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Asthma Medications

The information below is a guide to medications used in the treatment of asthma.  It is not intended as a substitute for the advice of an allergist.  If you have asthma, it is critical that you be under the care of an allergist.  If the medicines prescribed for you by your allergist are not controlling your asthma, you should be seen by your allergist immediately.

Antihistamines: Histamines are chemicals released in your body during an allergic reaction.  They cause inflammation and can lead to nasal and sinus congestion (as in hay fever) and other allergic symptoms, including hives.  Antihistamine medications reduce the effects of histamines on the body.  They are available as oral medications (liquids, tablets, capsules, pills) or as nasal sprays.  Antihistamines are often categorized as sedating vs. non-sedating.  The side effects of Antihistamines include: dry mouth, constipation and drowsiness.  These are much more common with sedating Antihistamines.  Men with prostate problems should consult their doctor before taking any form of Antihistamine (even over the counter Antihistamines) since Antihistamines can cause difficulty urinating.   Antihistamines should be given to children only under the supervision of a pediatrician or allergist, since these medications can sometimes cause nightmares, agitation and learning difficulties in children. 

Most decongestants work by causing constriction of the blood vessels in the nasal and sinus passages.  This decreases blood flow, thereby decreasing the amount of fluid that can be secreted (leak) into the nose and sinuses.  Decongestants may be taken orally (as liquid, tablet or capsule) or in the form of a nasal spray.  Many are available without prescription.  Side effects include agitation, sleep disturbances and increased blood pressure and heart rate.  If taken for more than brief intervals, many decongestants can cause a rebound rhinitis which is often more severe than the original condition and can lead to increased dependence on the decongestant.  If you are using a decongestant frequently, you should consult your allergist to see if there are other therapies which will help clear your congestion and prevent decongestant dependence.

Controller medications:
Because the symptoms of allergies and asthma include swelling, mucus secretion and inflammation, three categories of medicines , specifically aimed at reducing inflamation, are often prescribed.  These include: Mast cell stabilizers, corticosteroids and antileukotrienes.

• Mast Cell Stabilizers: are non-steroidal medicines which stop cells, called mast cells, from releasing substance called histamine, which causes inflammation. Two common mast cell stabilizing medicines which are often used to treat allergic rhinitis and asthma are cromolyn and nedocromil. Although some mast cell stabilizing medications are available over the counter, if you have a repeated need for these medications, you should consult your allergist.

• Corticosteroids: The corticosteriods used in the treatment of allergy and asthma are not the same as the anabolic steroids taken by athletes to increase their performance. The corticosteroids used by allergists to treat patients with allergies and asthma are very potent anti-inflammatories. All corticosteroid use should be supervised by your doctor. Corticosteroids come in the form of topical creams and ointments, as nasal sprays or inhalers, in pill form or injectable (given as shots).

Oral corticosteroids: are usually considered as short-term and are used by allergists in the treatment of asthma flare-ups, severe congestion, acute skin conditions such as poison oak.  They may be used for asthma.  Side effects may include weight gain, muscle cramps and gastric upset.  These usually subside quickly after the corticosteroid is discontinued.  Long term corticosteroid use may have serious side effects, including ulcers, cataracts, osteoporosis and diabetes.  Use of corticosteroids in children may interfere with growth and development.

Inhaled corticosteroids: are sometimes required for long-term control of persistent asthma.  Since they act locally, they have fewer systemic side effects.  These may include a fungal infection in the mouth (called oral thrush), which is usually controlled by rinsing with water after use.  In children, growth may be temporarily reduced, but this side effect tends to be limited and subsides after the first year of use.  Your allergist will help you to determine when the benefits outweigh the risk for asthmatic children who may need inhaled corticosteroids.

  1. Anti-Leukotrienes: Leukotrienes are chemicals, much like histamines.  They are released by immune cells in response to allergic stimuli.  Leukotrienes are responsible for the contraction of muscles in the lungs  and for the swelling of the lining of the lungs that produces asthmatic symptoms.  Anti-leukotrienes are used to control mild persistent asthma. They may be used in conjunction with corticosteroids in more severe asthma. One anti-leukotriene, motelukast, is also used in the treatment of hay fever.       

Bronchodilators: act on the smooth muscle in the lungs.  These are the muscles that contract, or spasm, in people with asthma, making it difficult for them to reath.  By relaxing the muscles in the lungs, the airway passages open more eaisily, allowing the patient with asthma to breath with less difficulty.  Categories of bronchodilators that are used to treat asthma include: beta-agonists, theophylline, and anti-cholinergics. 

Beta-agonist bronchodilators
relax the smooth muscle surrounding the bronchial tubes.  Short acting beta-agonists, such as albuterol, are effective almost immediately and can last up to six hours.   Long acting beta-agonists, like salmeterol, may last up to twelve hours.  Side effects include agitation, sleep disturbances, rapid heart rate and sometimes headaches.  Long acting beta-agonists may cause severe side effects which can be life threatening.  You should consult your allergist before using beta-agonist bronchodilators.

is one of the oldest and most trusted bronchodilators.  It may be taken orally or given intravenously.  Theophylline levels should be monitored closely to prevent toxicity.  Side effects include: rapid heart rate, gastric discomfort and headache.  If levels of theophylline are not monitored closely, seizures may occur. .

Anticholinergic agents
are often used in conjunction with beta-agonists. Side effects include: cough and headache.

Anti-IgE antibody:
may reduce allergic symptoms by binding to the antibody that initiates the allergic response, called immunoglobin E (or IgE). In 2003, anti-IgE was approved for some patients with moderate to severe persistent allergic asthma who are not controlled well with other therapies, cannot use corticosteroids, require frequent visits to emergency rooms, are unable to perform daily activities normally and cannot tolerate other medications. Anti-IgE must be given by injection once every two to four weeks. 

When to see an asthma specialist

Patients should see an allergist/immunologist if they:

• Are not using medications as prescribed, and this is limiting their ability to control their asthma.
• Have potentially fatal asthma, meaning a prior severe, life threatening episode that included intubation.
• Have persistent asthma, particularly moderate-severe or uncontrolled persistent asthma.
• Need for daily asthma reliever medications.
• Would like to try to minimize their need for medications.

Copyright © 2008-2010 Dr. Beth Cowan