Asthma is an inflammatory disease affecting the respiratory airways. The modern researches have made available lots of effective medicines for the asthma treatment. The initial treatment of asthma depends on the severity of the symptoms and the frequency of attack. Asthma treatment often requires a life long treatment thus requires a long term association with the doctor. If the disease gets well controlled then the doctor may reduce the medicines dose and if the disease does not get controlled well then he may be able increase the dose. Thus a regular medical check up and consultation is necessary.
Before starting the medication, the doctor will make a detailed study on the patient’s medical history. Medication is usually started in a step wise manner which helps in changing the type of medicine and its dose depending up on its effectiveness. The asthma treatment medicines are broadly classified into two types The Long Term Control Medicines and The Quick relief Medication.
Long term medication helps in preventing asthma symptoms. They act by reducing the chance of inflammation in the breathing tubes. These medicines should be taken daily to prevent the attack.
he most important long term medicines are:
The most commonly used and most widely preferred long term asthma medication is the inhaled corticosteroids. It is preferred because of its effective anti-inflammatory action. They act by relieving the swelling and inflammation in the breathing tubes and thus stops the reactions which otherwise may lead to severe asthma attack. The advantage of inhaled corticosteroids is that it is not habit forming and thus can be taken daily. Inhaled corticosteroids have some side effects also but their advantage outweighs it.
Long acting beta agonist drugs are mostly used when the inhaled corticosteroids does not respond well, which is known as adjunctive therapy. Their action is closely related to the hormone Adrenaline secreted
by Adrenal gland. They help in the relaxation of the constricted bronchial smooth muscle and there by dilates the airway. Long acting beta agonist can keep the air passages opened for 12 hours or longer. They should not be used alone or as a single medication. Examples for long acting beta agonist are Salmeterol (Serevent) and Formoterol (Foradil).
Leukotriene Modifiers are also known as Leukotriene Inhibitors. Leukotrienes are chemical substances which promotes inflammation. Leukotriene inhibitors act by blocking the leukotrienes there by reducing the inflammation. This is mostly used in mild asthma. It is very effective for controlling exercise induced asthma. Example for leukotriene modifiers are Accolate, Singulair, Zyflo.
Methylxanthines used as long acting bronchodilators. Chemically methylxanthines are closely related to caffeine. Few years back it was the drug of choice used for asthma treatment. But now it is less frequently used because of their caffeine like side effects.
Cromolyn sodium helps in preventing the inflammation of airways by reducing the release of chemicals that are produced during inflammation. It is used to control asthma with mild severity and should be taken prior to attack.
Omalizumab works by acting on the patient’s immune system. In allergic asthma there will be an elevated level of IgE antibody. This IgE antibody binds to the cell to release chemicals which may worsen the symptoms even more. Omalizumab when injected to the patient’s body helps in preventing the binding of IgE antibody to the cell surface receptors and thus helps in controlling the disease.
Quick relief medicines are used to relieve asthma symptoms after the onset of asthma attack. These medicines act very quickly thus gives immediate result. Quick relief medicines should be taken when the symptoms starts appearing. It should always be carried along with the asthma patient. Quick release medicines should not be used in place of long term medicines. Quick relief medications include:
Short acting beta agonist work rapidly and thus relieves the inflammation of airways quickly. Its effect usually lasts for four hours. Albuterol (Proventil, Ventolin) is the most commonly used medications of this category.
Their action is not as rapid as that of beta agonist but their effect lasts longer than the beta agonist. Their mode of action is similar to that of short acting beta agonist. The most commonly used anticholinergic drug is Ipratropium Bromide (Atrovent).
Newer types of asthma inhalers have been developed by some pharmaceutical companies which use a combination of more than one different asthma medications. The most widely used combination asthma medications are produced by combining a steroid with a long acting beta antagonist.
Metered dose inhaler is the most commonly used device for delivering asthma drug to the patient’s lung. It consists of a pressurized canister, medicine, stabilizer and a mouth piece with discharge nozzle and dust cap. The medicine is released when the pressurized canister is pushed. The patient is asked to take a full deep breath for the delivery of medicine to the lungs. Thus there should be a good coordination between the patient’s breath and the pushing of canister. Medicines delivered using a metered dose inhaler is mostly bronchodilator, corticosteroids or mast cell inhibitors.
Spacers are devices which are attached to the metered dose inhalers. The spacer act as an intermediate reservoir for storing the drug released when the canister is pushed. Thus unlike the ordinary metered dose inhalers, the inhalers with attached spacers does not need coordination between the patients breath and the pushing of canister. The drug gets delivered when the patient inhales.
In dry powder inhalers the drug is delivered in powder form. The drug gets delivered when the patient inhales forcefully. It is difficult to use than the other type of inhalers.
Nebulizers are devices which help in the delivery of larger dose of drugs. it converts the drug into mist form. This mist form of drug is inhaled by the patient with the help of a face mask attached to it. Nebulizers are used especially by children and patients who finds difficult to use metered dose inhalers.
Even though the medication helps in controlling the disease, it has got some side effects too. For example:
Cortisone drugs – It may lead to stunted growth, acne production, excess body hair, increased apatite, weight gain, leg cramps, fatigue, and high blood pressure. There are cases which lead to death of the patient when the drug was suddenly discontinued.
Corticosteroids – It may cause candidiasis in mouth, oral thrush, dermal thinning, increases apatite, weight gain, osteoporosis, muscle weakness, cataract in eye and increases blood cholesterol level. When the mode of drug intake is suddenly changed from oral to inhaler form it leads to life threatening effect.
Bronchodilators - Bronchodilators like Beta agonist, theophylline and anticholinegics was found to cause side effects like insomnia, nervousness, irregular heart rate, restlessness, head ache, intestinal discomfort, nausea, vomiting, diarrhea and depression.
Antihistamines – Antihistamines may cause restlessness, nervousness, constipation, nightmares while sleeping, constipation, drowsiness and dry mouth.
Anti-inflammatory drugs – It may increase blood pressure and blood sugar. It also triggers weight gain, osteoporosis, ulcers and coughing.
Leukotriene modifiers – It may lead to hyper bilirubinemia and reversible hepatitis.
Decongestants – The major side effects are sleeplessness, hypertension. The prolonged use of decongestants may some times cause more severe nasal congestion.
There are remedies available to overcome these side effects. The doctors will advice you alternative methods or additional drug supplements along with the asthma treatment medicines to over come this problem. For example: The oral thrush can be avoided either by washing the mouth after taking the medicine or by using a spacer for delivering medicine to the lungs. Spacers are often attached to the inhaler. In the case of Osteoporosis or the condition the bones become weak and brittle, calcium and vitamin D tablets are taken along with asthma medicine which can make the bone stronger.
Thus even though asthma is a life threatening disease, with proper control and medication it can be prevented to a greater extend.