Treating the Inflammation of Asthma
Anti-inflammatory medications are some of the most important treatment options for people with asthma. They prevent asthma attacks and work by reducing swelling and mucus production in the airways. As a result, airways are less sensitive and less likely to react to asthma triggers.
Direct anti-inflammatory medications include corticosteroids (inhaled and oral). Other controller medications that will be discussed here are mast cell stabilizers and leukotriene modifier medications. Although not true “anti-inflammatory” medications, they work with corticosteroids to augment the anti-inflammatory action.
Inhaled corticosteroids are the most effective medications to reduce airway inflammation and mucus production. The use of these medicines leads to better asthma control with fewer symptoms and flare-ups and less of a need for hospitalization. Inhaled steroids prevent symptoms; they do not relieve symptoms. Dosages vary and they need to be taken every day for best results. Some results are seen in 1 to 3 weeks, with the best results seen after 3 months of daily use.
Inhaled corticosteroids include:
- Beclomethasone (Qvar®)
- Budesonide (Pulmicort®; Symbicort® – combination budesonide and formoterol- a long acting beta agonist)
- Flunisolide (Aerobid®)
- Fluticasone (Flovent® HFA; Advair® – combination fluticasone and salmeterol -a long acting beta agonist)
- Mometasone (Asmanex®)
- Triamcinolone (Azmacort®)
Inhaled corticosteroids come in three forms: metered dose inhaler (MDI), dry powder inhaler (DPI), and nebulizer solutions. The MDI form works best when used with a valved holding chamber or "spacer," which ensures that an adequate amount of the medication reaches the lungs. Inhaled corticosteroids have very few side effects, especially at lower doses. It is rare, but if you are taking higher doses, thrush (yeast infection in the mouth) and hoarseness may occur. Rinsing the mouth, gargling after each use and using a spacer device with metered dose inhalers will help prevent these side effects. Thrush is easily treated with an anti-fungal mouthwash.
Inhaled steroids are safe to give to both adults and children. Side effects are minimal. Your doctor will prescribe the lowest effective dose to control the asthma.
Many parents are concerned about giving their children "steroids." These steroids are NOT the same as anabolic steroids that some athletes take to build muscle. These steroids are anti-inflammatory medications, the cornerstone of asthma therapy. There are many benefits to using inhaled steroids for asthma, including:
- reduced frequency of asthma attacks
- decreased use of beta-agonist bronchodilators
- improved lung function
- reduced emergency room visits and hospitalizations
(To learn more about using inhaled steroids in children, read the document, "Treating Asthma in Children.")
Oral (and intravenous) corticosteroids (systemic corticosteroids)
Systemic corticosteroids are used to treat severe asthma episodes. These medications are used with other medications to either control sudden and severe asthma attacks or to treat long-term, hard-to-control asthma.
Systemic steroids take 3 hours to begin working and work best after 6 to 12 hours. Sometimes corticosteroids are taken in high doses for a few days (called a steroid burst). They may also be given in a low dose daily or every other day for long-term control.
Systemic steroids include:
- Methylprednisolone (Medrol®, Methylpred®, Solu-Medrol®)
- Prednisone (Deltasone®)
- Prednisolone (Prelone®, Pediapred®, Orapred®)
Side effects of systemic steroids tend to occur after prolonged use and include: acne, weight gain, mood or behavior changes, upset stomach, bone loss, eye changes, and slowing of growth. These side effects rarely occur with short-term use, as when used for an acute asthma episode.
Mast cell stabilizers
Mast cell stabilizers are inhaled asthma medications that work by preventing the release of histamine and other inflammatory substances from immune cells called mast cells. They effectively prevent asthma symptoms, especially in children with allergies and asthma and in people with exercise-induced asthma. These medications need to be taken two to four times a day, and take 3 to 4 weeks to start working.
Mast cell stabilizers include:
- Cromolyn sodium – (Intal® – also is effective for exercise-induced asthma when taken 30 minutes before activity)
- Nedocromil sodium (Tilade®)
These medications are very safe and have few side effects. Tilade® can cause dry throat and can have a bad taste.
Leukotrienes are chemicals that occur naturally in our bodies and cause tightening of airway muscles and production of mucus. Leukotriene modifier medications work by blocking the actions of leukotrienes in the body. Studies are showing that these medications are helpful in improving airflow and reducing asthma symptoms.
They are taken as pills one to four times a day and may decrease the need for other asthma medications.
Leukotriene modifiers include:
- Montelukast (Singulair®)
- Zafirlukast (Accolate®)
- Zileuton (Zyflo®)
The most common side effects of leukotriene modifiers are headache and nausea. Leukotriene modifiers may interfere with the proper action of some other medications (for example, theophylline and the blood thinner warfarin). Make sure you inform your doctor of all the medications you are taking.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/16/2007...#11871