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.
Anti-inflammatory medications include corticosteroids (inhaled and oral), mast cell stabilizers, and the leukotriene modifier medications.
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, flare-ups and 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 1-3 weeks, with the best results after 3 months of daily use.
Inhaled corticosteroids include:
- Advair (a combination medication that includes a corticosteroid plus a long acting bronchodilator)
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 holding chamber called a "spacer," which ensures that an adequate amount of the medication reaches the lungs. Inhaled corticosteroids are also available in dry powder inhalers and liquid form for nebulizers.
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 or your child's doctor will prescribe the lowest dose that effectively controls your or your child's 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.
To learn more about using inhaled steroids in children, see Treating Asthma in Children.
The benefits of inhaled steroids far exceed their risks, and include:
- reduced frequency of asthma attacks
- decreased use of beta-agonist bronchodilators
- improved lung function
- reduced emergency room visits and hospitalizations
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 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 6-12 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:
- Medrol, Methylpred, Solu-Medrol (methylprednisolone)
- Deltasone (prednisone)
- Prelone, Pediapred, Orapred (prednisolone)
Side effects of systemic steroids tend to occur after years of 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 is used for an acute asthma episode.
Mast cell stabilizers: Intal and Tilade
These two medications 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 2-4 times a day, and take 3-4 weeks to start working.
- Intal (also is effective for exercise-induced asthma when taken 30 minutes before activity
These medications are very safe and have few side effects. Tilade can cause dry throat and can have a bad taste.
Leukotriene modifiers: Accolate and Singulair
There is a fairly new type of asthma medicine called leukotriene modifiers. Leukotrienes are chemicals that occur naturally in our bodies and cause tightening of airway muscles and production of mucus and fluid. 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 1-4 times a day and may decrease the need for other asthma medications.
Leukotriene modifiers include:
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. Other side effects may be found as these medications become more widely used.
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