Asthma in Teens and Adults

Medications

Medicine does not cure asthma. But it is an important part of managing the condition. Medicines for asthma treatment are used to:

• Prevent and control the underlying airway inflammation , to minimize asthma symptoms.
• Decrease the severity, frequency, and duration of asthma attacks.
• Treat the attacks as they occur.

Asthma medicines are divided into two groups: those for prevention and long-term control of inflammation and those that provide quick relief for asthma attacks. Most people with persistent asthma need to use long-term medicines daily. Quick-relief medicines are used as needed and provide rapid relief of symptoms during asthma attacks.

Because asthma develops from a complex interaction of genetics, environmental factors, and the reaction of the immune system, different people may use different medicines and doses of medicines. Special consideration may be necessary if you:

• Are pregnant. If a woman had asthma before becoming pregnant, her symptoms may become better or worse during pregnancy. Pregnant women whose asthma is not well controlled may be at risk for a number of complications.
• Are an older adult. Older adults tend to have worse asthma symptoms and a higher risk of death from asthma than younger people. They may also have one or more other health conditions or take other medicines that can make asthma symptoms worse.
• Have exercise-induced asthma. Exercise often causes asthma symptoms. Steps you can take to reduce the risk of this include using medicine immediately before you exercise.
• Need surgery. People with moderate to severe asthma are at higher risk than people who do not have asthma of developing problems during and after surgery.

Medicine delivery

Most medicines for asthma are inhaled. Inhaled medicines are used because a specific dose of the medicine can be given directly to the bronchial tubes. Different types of delivery systems may be used to do this, and one type may be more suitable for certain people or age groups than another. Delivery systems include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler is used most often.

Sometimes doctors recommend the use of a spacer with a metered-dose inhaler (MDI). The spacer is attached to the MDI. A spacer may deliver the medicine to your lungs better than an inhaler alone, and for many people it is easier to use than an MDI alone. Using a spacer with inhaled corticosteroids can help reduce their side effects and result in less use of oral corticosteroids.

It is important to keep track of the inhaler doses and discard the inhaler when you have used the number of doses indicated on the package labeling. This not only prevents you from having an empty inhaler when you need medicine, but it also prevents you from inhaling only propellant after the medicine has run out. Some metered-dose inhalers and dry powder inhalers have counters that let you know how much medicine is left. For more information, see:

Asthma: Using a metered-dose inhaler.

Asthma: Using a dry powder inhaler.

Medication Choices

The most important asthma medicines are:

• Inhaled corticosteroids. These are the preferred medicines for long-term treatment of asthma. They reduce inflammation of your airways and are taken every day to keep asthma under control and to prevent sudden and severe symptoms (asthma attacks). Inhaled corticosteroids include mometasone, triamcinolone, fluticasone, budesonide, and ciclesonide.
• Oral or injected corticosteroids (systemic corticosteroids) to get your asthma under control before you start taking daily medicine. You may also need these medicines to treat asthma attacks. Oral corticosteroids are used much more than injected corticosteroids. Oral corticosteroids include prednisone and methylprednisolone.
• Short-acting beta2-agonists for asthma attacks. They relax the airways, allowing you to breathe easier. These medicines include albuterol and pirbuterol.

Other long-term medicines for daily treatment include:

• Leukotriene pathway modifiers (such as zafirlukast, zileuton, or montelukast).
• Long-acting beta2-agonists (such as salmeterol and formoterol). These medicines are combined with inhaled corticosteroids as a single medicine.
• Less commonly, your doctor may recommend mast cell stabilizers (such as cromolyn) or theophylline (such as Uniphyl).

Other medicines may be given in some cases.

• Anticholinergics (such as ipratropium) are usually used for severe asthma attacks.
• Other medicine such as omalizumab may be used if asthma does not improve with treatment. An asthma specialist typically prescribes this medicine.

Medicine treatment for asthma depends on a person’s age, his or her type of asthma, and how well the treatment is controlling asthma symptoms.

• The least amount of medicine that controls the asthma symptoms is used.
• The amount of medicine and number of medicines are increased in steps. So if asthma is not controlled at a low dose of one controller medicine, the dose may be increased. Or another medicine may be added.
• If the asthma has been under control for several months at a certain dose of medicine, the dose may be reduced. This can help find the least amount of medicine that will control the asthma.
• Quick-relief medicine is used to treat asthma attacks. But if you or your child needs to use quick-relief medicine a lot, the amount and number of controller medicines may be changed.

Your doctor will work with you to help find the number and dose of medicines that work best.

What to Think About

At the start of asthma treatment, the number and dosage of medicines are chosen to get the asthma under control. Your doctor may start you at a higher dose within your asthma classification so that the inflammation is immediately controlled. After the asthma has been controlled for several months, the dose of the last medicine added is reduced to the lowest possible dose that prevents symptoms. This is known as step-down care. Step-down care is believed to be a better way to control inflammation in the bronchial tubes than starting at lower doses of medicine and increasing the dose if it is not enough.²⁰

Because quick-relief medicine quickly reduces symptoms, people sometimes overuse these medicines instead of using the slower-acting long-term medicines. But overuse of quick-relief medicines may have harmful effects, such as decreasing the future effectiveness of these medicines.²¹ Overuse of quick-relief medicine is also an indication that asthma symptoms are not being controlled. Be sure to talk with your doctor immediately.

You may have to take more than one medicine daily to manage your asthma. It can be difficult to remember when to take your medicine and which medicine to take. To help yourself remember, understand the reasons people don't take their asthma medicines, and then find ways to overcome those obstacles, such as taping a note to your refrigerator to remind yourself.

Using the fewest medicines possible is important for older people, because they may be taking medicines for other conditions. Tell your doctor about all the medicines you are taking, so he or she can select asthma medicines that won't interfere with other medicines.

Some people only have symptoms during certain times of the year (seasonal asthma). If you know when you will most likely have symptoms, start using a medicine to decrease inflammation before the symptoms start.

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Author:	Maria G. Essig, MS, ELS	Last Updated: April 21, 2009
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Harold S. Nelson, MD - Allergy and Immunology
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