Types of Asthma Medications

Asthma medications are drugs used for the management of asthma, a chronic respiratory disease. Some types of asthma medications provide rapid symptom relief from acute asthma attacks, while others help prevent and/or control the symptoms over a long term.

Asthma medications are drugs used for the management of asthma, a chronic respiratory disease. Some types of asthma medications provide rapid symptom relief from acute asthma attacks, while others help prevent and/or control the symptoms over a long term.

Many asthma medications are inhaled, but asthma medications are also taken orally, or as injections in some situations. Asthma medications are primarily of two types:

• Short-term quick relief: Quick relief medications act fast, and are taken to relieve symptoms from acute asthma attacks for short durations.
• Long-term control: Long-term medications are taken for management of asthma over a long period. These medications are slower to work, and are taken daily to relieve symptoms and prevent asthma attacks.

All the asthma medications are bronchodilators that work in different ways to open up the airway and relieve asthma symptoms. Asthma medications relax the smooth muscles around the airway, reduce airway swelling, bronchospasms and mucus in the lungs.

Inhaled corticosteroids are usually the first-line treatment for both acute and chronic asthma. Corticosteroids are potent anti-inflammatory agents which reduce the swelling of the airway and mucus in the lungs. Other important medications include beta agonists and monoclonal antibodies which work in unique ways to prevent inflammation and dilate the airway.

Asthma is a disease that affects the lungs, inflames and narrows the airway and bronchial tubes in the lungs, making it hard to breathe. An acute asthma attack can diminish oxygen supply to the body, cause weakness and fatigue, and can sometimes even lead to death.

Asthma can affect both children and adults and is a chronic disease that flares up in acute episodes with certain triggers. The airways of asthma patients get hypersensitive and may overreact to even the slightest of triggers that don’t usually affect people without asthma.

Symptoms of asthma

During an asthma attack, the smooth muscles around the airway tighten, and the bronchial passages get inflamed, swollen, narrow and/or filled with mucus. The symptoms of asthma include:

• Difficulty in breathing and shortness of breath
• Coughing, particularly at nighttime
• Trouble sleeping because of difficulty in breathing
• Wheezing, making a whistling sound while breathing
• Pain, pressure and/or tightness around the chest

Categories of asthma

Asthma may range from mild to severe, and life-threatening for some. Symptoms may also vary among individuals. Asthma is usually classified into one of the following categories:

• Mild intermittent asthma: Occasional asthma attacks with mild symptoms occurring less than twice a week and less than two nighttime attacks in a month.
• Mild persistent asthma: Mild symptoms with asthma attacks occurring three to six times a week, and up to four times at night in a month.
• Moderate persistent asthma: Similar frequency as mild persistent asthma with more severe symptoms that affect daily activities.
• Severe persistent asthma: Ongoing asthma symptoms day and night leading to limitation of daily activities.

What are the types of asthma?

Asthma may start in childhood or as an adult, and there is usually a genetic predisposition. Adult-onset asthma starts in adulthood, typically before the age of 40, triggered by viral infections or environmental irritants. Asthma may start in childhood due to infections or exposure to pollutants such as tobacco smoke.

Some of the common types of asthma include:

• Allergic asthma: Triggered by external allergens such as pollen, dust or pet dander.
• Nonallergic asthma: Triggered by weather or internal factors such as stress or cold.
• Occupational asthma: Caused by working with chemicals or other irritants in the air.
• Exercise-induced bronchoconstriction: Narrowing of airway caused by breathing in air that is drier than the air in the body. Symptoms usually occur about 10 minutes after starting exercise and resolve in a short while after stopping exercise.
• Eosinophilic asthma: A severe form of asthma marked by high levels of white cells known as eosinophils, which typically starts around the age of 35 to 50 years.
• Asthma-COPD overlap: Asthma that is present along with chronic obstructive pulmonary disease (COPD), which is not common.
• Status asthmaticus: Long-lasting asthma attack that is not controlled with medications, a medical emergency.

What is the main cause of asthma?

Causes for asthma include

• Genetic susceptibility and family history of asthma
• Stress
• Exercise
• Environmental factors such as:
  • Weather
  • Smoking
  • Irritants in the air
• Diseases and conditions such as:
  • Sinusitis
  • Viral infections
  • Gastroesophageal reflux disease (GERD)
  • Obesity
• Hypersensitivity to certain medications such as aspirin, sulfites, or non-steroidal anti-inflammatory drugs (NSAIDs)

Asthma cannot be cured completely but can be controlled well with medications and by taking precautions to avoid asthma triggers. With appropriate treatment, it is possible for most people to live a normal and fulfilling life, including elite athletes who undertake intense physical activity.

Most asthma medications are inhaled, a few are taken orally and sometimes administered as injections. Several types of metered dose inhalers and nebulizers are available for inhalation of asthma medications. Types of asthma medications include:

Short-term quick relief medications

• Short-acting beta2 agonists (SABAs)
• Short-acting anticholinergics
• Beta2 agonist/anticholinergic combinations
• Systemic (oral) corticosteroids

Long-term control medications

• Long-acting beta2 agonists (LABAs)
• Inhaled corticosteroids
• Beta2 agonist/corticosteroid combinations
• Long-acting anticholinergics
• Nonselective phosphodiesterase (PDE) inhibitors
• Mast cell stabilizers
• Leukotriene receptor antagonists
• Monoclonal antibodies (biologics)

Asthma medications work in different ways to reduce asthma symptoms. Some medications relax the smooth muscles around the airways, some reduce the swelling and some reduce mucus secretion. Some block the activity of specific immune cells which release inflammatory proteins.

