Antiasthmatic drugs are medicines that treat or prevent asthma attacks.
For people with asthma, the simple act of breathing can be a struggle. Their airways become inflamed and blocked with mucus during asthma attacks, narrowing the opening through which air passes. This is not such a problem when the person breathes in, because the airways naturally expand when a person takes a breath. The real problem arises when the person with asthma tries to breathe out. The air cannot get out through the blocked airways, so it stays trapped in the lungs. With each new breath, the person can take in only a little more air, so breathing becomes shallow and takes more and more effort.
Asthma attacks can be caused by allergies to pollen, dust, pets or other things, but people without known allergies may also have asthma. Exercise, stress, intense emotions, exposure to cold, certain medicines and some medical conditions also can bring on attacks.
The two main approaches to dealing with asthma are avoiding substances and situations that trigger attacks and using medicines that treat or prevent the symptoms. With a combination of the two, most people with asthma can find relief and live normal lives.
Asthma — A disease in which the air passages of the lungs become inflamed and narrowed.
Inflammation — Pain, redness, swelling, and heat that usually develop in response to injury or illness.
Inhalant — Medicine that is breathed into the lungs.
Mucus — Thick fluid produced by the moist membranes that line many body cavities and structures.
Nebulizer — A device that turns liquid forms of medicine into a fine spray that can be inhaled.
Three types of drugs are used in treating and preventing asthma attacks:
- Bronchodilators relax the smooth muscles that line the airway. This makes the airways open wider, letting more air pass through them. These drugs are used mainly to relieve sudden asthma attacks or to prevent attacks that might come on after exercise. They may be taken by mouth, injected or inhaled. Bronchodilators may be taken in pill or liquid form, but normally are used as inhalers, which go directly to the lungs and result in fewer side effects.
- Corticosteroids block the inflammation that narrows the airways. Used regularly, these drugs will help prevent asthma attacks. Those attacks that do occur will be less severe. However, corticosteroids cannot stop an attack that is already underway. These drugs may be taken by mouth, injected or inhaled.
- Leukotriene modifiers (montelukast and zafirlukast) are a new type of drug that can be used in place of steroids, for older children or adults who have a mild degree of asthma that persists. They work by counteracting leukotrienes, which are substances released by white blood cells in the lung that cause the air passages to constrict and promote mucus secretion. Leukotriene modifiers also fight off some forms of rhinitis, an added bonus for people with asthma. However, they are not proven effective in fighting seasonal allergies.
- Cromolyn also is taken regularly to prevent asthma attacks and may be used alone or with other asthma medicines. It cannot stop an attack that already has started. The drug works by preventing certain cells in the body from releasing substances that cause allergic reactions or asthma symptoms. One brand of this drug, Nasalcrom, comes in capsule and nasal spray forms and is used to treat hay fever and other allergies. The inhalation form of the drug, Intal, is used for asthma. It comes in aerosol canisters, in capsules that are inserted into an inhaler, and in liquid form that is used in a nebulizer.
Using antiasthmatic drugs properly is important. Because bronchodilators provide quick relief, some people may be tempted to overuse them. However, with some kinds of bronchodilators, this can lead to serious and possibly life-threatening complications. In the long run, patients are better off using bronchodilators only as directed andalsousing corticosteroids, which eventually will reduce their need for bronchodilators. However, a 2004 Canadian study has questioned a standard practice of increasing steroids after asthma attacks or worsened symptoms. Also, research in 2004 showed that people with asthma who worked closely with their physicians to self-manage their asthma had fewer attacks, which reduces the need for bronchodilators. Carefully managing asthma also reduces visits to the emergency department and hospitalizations.
Corticosteroids are powerful drugs that may cause serious side effects when used over a long time. However, these problems are much less likely with the inhalant forms than with the oral and injected forms. While the oral and injected forms generally should be used only for one to two weeks, the inhalant forms may be used for long periods.
It is important to remember that leukotriene modifiers are used to prevent and manage asthma, not to stop an attack. A physician or pharmacist can advise patients on possible interactions with other drugs.
Patients who are using their antiasthmatic drugs correctly but feel their asthma is not under control should see their physicians. The physician can either increase the dose, switch to another medicine or add another medicine to the regimen. A 2004 survey showed that 70% of people with mild to moderate asthma were not taking the correct dose of asthma medication.
When used to prevent asthma attacks, cromolyn must be taken as directed every day. The drug may take as long as four weeks to start working. Unless told to do so by a physician, patients should not stop taking the drug just because it does not seem to be working. When symptoms do begin to improve, patients should continue taking all medicines that have been prescribed, unless a physician directs otherwise.
Inhalant forms of antiasthmatic drugs may cause dryness or irritation in the throat, dry mouth, or an unpleasant taste in the mouth. To help prevent these problems, gargling and rinsing the mouth or taking a sip of water after each dose is recommended.
More serious side effects are not common when these medicines are used properly. However, anyone who has unusual or bothersome symptoms after taking an antiasthmatic drug should get in touch with a physician.
A physician or pharmacist should be consulted before combining antiasthmatic drugs with any other prescription or nonprescription (over-the-counter) medicine.
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