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Long-term control medications for the prevention or treatment of asthma attack

Drugs used to control long-term persistent inflammation and prevent lung injury. For long-term control of the disease, patients with moderate to severe asthma require medications to control inflammation. Typically, these are patients who are taking the short-acting beta2 agonists more than twice a week. The standard agents for maintenance treatments are inhaled corticosteroids (commonly called steroids). Others include leukotriene-antagonists, and cromolyn. Combinations of steroids

and other medications (such as long-acting beta2 agonists or leukotriene-antagonists) are proving to be effective for both treating and preventing asthma attacks in patients with moderate to severe asthma.

Long-acting beta-agonists: Long-acting beta2 agonists relax bronchial smooth muscle, similar to the short-acting beta2 agonists. They work more slowly, however, and for this reason they aren't considered good rescue medications. This class of drugs is chemically related to adrenaline, a hormone produced by the adrenal glands. The effects of one dose of a long-acting beta2 agonist last for about 12 hours, so they are particularly effective during the night. These agents also may be used for prevention of exercise-induced asthma in people and to protect against aspirin-induced asthma. They relax the muscles of the breathing passages, dilating the passages and decreasing the resistance to exhaled airflow, making it easier to breathe. They may also help to reduce inflammation, but they have no effect on the underlying cause of the asthma attack. Side effects include rapid heartbeat and shakiness. Salmeterol (Serevent) and formoterol (Foradil) are long-acting beta-agonists. Long-acting beta2-agonists, including salmeterol (Serevent) and formoterol (Foradil), are used for preventing an asthma attack (not for treating symptoms). Long-acting beta-agonists usually are used with inhaled corticosteroids to control symptoms and are particularly useful for treating nocturnal symptoms and exercise-induced asthma. The side effects are the same as those of short-acting beta2 agonists: tachycardia (rapid heartbeat), skeletal muscle tremor, hypokalemia, increased lactic acid, headache, and hyperglycemia

Inhaled corticosteroids are the main class of medications in this group. The inhaled steroids act locally by concentrating their effects directly within the breathing passages, with very few side effects outside of the lungs. Beclomethasone (Vancenase, Beclovent) and triamcinolone (Nasacort, Atolone) are examples of inhaled corticosteroids. Corticosteroid medications for long-term control can be taken orally or inhaled. The oral form typically is used only when long-term control cannot be obtained with inhaled corticosteroids. Inhaled corticosteroids are used to treat all categories of asthma except the mild intermittent type. They work primarily by reducing inflammation in the asthmatic airway. They also increase receptors for the beta2 agonists and decrease microvascular leaking, which contributes to increased fluid in the bronchial tubes. These factors are felt to be of minor importance compared to the anti-inflammatory benefit. Oral corticosteroids usually are used only in patients who have severe persistent asthma. They also can be used to treat acute exacerbations, although this use is not common. As with inhaled corticosteroids, their main mechanism of action is the reduction of inflammation.

Leukotriene modifiers are a class of drugs that block part of the inflammatory cascade that typically occurs in asthma. Leukotriene inhibitors are another group of controller medications. Leukotrienes are powerful chemical substances that promote the inflammatory response seen during an acute asthma attack. By blocking these chemicals, leukotriene inhibitors reduce inflammation. The leukotriene inhibitors are considered a second line of defense against asthma and usually are used for asthma that is not severe enough to require oral corticosteroids. Zileuton (Zyflo), zafirlukast (Accolate), and montelukast (Singulair) are examples of leukotriene inhibitors. They are taken orally and may be used solely as anti-inflammatory medication instead of corticosteroids. They often are used with inhaled corticosteroids and work well to prevent exercise-induced asthma. Side effects are rare but include Churg Strauss syndrome and kidney problems. One drug in this class can cause elevated liver enzymes characteristic of hepatitis, when used in the usual dosage; another can do so at increased dosage levels.

Methylxanthines are another group of controller medications useful in the treatment of asthma. This group of medications is chemically related to caffeine. Methylxanthines work as long-acting bronchodilators. At one time, methylxanthines were commonly used to treat asthma. Today, because of significant caffeinelike side effects, they are being used less frequently in the routine management of asthma. Theophylline and aminophylline are examples of methylxanthine medications. The chief methylxanthine drug is theophylline. It may exert some anti-inflammatory effect, and is especially helpful in controlling nighttime symptoms of asthma. When, for some reason, a patient cannot use an inhaler to maintain long-term control, sustained-release theophylline is a good alternative. The blood levels of the drug must be measured periodically, as too high a dose can cause an abnormal heart rhythm or convulsions.

