Long-term control medications

Inhaled corticosteroids are the most potent and consistently effective long-term control medications for asthma. Their action reduces inflammation in the airways. Inhaled corticosteroids reduce asthma episodes, decrease emergency-room and hospital visits and prevent death from asthma. They improve breathing test results and reduce airway twitchiness. They also may prevent damage to the airways caused by asthma. Regular daily use is especially important, because it can take days to weeks before the inhaled corticosteroids begin to work.

When taken at recommended dosage levels, these corticosteroids have few serious side effects. Occasional minor side effects from inhaled corticosteroids include hoarseness and thrush (a yeast infection in the back of the throat and tongue). These problems can be reduced by using a spacer with the inhaler and by rinsing the mouth with water or gargling with mouthwash after taking the medication.

Inhaled corticosteroids help many people with asthma reduce their need for oral (taken by mouth) corticosteroids, which can have more serious side effects, such as decreased growth, osteoporosis, cataracts and glaucoma.

Long-acting bronchodilators include inhaled and oral medicines. Inhaled salmeterol (Serevent Diskus®) and formoterol fumarate (Foradil®) last 12 hours and must be used with an inhaled corticosteroid or another type of medicine to control asthma inflammation. Inhaled forms of long-acting beta-agonists are preferred, because they have fewer side effects and last longer than sustained-release albuterol pills.

Tiotropium (Spiriva) relaxes the airway’s smooth muscle and is sometimes used in adults with asthma. The effects last for 24 hours. This medicine should not be used for quick relief of asthma episodes. It comes as a capsule containing a fine powder that is crushed and inhaled. The most common side effect with this medicine is a dry mouth.

Advair® is a combination of fluticasone propionate (Flovent®) and salmeterol (Serevent®). Other combination asthma inhalers are expected in the future.

Leukotriene modifiers are a newer class of medication available for controlling asthma. Leukotrienes are potent substances that can cause bronchia to constrict and increase mucus production, leading to increased asthma symptoms. Zafirlukast (Accolate®) and montelukast (Singulair®) are oral medications that block the actions of leukotrienes. They are used in adults and children alone or in combination with inhaled corticosteroids.

Cromolyn sodium and nedocromil are under a class of medications called mast-cell stabilizers. Cromolyn sodium (Intal®) is an inhaled medication that prevents the airways from becoming inflamed. It is mainly used to control mild to moderate allergic asthma by preventing the allergic reaction. Cromolyn sodium is given through a metered-dose inhaler (MDI) or a nebulizer. It may be used throughout the year or only during certain seasons, depending on the type of allergies a person has.

Cromolyn sodium also is prescribed to help control asthma triggered by exercise or cold air. In these situations, cromolyn is taken just before exercise or exposure to cold air.

Nedocromil (Tilade®) is another nonsteroidal asthma medication such as cromolyn sodium. Nedocromil is used in mild to moderate persistent asthma as a metered-dose inhaler. Both cromolyn sodium and nedocromil can take two to six weeks of regular use before they begin to work.

When used on a regular basis – usually once or twice daily – theophylline (a methylxanthine medication) helps maintain relaxed and open airways to the lungs. Because theophylline can take up to several hours to relieve symptoms, it is not used for treating asthma episodes that already are underway. It also is used less frequently than inhaled corticosteroids.

Theophylline is available in a variety of forms and strengths to fit an individual’s needs. Capsules are a convenient form of this medication for young children, because they can be opened and mixed with foods such as applesauce or yogurt.

Never adjust your theophylline dosage on your own. Taking less than prescribed or skipping doses can lead to an asthma episode. Taking more than prescribed can lead to serious side effects, including seizures.

Monoclonal antibodies are a class of medications that work by blocking antibodies called immunoglobulin E (IgE) from attaching to allergy cells.

Omalizumab (Xolair®) in an injection given every two to four weeks to decrease the number of asthma episodes and the need for other medications. It is used only in moderate to severe persistent asthma.