Anti-inflammatory medications are one of the most important treatment options for people with asthma. Inflammation causes the inner lining of the airways to swell and mucus to be produced. It makes the airways more sensitive to asthma triggers. Anti-inflammatory medicines help to stop this process and prevent asthma attacks.
Direct anti-inflammatory medications include corticosteroids (inhaled and systemic). Other controller medications that will be discussed here are mast cell stabilizers and leukotriene modifiers. Although not true "anti-inflammatory" medications, they work with corticosteroids to enhance the anti-inflammatory action.
Inhaled corticosteroids (ICS) are the most effective medications 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) inhaler
- Improved lung function
- Fewer emergency room visits and hospitalizations
- Better asthma control
It is important to remember that inhaled steroids prevent symptoms; they do not relieve symptoms. They need to be taken every day and should not be stopped or decreased unless discussed with your asthma care provider.
Inhaled corticosteroids include:
- Beclomethasone (Qvar®HFA)
- Budesonide (Pulmicort®; Symbicort® – combination budesonide and formoterol- a long-acting beta agonist)
- Ciclisonide (Alvesco® HFA)
- Fluticasone (Flovent® HFA; Advair® HFA and diskus – combination fluticasone and salmeterol -a long-acting beta agonist)
- Fluticasone furoate (Arnuity Ellipta)
- Mometasone (Asmanex,® Dulera® - combination mometasone and formoterol – a long-acting beta agonist)
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." The chamber helps deliver more medication to the airways with less deposited in the 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 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.
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. These steroids 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 3 hours to begin working and work best after 6 to 12 hours. Sometimes corticosteroids are taken in high doses for a few days (steroid burst) or in decreasing doses over time (steroid taper). They may also be given in a low dose daily, or every other day for long-term control.
Systemic steroids include:
- 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: 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 medications that prevent the release of histamine and other inflammatory substances from cells called mast cells.
Cromolyn sodium (Intal®) is currently the only mast cell stabilizer, and is available as a nebulizer solution. It prevents asthma symptoms, especially in children with allergies and asthma and in people with exercise-induced asthma.
Cromolyn needs to be taken two to four times a day, and takes 3 to 4 weeks to begin working. For exercise-induced asthma, Cromolyn can be taken 30 minutes before the activity to prevent symptoms. Cromolyn sodium is very safe and has few, if any, side effects.
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 show that these medications are helpful in improving airflow and reducing 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.
It is 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.