Controlling Asthma with Medication

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Category: Immunodeficiency Articles Published on Monday, 14 July 2008 Written by Yong Tsai, MD
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Asthma, known as chronic inflammation of the lining of the airway, can be triggered by allergens such as trees, grasses, weeds, dust mites, and animal dander (allergic asthma) or irritants ( non-allergic asthma).

The first step in treating allergic asthma is to avoid the aggravating allergens and then with immunotherapy (allergy injections), if necessary.  Whether you have allergic or non-allergic asthma, most patients still need relief with medication for wheezing, chest tightness or shortness of breath.

Let's look at the three basic classes of asthma medications: short acting bronchodilators, long acting bronchodilators and anti-inflammatory medication.

Short acting bronchodilators (quick-relief inhalants or rescue medication) work by rapidly relaxing muscles in the airway, causing the airway to open, usually within five minutes.  Drugs in this class include Albuterol (Proventil,), Levalbuterol (Xoponex) and others.

Long-acting bronchodilators, such as inhaled salmeterol, formoterol can dilate the airway for up to 12 hours per dose.  While long-acting bronchodilators are commonly used to prevent nighttime and exercise-induced asthma, they require about 10 to 30 minutes to take effect and four to six hours to reach full effect. Therefore, they should not be used as “ rescue medication”. Studies have shown that long acting bronchodilators can enhance the anti-inflammatory properties of inhaled corticosteroids when used together such as Advair (a combination of fluticasone with salmeterol).

Decreasing airway inflammation with the use of anti-inflammatory medication can lessen the frequency and severity of asthma attacks and airway damage. Inhaled corticosteroids, which have few side effects, can provide the most effective long term control for moderate to severe asthma.

Cromolyn sodium and Nedicromil, which are not as strong as corticosteroids, are widely prescribed to prevent or treat mild asthma because of their ability to stop the release of mast cells into the bronchial tissue. Leukotriene blockers, such as Singulair (montelukast) and Accolate (zafirlukast), can relieve asthma and allergic rhinitis, but not as effectively as inhaled corticosteroids.  Still, leukotriene blockers are a good choice for patients with mild allergic rhinitis and asthma.

During moderate to severe episode of asthma, you may require a short course of oral corticosteroid to rapidly gain control over worsening symptoms.  In such cases, oral corticosteroids can help quick-relief medications work more effectively, resulting in a more rapid reversal or reduction of airway inflammation.

With bronchodilators and anti-inflammatory drugs, asthma episodes can be well controlled and even prevented.  Furthermore, a ground-breaking anti-IgE therapy called Xolair can offer new hope for severe allergic asthmatics.

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