During an asthma attack • The airways become inflamed and swollen. • Mucus builds up thickly in the airways. • The muscles around the airways contract, narrowing the airways. The changes in the airways prevent normal air movement; this affects breathing and creates coughing. It usually needs to be treated by administering a combination of more than one drug: some drugs open the airways, while others inhibit and even stop the overproduction of mucus (anti-inflammatory).
There are three classes of drugs:
1. For quick relief of tightness
When small muscles constrict the narrow airways in your lungs, it is called bronchospasm. Quick-acting beta-agonists, or bronchodilators, are drugs that are taken as prophylaxis for bronchospasm or before exercise. They are available in inhalers: albuterol (Proventil, Ventolin), Buret, Alupent, Maxair and Breathair. They start working within less than five minutes, peak effect occurs between 30-60 minutes, and it lasts for a period of 4-6 hours. The usual dose is 1 or 2 puffs every 4-6 hours for coughing fits. Allow at least 5 minutes between the second puff and the first puff to allow the first puff to work. More than 8 puffs in 24 hours are dangerous to your heart. Using quick-relief medication too often (for example, more than 8 puffs in 24 hours or more than one canister in a month) suggests that your asthma may not be controlled very well, and you should visit your healthcare provider for a review. You may need to start or increase maintenance control medication(s).
2. For longer periods of prolongation of constriction
Salmeterol (Serevent) is an extended-action beta 2 agonist. Not an immediate relief medication. Serevent is for nocturnal symptoms and exercise-induced asthma. Therapy is given by inhaling through a device known as an inhaler: 2 puffs through a spacer every 12 hours. The powdered form of the inhaled medication (serevent Discus) is given 1 puff every 12 hours. It may also be given with an inhaled corticosteroid (Advair Discus) or another anti-inflammatory medication. § A class of drugs known as methylxanthines (of which theophylline, Slo-bid, Theo-dur and others) served as frontline asthma therapy for many years, although today stands as a drug of second- and third-line options. These side effects and adverse interactions with many other drugs add to the dangers of these treatments.
3. For chronic control of inflammation for all types of asthma except mild intermittent, treatments that reduce and prevent airway inflammation are prescribed. Anti-inflammatory drugs are: corticosteroids mast cell stabilizers leukotriene modifiers. These drugs are taken chronically and should not be used for acute symptom control. You will need to take this medication every day.
§ Corticosteroids are very powerful drugs that reduce or eliminate the airway inflammation that leads to asthma symptoms. Inhaled steroids may be used less often because of the many significant side effects that oral (pill) steroids will cause. Patients are usually placed on inhaled corticosteroids with the use of a spacer and used twice daily; Mouth rinsed after each inhalation to reduce the risk of oral candidiasis (thrush). Tablet steroids are added if asthma seems to worsen or is present almost constantly. You will need a medication, possibly an anti-inflammatory, if asthma symptoms occur more than once or twice per week and need to be administered daily.
Mast cell stabilizers are good choices for the prophylaxis of mild to moderate asthma. Such drugs as cromolyn sodium (Intal), nedocromil (Tilde), are extremely safe and, in addition to their anti-allergic action, are very useful for controlling both allergic and exercise-induced asthma. They can be started as a preventive before your allergy season begins, or can be used before you are exposed to a known stimulus (such as before visiting a friend or family member who keeps a dog). Both drugs can be taken 15-30 minutes before performing any activity to prevent exercise-induced bronchospasm for a period of 1-2 hours. They are not intended and are of no value in an acute attack.
Leukotriene modifiers. Leukotrienes are very potent pro-inflammatory mediators in the lungs of an asthma sufferer that cause increased mucous production, bronchospasm and allergic response. There is a class of medications referred to as leukotriene inhibitors; there are medications such as Accolate, Singulair, and Zyflo; they block the action of leukotriene and improve asthma-related symptoms—such as less mucus or relaxed bronchi.
Are medications for asthma safe?
Medications for asthma are safe if taken as prescribed. Some patients fear becoming addicted to their medications. This is not true. Others think that if one needs to take medication constantly, it will no longer work. This happens in some people and can be managed. Report it to your health care provider when it occurs.
Tips for proper medication use
You need to start taking your bronchodilator medication once you figure out that your asthma is worsening. You should be aware of a few warning signs: when your peak flow numbers decrease or when you begin experiencing certain symptoms such as coughing, chest tightness, wheezing, or shortness of breath. Thus, you will be in a better position to control your attack of asthma. The sooner you can start taking your medication, the better you are going to control an asthma attack.
You also won't have to take as much medication in that case.
Remember: bronchodilators give quick relief for symptoms, but do not reduce or stop the inflammation that causes the symptoms. When you have become dependent on using a bronchodilator, it is a sign that the inflammation in your airways is getting worse. If you take a beta 2-agonist to relieve symptoms every day or if you take one more than three or four times a day, your asthma may be getting much worse. You probably need another kind of medication. Discuss this with your health care provider right away. Take your anti-inflammatory medications exactly the way your health care provider recommends, even if you are not feeling symptoms. This will reduce the inflammation in the airways, and therefore asthma attacks will not start. This medication must be taken every day to properly serve its purpose.
Safety Reminders:
Remember: Your asthma action plan is not working if you are still experiencing symptoms with activity, at rest, at night, or early in the morning.
Discuss your medication plan with your healthcare provider. He/she may need to change the dose or type of your medication. If you experience side effects, call your healthcare provider right away and do not stop the medication completely until you have discussed that decision with him/her.
