Treating the Inflammation of Asthma

What does inflammation have to do with asthma?

If you have asthma, you know that inflammation causes the inner lining of your airways to swell and produce mucus. This inflammation makes the airways more sensitive to certain asthma triggers that cause asthma attacks. Because of this, anti-inflammatory medications are one of the most important treatment options for people with asthma - they help to stop the process that leads to asthma attacks.

Direct anti-inflammatory medications include corticosteroids that are inhaled directly into the lungs or that are systemic (given in a way that the medicine affects the whole body, such as tablets/pills). Mast cell stabilizers and leukotriene modifiers are medicines that work differently and help to improve the anti-inflammatory action of corticosteroids. Monoclonal antibodies (biologic therapy) that offer new ways of treatment targeting the eosinophil cells that are responsible for inflammation in the airways that contribute to asthma.

What are some anti-inflammatory medications for asthma?

Inhaled corticosteroids

Inhaled corticosteroids are the most effective medications you can take to reduce airway swelling and mucus production. The benefits of using these medicines include:

• Fewer symptoms and asthma flare-ups.
• Decreased use of short-acting beta agonists (reliever, or rescue) inhaler.
• Improved lung function.
• Fewer emergency room visits and hospitalizations.
• Better asthma control.

It’s important to remember that inhaled steroids prevent symptoms, but they don’t relieve symptoms. They need to be taken every day and shouldn’t be stopped or decreased unless you’ve discussed this with your asthma care provider.

Inhaled corticosteroids include:

• Beclomethasone dipropionate (Qvar RediHaler®).
• Budesonide (Pulmicort®; Symbicort®). Symbicort combines budesonide and formoterol.
• Ciclisonide (Alvesco® HFA).
• Fluticasone (Flovent® HFA; Advair® HFA and diskus, Wixela® Inhub, AirDuo®). These products combine fluticasone and salmeterol.
• Fluticasone furoate (Arnuity® Ellipta; Breo® Ellipta; Trelegy®Ellipta). Breo combines fluticasone furoate with vilanterol, a long-acting beta agonist. Trelegy combines fluticasone, vilanterol and umeclidinium.
• Fluticasone propionate (ArmonAir® RespiClick).
• Mometasone (Asmanex®, Dulera®). Dulera combines mometasone and formoterol.

Inhaled corticosteroids come in three forms: the metered dose inhaler (MDI), the dry powder inhaler (DPI) and nebulizer solutions. The MDI form works best when used with a valved holding chamber or "spacer." The chamber helps deliver more medication to your airways and leaves less medicine in your mouth and throat.

Inhaled corticosteroids are safe to use for both adults and children. They have very few side effects, especially at lower doses.

It’s rare, but if you’re taking higher doses, thrush (yeast infection in the mouth) and hoarseness may occur. You can help prevent this things from happening by rinsing your mouth, gargling and spitting after each use, and by using a spacer device with MDIs. If you get thrush, you can treat it easily with an anti-fungal mouthwash that is prescribed by your doctor.

Your doctor will prescribe the lowest dose possible to control your asthma. Many people are concerned about taking "steroids." These steroids are NOT the same as anabolic steroids that some athletes take to build muscle. The steroids in asthma medications are anti-inflammatory medications, and daily use will lead to asthma control.

Systemic corticosteroids (oral or intravenous)

Systemic corticosteroids are used to treat severe asthma episodes. They are medicines in pill or liquid form that are swallowed (oral), or liquids that are given through a vein (intravenous). 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 can take up to three hours to begin working and work best after six to 12 hours. Sometimes corticosteroids are taken in high doses for a few days (a steroid burst) or in decreasing doses over time (a steroid taper). They may also be given in a low dose daily, or every other day, for long-term control.

Systemic steroids, available also as generic products, include:

• Cortisone acetate.
• Dexamethasone.
• Hydrocortisone (Cortef®).
• Methylprednisolone (Medrol®, Solu-Medrol®, Depo-medrol®).
• Prednisone (Deltasone®).
• Prednisolone (Prelone®, Pediapred®, Orapred®).

Side effects of systemic steroids tend to occur after long-time use and include a range of issues:

• Acne.
• Weight gain.
• Mood or behavior changes.
• Upset stomach.
• Bone loss.
• Eye changes like glaucoma or cataracts.
• Growth slowdown.

These side effects rarely occur with short-term use. You would only use them on a short-term basis for an acute asthma episode. If you are using steroids over a longer term for hard-to-control asthma, you should be under the care of a pulmonologist or allergist. These providers will consider more advanced treatment and possible referral to other specialties.

Leukotriene modifiers

Leukotrienes are chemicals that occur naturally in our bodies. They cause airway muscles to tighten and mucus production. Leukotriene modifier drugs work by blocking the actions of leukotrienes in the body. Studies show that these drugs improve airflow and reduce asthma symptoms. They come in pill form, taken once or twice per day, and may reduce 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.

Monoclonal antibodies

Monoclonal antibodies (biologic therapy) for severe asthma help block the response to airway triggers that cause inflammation. They target the cells that are part of the body’s immune system. These products include a wide range of medicines that are administered either by an injection in your doctor’s office, IV infusion in a clinic or hospital or self-injection at home. People taking biologics receive treatment every 2 to 8 weeks depending on the particular biologic. You should be under the care of a pulmonologist or allergist.

Mast cell stabilizers

Mast cell stabilizers are medications that prevent the release of histamine and other inflammatory substances from cells called mast cells. They are rarely used.

A note from Cleveland Clinic

It’s important to remember that asthma is a chronic (meaning present all the time) inflammation of the airways in the lungs. Daily treatment with the medication your doctor has prescribed for you will lead to better asthma control and, in the long term, healthier lungs.