The two main types of anti-inflammatory are steroids (oral [pill or syrup] and inhaled forms) and cromolyn-type mediations.  Both of these drugs, in the inhaled form, are safe and effective in asthma.  They should be used as daily, maintenance medications as they do not result in immediate relief of symptoms.  These anti-inflammatory medications may prevent the permanent damage to the lungs that experts believe is occurring over many years in the uncontrolled asthmatic.  Examples of inhaled steroid medications are Fovent, Vanceril, Asmacort and Pulmocort. Examples or cromolyn-type inhaled medications are Intal and Tilade.

Consequently, national expert guidelines for the treatment of asthma recommend that any asthmatic experiencing symptoms more than twice a week should be treated with maintenance medications like inhaled steroids or cromolyn-type medications.  These recommendations also apply to children and pregnant women.  In children, the cromolyn-type is usually the first choice, with inhaled steroids being used in more persistent cases. For most adults, inhaled steroids are much more effective than cromlyn-type medications, and they are considered to be extremely safe drugs when given in low to moderate doses.

There is a little concern about long-term inhaled steroids in children because of possible growth delay.  However, most of the experts believe that if the asthma is serious enough it’s well worth the small risk of treating with inhaled steroids.

The oral form of steroids (e.g. prednisone) should be reserved for two situations because long-term use is fraught with serious side effects.

1. For short courses (5-14 days) used in asthma exacerbations – when a patient is having to use their bronchodilator very frequently or when the asthma is interfering with their daily routine (nighttime awakenings, missing work or school).
2. Chronic, daily use of oral steroids is reserved for the most severe asthmatic when all other types of asthma drugs have been tried. I believe that any asthmatic taking chronic, daily oral steroids should definitely be followed by an asthma specialist (Allergy/Immunologist or Pulmonary specialist).