Short-term quick relief medications

Short-acting beta2 agonists

Beta2 agonists boost the activity of beta2 receptors which are present on smooth muscles. Beta2 receptors relax the smooth muscles around the airway and help dilate it.

Beta2 agonists are usually the first-line treatment for acute asthma attacks. SABAs have a quick onset of under 5 minutes with duration of effects from three to six hours. Commonly prescribed SABAs include:

• Albuterol sulfate (Ventolin HFA, Proventil HFA, ProAir Digihaler)
• Levalbuterol tartrate (Xopenex HFA)
• Terbutaline sulfate (Brethine)
• Short-acting anticholinergics

Anticholinergics relax the respiratory muscles and reduce mucus secretion in the lungs by blocking the activity of acetylcholine. Acetylcholine is a chemical messenger (neurotransmitter) released by nerve cells. Acetylcholine’s functions include making smooth muscles contract and increasing mucus secretions, in addition to others.

Short-acting anticholinergics have an onset time of 15 minutes with effects lasting up to five hours. A short-acting anticholinergic approved by FDA for COPD is also used off-label for acute asthma attacks, in combination with beta2 agonists:

• Ipratropium bromide (Atrovent HFA)
• Beta2 agonist/anticholinergic combinations
• Beta2 agonist/anticholinergic combination medication used for asthma is:
• Albuterol sulfate/ipratropium bromide (Combivent Respimat)

Systemic (oral) corticosteroids

Corticosteroids are powerful anti-inflammatory drugs which have effects on many types of cells that cause inflammation. Oral corticosteroids are used for short durations of up to 10 days for controlling acute asthma episodes, and also for long-term control of asthma. Oral corticosteroids used for asthma include:

• Prednisone (Rayos)
• Methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol)
• Prednisolone sodium phosphate (Pediapred, Orapred ODT)

Long-term control medications

Long-acting beta2 agonists (LABAs)

Long-acting beta2 agonists are prescribed along with corticosteroids as a preventive treatment for asthma symptoms. LABAs are not used for acute asthma attacks. LABAs have an onset time of approximately 15 minutes and effects last from 12 to 24 hours. Commonly prescribed LABAs include:

• Salmeterol Xinafoate (Serevent)
• Formoterol fumarate (Perforomist)
• Olodaterol hydrochloride (Stiolto Respimat)

Inhaled corticosteroids

Inhaled corticosteroids are preferred over oral ones for long-term asthma management because they work topically and cause fewer adverse effects. Inhaled corticosteroids for long-term control of asthma include:

• Ciclesonide (Alvesco)
• Beclomethasone dipropionate (QVAR Redihaler)
• Fluticasone propionate (Flovent Diskus, Flovent HFA)
• Budesonide inhaled (Pulmicort Respules, Pulmicort Flexhaler)
• Mometasone furoate (Asmanex Twisthaler, Asmanex HFA)

Beta2 agonist/corticosteroid combinations

Beta2 agonist/corticosteroid combinations used for long-term asthma management include:

• Budesonide/formoterol (Symbicort)
• Mometasone/formoterol (Dulera)
• Salmeterol/fluticasone inhaled (Advair Diskus, Advair HFA)
• Fluticasone furoate/vilanterol trifenatate (Breo Ellipta)

Long-acting anticholinergics

The long-acting anticholinergic used for asthma management therapy is:

• Titropium (Spiriva HandiHaler, Spiriva Respimat)

Nonselective phosphodiesterase (PDE) inhibitors

Nonselective phosphodiesterase enzyme inhibitors have both anti-inflammatory and bronchodilatory properties. PDE inhibitors are used to control and prevent asthma symptoms, particularly at night time. The PDE inhibitor used for long-term management of asthma is:

• Theophylline (Theo-24, Theochron)

Mast cell stabilizers

Mast cell stabilizers inhibit the release of inflammatory proteins by mast cells. Mast cells are a type of immune cells that serve as the first-line defense against antigens that enter the body. Mast cell stabilizers may prevent the triggering of asthma from cold air, exercise and sulfur dioxide. The mast cell stabilizer used for control of asthma is:

• Cromolyn sodium oral inhalation

Leukotriene receptor antagonists

Leukotriene receptor antagonists prevent stimulation of leukotriene receptors by leukotrienes. Leukotrienes are inflammatory chemicals released by mast cells and eosinophils, which induce bronchospasms. Leukotriene receptor antagonists used in long-term management of asthma include:

• Zafirlukast (Accolate)
• Montelukast sodium (Singulair)

Monoclonal antibodies (biologics)

Monoclonal antibodies are genetically engineered biologic proteins which are used to reduce allergic response in persistent asthma. Each type of monoclonal antibody modulates the activity of specific types of immune cells or cell-signaling proteins which stimulate inflammatory response.

Monoclonal antibodies may reduce or block the inflammatory activity of mast cells, basophils and eosinophils, and signaling proteins such as interleukin receptors.

Monoclonal antibodies are administered as injections or infusions and are usually an add-on treatment for severe asthma. Monoclonal antibodies used for management of asthma include:

• Omalizumab (Xolair)
• Mepolizumab (Nucala)
• Reslizumab (Cinqair)
• Benralizumab (Fasenra)
• Dupilumab (Dupixent)

• Please visit our medication section of each drug within its class for more detailed information.
• If your prescription medication isn’t on this list, remember to look on MedicineNet.com drug information or discuss with your healthcare provider and pharmacist.
• It is important to discuss all the drugs you take with your doctor and understand their effects, possible side effects and interaction with each other.
• Never stop taking your medication and never change your dose or frequency without consulting with your doctor.