There are many different types and brands of asthma drugs on the market.  We believe it is helpful to classify the drugs to help understand how they are used.  The two main types are bronchodilators and anti-inflammatory medications (steriods/cortisone-type medications and cromolyn-type medications).  Two other types of medications- Leukotriene modifiers (e.g., Accolate and Zyflo) and phosphodiesterase inhibitors (e.g. theophylline) – are difficult to classify since they seem to have properties of both bronchodilators and anti-inflammatory medications.

Bronchodilators are medications that dilate (open up) the bronchial tubes to permit easier breathing and relieve symptoms.  There are short-acting bronchodilators that are used for quick relief of asthma symptoms (e.g., albuterol and trade names including Ventolin and Proventil HFA.) Most doctors instruct patients to use them as needed – the moment that asthma symptoms arise.  In children, brochodilators are sometimes used on a regular basis, because kids may not let their parents know when they are having symptoms.

Long acting bronchodilators (Serevent) keep the bronchial tubes dilated over many hours. Important to know, however, is that these medications may take a while (maybe an hour or so) to start working.  They should never be used for quick relief of asthma symptoms.  That is, they are prescribed as maintenance medications – they are taken daily without regard for the symptoms the patient is having at that particular moment.  Most of the asthma experts believe that this type of long-acting bronchodilator should be used in conjunction with daily anti-inflammatory medications, as well as a short-acting bronchodilator for quick relief.

Theophylline and lekotrience modifier are considered by some to be long-acting bronchodilators also, but have been used as the sole medication in some patients.

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).

Yes! Although your doctor may want to switch which drugs you are taking, you must continue to take appropriate treatment during pregnancy.  Very effective anti-asthma drugs are available that are considered to be safe for pregnancy.  The fetus depends on his mother’s lungs for oxygen.  If your doctor refuses to put you on medications to control your asthma during pregnancy, find another doctor willing to do it.

No and yes,  First of all, asthma is very treatable. If you can’t do your normal activities or are unable to exercise as much as you want, then there is something wrong with your asthma treatment program.  There are Olympic athletes (e.g., Jacki Joyner-Kersey) who have significant asthma! In general, there are very few activities that asthmatics need to avoid.

So, having asthma is no excuse for being a couch potato.  It is a shame that some asthmatic children are kept from physical education classes or recess, because they are not being treated appropriately for their asthma.  In fact, some experts theorize that inactivity can . over the long run, worsen asthma.

If your asthma is not under control, then you should limit your activity briefly until you can get adequately be your doctor.  It is the rare asthmatic who has such severe symptoms that they must  limit their activity despite maximal medical treatment.

Most agree that you should consider getting specialist care for your asthma with an Allergy/Immunology in the following instances:

1. You have been hospitalized (kept overnight in the hospital) for your asthma in the recent past.
2. You are chronically taking oral steroids (pills or syrup) for your asthma.
3. You are chronically taking more than 2 different types of medications for your asthma.
4. You have been to the emergency room for asthma more than once or twice in the past year.
5. You are going through more than one bronchodilator inhaler each month.
6. You are missing work, school, or not sleeping well regularly because of the asthma.
   

Scientific evidence shows that immunotherapy does improve asthma n allergic patients, as shown in a recent meta-analysis (a statistic analysis of many studies pooling all the information from hundreds or thousands of patients) in the pulmonary journal The American Review of Respiratory and Critical Care Medicine.  Although some recent studies have shown that immunotherapy is not necessarily better than full medication treatment for asthma, these allergen injections will often lessen the amount of medication needed to control asthma.  These injections are a great choice for those patient who don’t comply well with medications, those who don’t want to rely too much on medications and especially for those patients who also have allergic rhinitis (“hay fever”).  Allergen immunotherapy in appropriately selected patients should improve allergic rhinitis and asthma symptoms, and decrease the requirement for medicating both conditions.

I consider this an “old doctor’s tale.”  Some of the newer prescription antihistamines (Zyrtec, Claritin) have been shown in studies to be very safe in asthmatics – perhaps even making the asthma improve.  There were studies done many years ago that suggested that older antihistamines (like some of the over-the-counter drugs available today) could worsen asthma.  A recent meta-analysis showed that antihistamines do not increase asthma symptoms or decrease lung function in asthmatics.  Indeed, many asthmatics have allergies, and I don’t believe that they should be denied the newer prescription antihistamines.

Two prescription medications, albuterol and cromolyn (see above), are recommended for the prevention of exercise-induced asthma symptoms.  Usually, they are taken 15 to 30 minutes before exercise.  Albuterol is thought to be the most effective in this regard.  Long-acting bronchodilators are also thought to be helpful for prolonged exercise (e.g., more than 4 hours).