Cromolyn sodium is another medication that can prevent the release of chemicals that cause asthma-related inflammation. These anti-inflammatory agents are delivered by inhalation. This drug is especially useful for people who develop asthma attacks in response to certain types of allergic exposures. When taken regularly prior to an exposure, cromolyn sodium can prevent the development of an asthma attack. However, this medicine is of no use once an asthma attack has begun. They are safe and have minimal side effects, apart from an unpleasant taste. They may be used as long-term anti-inflammatory medications and work best in children. They are not as predictably effective as corticosteroids, however, and should be discontinued if found to be ineffective. They can be used prior to exercise to prevent exercise-induced asthma. Cromolyn sodium (Intal) serves as both an anti-inflammatory drug and has antihistamine properties that block asthma triggers such as allergens, cold, or exercise. Nedocromil (Tilade) is similar to cromolyn. A cromolyn nasal spray called Nasalcrom has been approved for over-the-counter purchase, but only to relieve nasal congestion caused by allergies. Asthmatic patients should not use it for self-medication without the advice of a physician.

More information on asthma

What is asthma? - Asthma is a chronic inflammatory respiratory disease characterized by periodic attacks of wheezing, shortness of breath, and a tight feeling in the chest.
What types of asthma are there? - Types of asthma include child-onset asthma, adult-onset asthma, exercise-induced asthma, cough-variant asthma, occupational asthma, nocturnal asthma.
What's bronchial asthma? - Bronchial asthma is a disease of the lungs in which an obstructive ventilation disturbance of the respiratory passages evokes a feeling of shortness of breath.
What is exercise-induced asthma? - Exercise-induced asthma is a form of asthma that some people have during or after physical activity. Exercise-induced asthma is common.
What is adult-onset asthma? - Adult onset asthma generally is the onset of asthma for the first time in someone of middle age or older. Adult-onset asthma develops after age 20.
What is status asthmaticus? - Status asthmaticus is a severe asthma episode that does not respond to standard treatment. Status asthmaticus is caused by severe bronchospasm.
What causes asthma? - Asthma is caused by inhaling an allergen that sets off the chain of biochemical and tissue changes leading to airway inflammation, bronchoconstriction, and wheezing.
What're the asthma triggers? - Many risk factors have been linked to triggering asthma attacks. There are two basic types of asthma triggers, allergic triggers, non-allergic triggers.
Asthma and allergy - Asthma attacks (worsening of asthma symptoms) can be triggered by allergies. Allergy is the leading cause of asthma.
What is an asthma attack? - An asthma attack occurs when the small and medium-sized airways become inflamed and constricted after being exposed to a trigger.
Asthma in children - Asthma is the most common chronic condition of childhood. Asthma symptoms can interfere with many school activities for children.
Asthma and pregnancy - During pregnancy, asthma or asthma episodes will become worse for an estimated one-third of pregnant women, particularly women who have severe asthma.
Asthma in adults and older people - Identifying asthma in the elderly can be difficult because asthma symptoms can be confused with symptoms of heart or lung diseases.
What're the complications of asthma? - Uncontrolled asthma in pregnant women puts them at higher risk for complications that can include early labor, hypertension, gestational diabetes.
What are the symptoms of asthma? - The symptoms of asthma include labored breathing, constriction of the chest, coughing and gasping usually brought on by allergies.
What're the warning signs of asthma? - Most people with asthma have warning signs before symptoms appear. There are many warning signs of an asthma episode.
How is asthma diagnosed? - The diagnosis of asthma is made on the basis of typical symptoms and signs. Positive allergy tests support a diagnosis of asthma.
What're the treatments for asthma? - Treatment of asthma is aimed at avoiding known allergens and respiratory irritants and controlling symptoms and airway inflammation through medication.
What quick relief (rescue) medications cure asthma? - Short-acting beta-agonists are the most commonly used asthma rescue medications. Anticholinergics are another class of asthma drugs.
Long-term asthma control medications - Combinations of steroids and other medications are effective for both treating and preventing asthma attacks in patients with moderate to severe asthma.
What're asthma inhalers? - Most asthma drugs are inhaled using special devices or nebulizers. Two common types include dry powder asthma inhalers and metered-dose asthma inhalers.
What're asthma nebulizers? - Asthma nebulizers can be used with all classes of inhaled medications but are most commonly used with short-acting beta2 agonists and ipratropium bromide.
How to control acute asthma attacks? - Acute asthma is an acute exacerbation of wheezing, unresponsive to usually effective therapy and necessitating care in an emergency room or hospital ward.
How to manage chronic asthma symptoms? - The aims of management are to recognize asthma, to abolish symptoms, to restore normal or best possible long term airway function.
What asthma relievers are available? - Asthma reliever is a drug that provides relief from asthma symptoms and is the most commonly used asthma medication.
What asthma preventers are available? - Asthma preventers are to be used twice a day regardless of whether your child has symptoms of asthma.
What's the treatment for childhood asthma? - The goals of asthma therapy are to prevent child from having chronic and troublesome symptoms, to maintain child's lung function.
What's the treatment for asthma in the elderly? - Diagnosis and treatment of asthma can be more complicated in people age 65 and older than in those who are younger.
What can be done to prevent asthma? - Avoiding known allergens and respiratory irritants can reduce asthma symptoms. People with asthma should minimize risk for respiratory tract infections.
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