People whose asthma is mild generally don't have to take anti-inflammatory drugs, but continuous use of anti-inflammatories is a crucial component of the asthma management plan for people who have frequent asthma symptoms.
The initial choice of asthma treatment used to counteract inflammation in adults is an inhaled corticosteroid. Medications in this class include:
- beclomethasone (QVAR)
- budesonide (Pulmicort)
- ciclesonide (Alvesco)
- flunisolide (AeroBid)
- fluticasone (Flovent)
- mometasone (Asmanex)
Recently updated guidelines from the National Asthma Education and Prevention Program (NAEPP) underscore the importance of inhaled steroids as the best long-term treatment for asthma symptoms.
Combination therapies—the corticosteroid fluticasone and the long-acting beta2 agonist salmeterol (Advair) as well as the corticosteroid budesonide and the long-acting beta2 agonist formoterol (Symbicort)—also are available. However, neither is a first-line treatment. Combination drugs containing a long-acting beta2 agonist (salmeterol or formoterol) should only be used when inhaled steroids containing a short-acting beta2 agonist are ineffective.
The most frequent side effects of inhaled corticosteroids are irritation of the throat and yeast infection in the mouth and throat. These side effects can be reduced by rinsing your mouth, gargling gently, and cleaning the inhaler after each use.
When used for long periods of time, corticosteroids can cause osteoporosis (bone loss), high blood pressure, roundness of the face, weight gain, diabetes, cataracts, and thinning of the skin. These side effects are less common with inhaled corticosteroids, as little of the medication is absorbed into the bloodstream.
Oral corticosteroids, such as methylprednisolone (Medrol) and prednisone (Sterapred), take six hours to start working and must be used at the lowest effective dose and for the shortest possible time to avoid side effects. Using oral corticosteroids for more than a few weeks may suppress the adrenal glands, which produce hormones crucial for maintaining the body's normal functions. If used for prolonged periods, the medications must be discontinued slowly, to allow adrenal function to recover.
The medications montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) are known as leukotriene modifiers. They counteract the actions of leukotrienes, which are cell products that narrow the airways and stimulate mucus production. This class of drugs helps prevent exercise-induced asthma and can enhance the action of inhaled corticosteroids. However, their effectiveness varies considerably from person to person.
Inhaled medications are usually taken through a device called a metered dose inhaler (MDI). An MDI delivers a highly concentrated amount of medication directly to the airways. Inhaled medications are less likely than oral medications to produce side effects that affect the whole body. Proper technique is important, and many people use their MDI incorrectly.
Because of government rules banning the class of inhaler propellant known as chlorofluorocarbons (CFCs), all inhalers are now CFC free and instead contain an ozone-friendly propellant known as hydrofluoroalkane (HFA). The HFA inhalers are similar in outward appearance to CFC inhalers, and the medication inside has not changed.
As with older MDIs, proper technique is important with the new HFA inhalers as well. People who find it difficult to use an MDI can add a spacer or holding chamber—an attachment that eliminates the need to release the medication and inhale simultaneously. Another option, a device called a nebulizer, vaporizes liquid medication into a fine mist that is easy to inhale.
Monoclonal Antibody to Treat Asthma
If inhaled corticosteroids do not adequately control severe allergy-related asthma, people age 12 and older may benefit from omalizumab (Xolair). Injected once or twice a month, it decreases sensitivity to inhaled allergens such as dust mites or animal dander by blocking the antibody that triggers the immune response. But treatments are costly—ranging from approximately $9,500 to $25,000 per year, depending on the dose.
In 2007, the FDA issued a black box warning for Xolair because of the risk of a potentially deadly allergic reaction known as anaphylaxis. This reaction was seen in two of every 1,000 patients taking Xolair.