Asthma doesn't have to put major limits on your life. There are many things that you can do to take control of your asthma and minimize its impact on your activities. Because each case of asthma is different, treatment needs to be tailored for each person. One general rule that does apply, though, is removing the things in your environment that you know are factors that make your asthma worse. When these measures are not enough, it may be time to try one of the many medications that are available to control symptoms.
Asthma medications may be either inhaled or in pill form and are divided into two types—quick-relief and long-term control. Quick-relief medicines are used to control the immediate symptoms of an asthma episode. In contrast, long-term control medicines do not provide relief right away, but rather help to lessen the frequency and severity of episodes over time.
Like all medications, asthma treatments often have side effects. These are usually mild and go away on their own. Be sure to ask your doctor about the side effects of the medications you are prescribed and what warning signs should prompt you to contact him or her.
There are two groups of asthma medications:
1. Long term controllers
2. Quick relievers
Long-Term Controller Therapy for Asthma
Long term control medications help you keep control of your asthma. The NHLBI Guidelines state that you probably need a long term control medicine if you have symptoms more than twice a week. You will need to take this medicine every day
The anti-inflammatory group of controller medicines is the most important group of long term controller which prevent or reverse inflammation in the airways. This makes the airways less sensitive, and keeps them from reacting as easily to triggers. In short, they actually prevent asthma episodes.
Cromolyn Sodium and Nedocromil Sodium (inhaled) prevent airways from swelling when they come in contact with an asthma trigger. These nonsteroids can also be used to prevent asthma caused by exercise.
Inhaled Corticosteroids (inhaled) prevent and reduce airway swelling and decrease the amount of mucus in the lungs. These are generally safe when taken as directed. They are not the same as anabolic steroids, which some athletes take illegally to build muscles. If you are taking an inhaled anti-inflammatory medicine and you feel your asthma symptoms getting worse, talk with your doctor about continuing or increasing the medicine which you are already taking. You may also need to add an oral corticosteroid or a short-acting beta agonist (bronchodilator) for relief.
Oral Corticosteroids (pills, tablets, liquids) are used as short-term treatment for severe asthma episodes or as long-term therapy for some people with severe asthma. Again, these are not the same as anabolic steroids.
Leukotriene modifiers (tablets) are a new type of long-term control medication. They prevent airway inflammation and swelling, decrease the amount of mucus in the lungs, and open the airways.
The long-acting bronchodilator group is another type of the long term controller medicines which help open the airways over a long period of time. They are taken in addition to anti-inflammatory medicines.
Long-acting beta agonists (inhaled) can be taken with or without an anti-inflammatory medicine to help control daily symptoms, including nighttime asthma. This type of medicine can also prevent asthma triggered by exercise. Because long-acting beta agonists can not relieve symptoms quickly, they should not be used for an acute attack. You also need a short-acting, inhaled beta agonist for acute symptoms. Long-acting, inhaled beta agonists are not a substitute for anti-inflammatory medicine. You should not decrease or stop taking your anti-inflammatory medicine without talking to your doctor, even if you feel better.
Combined therapy medicine (inhaled) contains both a controller and reliever medicine. This combination of a long-acting bronchodilator and corticosteroid is used for long-term control.
Anti-IgE therapy (injected) is a new treatment for people with moderate or severe allergic asthma. For people with allergic asthma, anti IgE therapy works by helping to reduce the production and diffusion of Immunoglobulin E (IgE), a primary trigger of allergic inflamation in the lungs. It attempts to stop allergic asthma at its root cause instead of just treating asthma symptoms. This drug is not inhaled, but rather injected by your doctor on a regular basis. It does not eliminate your need for other asthma medications, but it can help to reduce your use of them. Due to its significant cost, this form of therapy is currently reserved for moderate to severe cases requiring multiple medications.
Sublingual Immunotherapy (SLIT) is an alternative way to treat allergies without injections. Allergists give patients small doses of an allergen under the tongue to boost tolerance to the substance and reduce symptoms. SLIT is relatively safe and effective for the treatment of rhinitis and asthma caused by allergies to dust mites, grass, ragweed, cat dander, and tree pollens. If you are interested in learning more about SLIT, contact your healthcare provider.
Bronchial Thermoplasty (BT) (procedure) The U.S. Food and Drug Administration (FDA) approved the first device used in a non-drug procedure for adults with severe persistent asthma that is not well controlled with standard medications. The procedure, called bronchial thermoplasty or “BT” is an out-patient procedure done by pulmonologists using thermal energy to reduce excessive smooth muscle in the lungs, decreasing the ability of the airways to constrict and reducing the frequency of asthma attacks. BT does not eliminate the need for your asthma medications, but it has been shown to reduce the quantity of medications needed by people with severe asthma.
Quick-Reliever Medications for Asthma
Quick relief medicines (inhaled and pills) are used to ease the wheezing, coughing, and tightness of the chest that occurs during asthma episodes.
- Short-acting brochodilators (inhaled) are one type of quick relief medicines. They open airways by relaxing muscles that tighten in and around the airways during asthma episodes.
- Short-acting beta agonists (inhaled) relieve asthma symptoms quickly and some prevent asthma caused by exercise. If you use one of these medicines every day, or if you use it more than three times in a single day, your asthma may be getting worse, or you may not be using your inhaler correctly. Talk with your doctor right away about adding or increasing a medication, and about your inhaler technique.
- Oral beta agonists (syrup, tablets and long-acting tablets) syrup may be used for children, while long-acting tablets may be used for nighttime asthma. Oral preparations generally cause more side effects than the inhaled form.
- Theophylline (oral, slow-acting) can be used for persistently symptomatic asthma, and especially to prevent nighttime asthma. Theophylline must remain at a constant level in the blood stream to be effective. Too high a level can be dangerous. Your doctor will do regular blood tests. Sustained release theophylline is not the preferred primary long term control treatment but it is effective when added to other anti-inflammatory medicines to control nighttime symptoms.
Getting Reimbursement for Asthma Treatments
Health insurance can be tough to understand, so we are here to help. AAFA created a Web site, Insurance Coverage, Denials & the Appeals Process, to help you understand the process of trying to get an asthma or allergy service or procedure recommended by your doctor covered by your insurance.
Also learn more about asthma treatment from the American College of Asthma, Allergy & Immunology (ACAAI).
SOURCE: This information should not substitute for seeking responsible, professional medical care. First created 1995; updated 2012.
© Asthma and Allergy Foundation of America (AAFA) Editorial Board