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Long-Term Asthma Medications

Corticosteroids
Corticosteroid medications for long-term asthma 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.

Cromolyn sodium and nedocromil
These anti-inflammatory agents are delivered by inhalation. 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.

Leukotriene modifiers
Leukotriene modifiers (leukotriene receptor antagonists; e.g., Singulair®, Accolate®) are a class of drugs that block part of the inflammatory cascade that typically occurs in asthma. These drugs, which are taken orally, can be prescribed for adults and children 2 years of age and older.

They often are used with inhaled corticosteroids and should not be used to treat an acute asthma attack. Singulair also is approved to prevent exercise-induced asthma in patients over the age of 15. Side effects include the following:

• Dizziness
• Fatigue
• Fever
• Headache
• Stomach upset

Rare side effects include Churg Strauss syndrome, kidney problems, and elevated liver enzymes.

Long-acting beta2 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. The body can develop a slight tolerance to these drugs over time, which may render them slightly less effective. They 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.

Theophylline
Theophylline acts as both a bronchodilator and an anti-inflammatory. It usually is used in addition to beta2 agonists and other anti-inflammatory drugs.

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