take about 3 hours to start working and are most effective in 6 to 12 hours. Talk to your doctor about what to do when you forget to take your medication on time.
  • Discuss the possible effects of high-dose corticosteroids on your child's growth and bones.
  • If you need to have surgery and you are taking or have recently taken oral corticosteroids or have been taking high-dose inhaled corticosteroids, tell the surgeon and anesthesiologist before the surgery.
  • If you need to use oral corticosteroids for a long period of time, talk with your doctors about monitoring your eyes, your bones and your blood sugar in order
    to prevent or control some of the potential side effects of these drugs.

Anti-IgE Medications

Action
Anti-IgE medications (also called IgE blockers) block the effect of a protein called immunoglobulin E (IgE), which is important in allergic reactions. For people who have both asthma and allergies and who have a high level of IgE in their blood, blocking the effect of this protein may provide relief.

How They Are Prescribed
Omalizumab (Xolair) is the only anti-IgE medication that currently available. Xolair, which is given in injections, is technically known as a recombinant DNA-derived humanized IgG1K monoclonal antibody that selectively binds to human immunoglobulin E (IgE). Some people with asthma have severe allergies to airborne substances such as dust mites, pollen or animal dander. In these people, the immune system seems to over-react to these inhaled allergens in part by making too much IgE. Xolair blocks the effect of IgE and reduces the inflammation that narrows the airways.

Only a small number of people with asthma qualify to take Xolair. The medication is approved only for patients over the age of 12 who have moderate to severe, persistent allergic asthma and who have not improved sufficiently with inhaled corticosteroids and other controller medications. Before prescribing Xolair, a doctor orders laboratory tests to determine if the person has both allergies and a high IgE level in his or her blood. Xolair is expensive and not all insurance plans cover it.

Xolair is injected under the skin once or twice a month. Your doctor will determine the exact dose based on your weight and the IgE level in your blood. You still need to continue taking your other controller medications as ongoing treatment, as well as
rescue inhalers when necessary. It may take several weeks for you to notice an improvement after you start taking Xolair.

Xolair will not treat an acute asthma attack, and you must always remember to use your rescue inhaler and seek appropriate treatment for asthma attacks.

Xolair is listed by the FDA as a category B (category A is the safest) drug for use
during pregnancy. Because the use of Xolair by pregnant women has been limited, it should be used only when clearly needed. If you are pregnant, think you might become pregnant while taking Xolair, or if you are breast-feeding, talk to your doctor.

Side Effects
Because anti-IgE blockers are a newer medication in the treatment of asthma, fewer people have used them compared with the other controller medications. Some of the more common side effects include bruising, pain or a skin reaction at the injection site, fatigue, itching of the skin and dizziness.

IMPORTANT: If your doctor recommends Xolair, he or she will warn you about a rare but potentially life-threatening allergic reaction (anaphylaxis) that a few people developed during clinical studies of the drug. The symptoms of anaphylaxis include a
skin rash, shortness of breath (similar to an asthma attack), itching, and swelling of the tongue and throat. If you experience these symptoms, seek immediate emergency medical attention. Because of the small but real risk of anaphylaxis with Xolair, the injections are usually given in a doctor's office or clinic and the patient is asked to
remain in the office for two to three hours after the injection to make sure he or she is
not having a severe reaction.

Clinical studies also found a slightly increased risk of cancer among people taking
Xolair compared with people taking a dummy pill (placebo). The long-term risk of developing cancer while taking Xolair is unknown. Talk to your doctor about any concerns you may have about taking Xolair.

Notes

  • IgE blockers cannot be used to stop an asthma episode once it has started.
  • IgE blockers may be helpful as an additional therapy for people with severe asthma and multiple allergies.
  • IgE blockers are not for every person with asthma but may be helpful if you
    have severe asthma.

Commonly Prescribed Asthma Medications

Rescue Medications: Inhaled Short-Acting Beta2-Agonists

  • albuterol (Proventil, Ventolin)
  • bitolterol (Tornalate)
  • pirbuterol (Maxair)
  • terbutaline (Brethaire)

Controller Medications: Inhaled Anti-Inflammatory Agents
Inhaled Nonsteroidal Anti-Inflammatory Medications

  • Cromolyn sodium (Intal)
  • Nedocromil sodium (Tilade)

Injected Nonsteroidal Anti-Inflammatory Medications

  • Omalizumab (Xolair)

Inhaled Corticosteroids

  • beclomethasone (Beclovent and Vanceril)
  • budesonide (Pulimicort)
  • flunisolide (AeroBid)
  • fluticasone (Flovent)
  • triamcinolone (Azmacort)

Controller Medications: Combination Inhaled Corticosteroid and
Bronchodilator

  • Fluticasone and salmeterol (Advair)
  • Controller Medications: Oral Corticosteroids
  • prednisone (Deltasone, Prednicen-M, Sterapred)
  • prednisolone (Pediapred, Prelone)
  • methylprednisolone (Medrol)

Controller Medications: Oral Antileukotrienes

  • montelukast (Singulair)
  • zafirlukast (Accolate)
  • zileuton (Zyflo)

Controller Medications: Long-Acting Bronchodilators

  • Beta2-agonists:
    • salmeterol (Serevent)
    • formoterol (Foradil)
    • albuterol (Volmax, Proventil Repetabs)
  • theophylline (Slo-Phyllin, Uniphyl, Theo-Dur, Slo-Bid, UniDur)
Controller Medications: Injectable anti-IgE Blockers
  • Omalizumab (Xolair)

 

Last Update: February 2005 by Steven R. White, MD
  Associate Professor of Medicine
  University of Chicago
  Pulmonary and Critical Care Medicine

© Copyright 2005 American Medical Association
All rights reserved.
 


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