Asthma Treatment & Medication

Asthma is a chronic lung disease. There are25 million peoplewith asthma living in the United States. This includes 20 million adults and 5 million children. Asthma causes episodes of coughing, wheezing, chest tightness and shortness of breath. Symptoms can be mild or severe, and sometimes life-threatening. Asthma cannot be cured. But asthma management can be achieved through effective asthma treatment.

Treatment for asthma focuses on managing symptoms and preventing and treating asthma attacks. Different asthma treatments have different roles. So, it is important to understand treatments and their roles in helping with asthma control.

What are common types of asthma medications?

There are four basic types of asthma medicines. They each treat a different part of your asthma:

• bronchodilatorsrelax and open the airways to treat symptoms such as coughing, wheezing, chest tightness and shortness of breath.

• anti-inflammatory medications减少和防止lung inflammation.

• combination medicationscombine a bronchodilator and anti-inflammatory in one device.

• leukotriene modifiersblock the action of leukotrienes, chemicals involved in immune system responses.

• biologicsare medications that target the specific cells and pathways that cause inflammation related to severe asthma.

Combination medications

Combination medications combine two medicines into one inhaler. The devices may contain an anti-inflammatory corticosteroid and a LABA. Or they may contain a LABA and a long-acting muscarinic antagonist, or LAMA. (LAMAs are anticholinergic medications that relieve cough, wheeze, sputum production and chest tightness. Most LAMAs are prescribed to treat COPD, but a few are approved for asthma as well.)

Combination medications are used daily and should be taken no more than once every 12 hours. They should not be used to treat severe symptoms or an asthma attack.

Leukotriene modifiers

Leukotriene modifiers are oral medications that block the action of leukotrienes. Common leukotriene modifiers include montelukast, zafirlukast, and zileuton. Leukotrienes are chemicals involved in immune system responses. These responses cause inflammation, swelling and tightening of the airways. They are available as granules, chewable or tablets. Leukotriene modifiers should not be used to treat sudden symptoms or asthma attacks.

Montelukast may cause behavioral side effects. This includes sleep disturbances, anxiety, depression, confusion, sudden mood changes and suicidal thoughts or actions. Talk with your doctor about these potential side effects before taking montelukast. Monitor for side effects during treatment.

Biologics

Biologics target cells and pathways that cause allergic inflammation and tightening of the airways (bronchoconstriction). This medication focuses on treating the source of symptoms rather than the symptoms themselves. They aim to stop symptoms before they can start.

Biologics are prescribed as an add-on therapy for severe asthma. They are usually administered as an injection or infusion every 2-4 weeks in a doctor’s office. Biologics are not used to treat asthma attacks.

When biologics are effective, they help patients gain long-term asthma control. They help improve asthma symptoms and reduce the risk of an asthma attack. The most serious side effect is anaphylaxis, a life-threatening allergic reaction. Your doctor should haveepinephrinereadily available for treatment after administering the biologic.

Have you ever wondered how your doctor decides which is the best way for you to take your asthma medicine?

Options include syrups, granules, tablets, or capsules that you swallow. Or they are aerosols and powders that you inhale from ametered-dose inhaler(MDI),dry powder inhaler(DPI) ornebulizer. Attaching a valvedholding chamberto an MDI allows patients to direct the medicine into the airways by holding it and inhaling at their own speed.

Healthcare providers prescribe treatments effective in disease control. They also want treatments that are convenient for patients’ needs and lifestyles. You should be part of the decision process. Discuss with your healthcare provider your needs and lifestyle.

Here are 5 patient-focused factors that are part of the decision process:

1. Age. This is always an important consideration, but especially with infants. Infants have smaller airways and lungs and breathe faster. National asthma guidelines say children should use a holding chamber when using an MDI. This is because the aerosolized spray comes out faster than most kids can inhale.
2. Ability to follow directions.This consideration crosses all age groups. It includes when and how to take a particular medication. Even adults may confuse the directions for using MDIs and DPIs.
3. Hand-breath coordination. Young children should be able to use an MDI with a holding chamber and mask. But they may not be able to breathe in long enough to use a DPI in a diskus device. Older individuals with asthma may want to use a holding chamber. This is if they are not able to manage the hand-breath coordination of an MDI or use a DPI or nebulizer. Some DPIs are breath actuated. This eliminates the need for a coordinated effort to deliver and inhale the medication. Albuterol is now available in a DPI.
4. Where you are going to use it? Most people with asthma keep their daily maintenance medications at home. But some may travel or spend their days at work or in school. People must first make sure their quick-relief inhaler is easily accessible, even if their asthma is well controlled. For people on the go, delivery systems need to be convenient, portable and low maintenance. MDIs with holding chambers offer low-cost, convenient and effective delivery of albuterol. This works for either premedication or quick-relief.
5. Patient preference and convenience. Your needs and preferences are an important consideration in the final selection of asthma treatment. The medications will not help if you don’t use them! Talk with your doctor about what works best for you.

To benefit from your medication, it must be taken at the right dose, at the right time and in the right way. Since there can be obstacles to any of these steps, review your Asthma Action Plan at every doctor’s visit. Demonstrate your delivery technique to be sure that you are taking your medication correctly. Discuss any problems you may have withasthma control.

如果你的哮喘症状持续,跟你做的事ctor about the need to adjust your medications. Talk with your doctor about concerns over cost. Any barrier to using your medication can affect your asthma control.

Reviewed by:
James Sublett, MD, FACAAI, FAAAI,is a board-certified allergist and immunologist with Family Allergy & Asthma in Louisville, Kentucky. He earned his medical degree from the University of Louisville. He is Past President of the American College of Allergy, Asthma & Immunology (ACAAI).

Dennis Williams, PharmD,is an Associate Professor at the University of North Carolina Eshelman School of Pharmacy. He practices at UNC Medical Center with the pulmonary medicine medical service. He has served as a member of the National Asthma Education Program Coordinating Committee and the National Asthma Educator Certification Board. He serves on Allergy & Asthma Network’s Board of Directors.