October 4, 2015
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Asthma Medications (cont.)

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What are asthma medication guidelines?

The asthma medication guidelines classify asthma into different categories based on asthma symptoms during the day, asthma symptoms during the nighttime, use of rescue medications, impact of asthma on daily life, use of oral steroids, and breathing tests done in medical offices (spirometry). The asthma classifications include mild intermittent asthma, mild persistent asthma, moderate persistent asthma, and severe persistent asthma.

Patients classified as having mild intermittent asthma generally only require short-acting rescue medications. Mild persistent asthma is treated with inhaled corticosteroids as recommended first-line therapy, with a leukotriene modifier, theophylline, or cromolyn as alternative therapies to the inhaled corticosteroids.

Patients with moderate persistent asthma are usually treated with an inhaled corticosteroid/long-acting beta-agonist, a higher dose of inhaled corticosteroid, or an inhaled steroid plus a leukotriene modifier or possibly theophylline.

Patients with severe persistent asthma are treated with the higher doses of inhaled corticosteroids plus the long-acting beta-agonists, leukotriene modifiers, possibly theophylline, possibly tiotropium, and possibly anti-IgE therapy. Patients with difficult-to-control asthma often end up on multiple types of medications, and some may require oral steroids to maintain control.

What are over-the-counter (OTC) asthma medications?

All asthma medications require a prescription since patients with asthma should be followed regularly by a health-care professional. There are currently no OTC asthma medications that are recommended for use in asthma treatment guidelines.

What are the potential risks and side effects of drugs used to treat asthma?

Common side effects of short-acting asthma medications (albuterol, levalbuterol) are a feeling of jitteriness, tremors, and/or heart palpitations. Hyperactivity can also occur, particularly in children.

The two most common side effects of inhaled corticosteroids are hoarseness or thrush, which is an overgrowth of yeast in the mouth. It is therefore recommended that patients using inhaled corticosteroids rinse their mouth after use. These side effects can also be minimized with proper inhaler technique. There is often concern about potential long-term side effects for inhaled corticosteroids. Numerous studies have repeatedly shown that even long-term use of inhaled corticosteroids has very few, if any, sustained clinically significant side effects, including changes in bone health, decreased growth, or weight gain. However, the goal always remains to treat all individuals with the least amount of medication that is effective. Patients with asthma should be routinely reassessed for any appropriate changes to their medical regimen. Although uncommon, the combination asthma medications may also cause palpitations or a sense of jitteriness due to the long-acting beta-agonists.

Montelukast, the leukotriene modifier medication, may cause mood changes or sleep disturbance, particularly in children. Zileuton may cause liver inflammation, so health-care professionals should periodically monitor liver blood tests.

Omalizumab is generally a well-tolerated medication. Patients may experience some local irritation at the injection site. There is also a warning about the possibility of severe allergic reaction (anaphylaxis) occurring with use of omalizumab. It is recommended that patients on this medication have injectable epinephrine to use in the rare case this occurs. Omalizumab should also always be administered in a health-care facility.

Tiotropium may cause dry mouth or irritation of the throat. Theophylline may cause a sense of restlessness. It also can interact with other non-asthma medications so its use requires regular monitoring of blood levels.

Medically Reviewed by a Doctor on 7/27/2015

Source: MedicineNet.com

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