Seasonal Advice, Treatment and Prevention
Allergy Advisor - Seasonal Update  WINTER/ SPRING/ SUMMER/ FALL
Limiting Exposure to Allergens in the Home 
Prevention of Allergy and Asthma in Children
Treatment of Allergy and Asthma
Skin Testing and Allergy Injection Treatment
Inhalers for Asthma
Spacers for Asthma Inhalers
Inhalers for Rhinitis
Tricks for - children to swallow pills
                  - eyedrops
Mexican Medications

Control of asthma with inhaled medications

Although mild asthma may respond well to treatment with oral medications such as theophylline, zafirlukast (Accolate) or montelukast (Singulair), nearly all asthmatics require inhaled medications.  Inhaled medications may be delivered as

• an aerosol from a canister under pressure (metered dose inhaler)
• an inhaler device that delivers a powder that is actively inhaled into the lungs
• a nebulizer that delivers medication as a mist from a liquid preparation, usually by attachment of the nebulizer to an oil-free compressor - this is mainly for bronchodilator drugs, Intal or Atrovent, and is becoming used extensively for corticosteroid treatment of young children with budesonide (Pulmicort Respules).

Metered dose inhalers require proper inhalation technique for the full dose to be inhaled, even when a spacer is used.  Inhaler technique must be checked in your allergist's office at least once a year to maintain proficiency.

It is vitally important to understand the difference between two types of asthma drugs - bronchodilator drugs and anti-inflammatory drugs. 

Bronchodilator drugs open up the airways in the lung within minutes of inhalation of the drug, by relaxing the smooth muscle that surrounds the airways.   

Short-acting bronchodilators:  The effect of the usual type of bronchodilator lasts for  3-4 hours and these short-acting drugs (e.g. albuterol, metaproterenol, terbutaline) are used as needed or before exercise to prevent wheezing.   The short-acting drugs provide rapid relief during a mild or moderately severe asthma attack, but they do nothing for the cause of the attack - inflammation.  These "rapid relievers"  may be needed repeatedly until the attack subsides spontaneously or is controlled by an anti-inflammatory drug. 

Long -acting bronchodilators:  Although bronchodilators do not prevent asthma attacks, certain long-acting bronchodilators (e.g.  Serevent and Foradil) can improve lung function over 10-12 hour periods.  This drug must NEVER be used for the emergency rescue from an acute attack of asthma.  

Anti-inflammatory drugs work to reduce the irritability of the lung airways by controlling the activities of inflammatory cells in the airway walls.  These drugs are essential to the proper control of moderate asthma.  They are used to reduce asthma severity over a period of time, and must be used on a regular basis, usually 2-3 times per day.  A very common cause of asthma attacks is failure to remember to take the anti-inflammatory drug regularly, as prescribed.  These drugs do not provide immediate relief from an asthma attack because they do not act as bronchodilators.   However, it is often advised to temporarily increase the dose of the anti-inflammatory drug during an acute attack.  Two types of anti-inflammatory drugs exist - mast cell stabilizers, and corticosteroids.  

Mast cell stabilizers   i.e., cromolyn sodium (Intal) is effective in controlling mild asthma.  Cromolyn sodium must be used 3-4 times daily for at least 8 weeks  before improvement occurs.  It also has a weak action in preventing wheezing from exercise when used immediately before exercise, but a short-acting bronchodilator is much more effective in preventing exercise-induced asthma.   Nedocromil (Tilade) is a more effective mast cell stabilizer drug than cromolyn but has been discontinued from the US market.

Inhaled corticosteroids are the most effective means of controlling asthma and are the usual type of drug given in the routine anti-inflammatory management of moderate asthma.  In the usual doses given they NEVER cause the long list of side effects that accompany use of corticosteroid tablets or injections.  The only side effect to be concerned about with approved doses is Candida (thrush) in the throat, a problem that is usually prevented by rinsing the mouth with water after each dose.  In usually recommended doses they are safe!   Combined preparations containing a corticosteroid and a long acting bronchodilator (Advair) are proving to be useful in limiting the amount of corticosteroid needed for control of asthma.

Further Reading
AAAAI: Inhaled medications

Disclaimer:   This site is for educational purposes only.  Any information that you have found in this web site is not intended to replace medical care or advice given to you by your own physicians. You should consider consulting your local medical library and other web sites for additional information. 

Comments and suggestions welcome!   Email: schumach@u.arizona.edu
Content Owner:  Michael J. Schumacher, MB, FRACP, The University of Arizona
Updated 8/2008