March 23, 2011

Asthma - Treatments and drugs


Prevention and long-term control is the key to preventing asthma attacks. Treatment usually involves learning to recognize your triggers and taking steps to avoid them, and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler such as albuterol. 

The right medications for you depend on a number of things, including your age, your symptoms, your asthma triggers and what seems to work best to keep your asthma under control. Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, medications to treat specific allergies are needed. 

Long-term control medications
In most cases, these medications need to be taken every day. Types of long-term control medications include:
  • Inhaled corticosteroids. These medications include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex), flunisolide (Aerobid), beclomethasone (Qvar) and others. They are the most commonly prescribed type of long-term asthma medication. You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a relatively low risk of side effects and are generally safe for long-term use.
  • Leukotriene modifiers. These oral medications include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo, Zyflo CR). They help prevent asthma symptoms for up to 24 hours. In rare cases, these medications have been linked to psychological reactions such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any unusual reaction.
  • Long-acting beta agonists (LABAs). These inhaled medications include salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer). LABAs open the airways and reduce inflammation. However, they've been linked to severe asthma attacks. LABAs should be taken only in combination with an inhaled corticosteroid.
  • Combination inhalers such as fluticasone and salmeterol (Advair Diskus) and budesonide and formoterol (Symbicort). These medications contain a LABA along with a corticosteroid. Like other LABA medications, these medications may increase your risk of having a severe asthma attack.
  • Theophylline. This is a daily pill that helps keep the airways open (bronchodilator). Theophylline (Theo-24, Elixophyllin, others) relaxes the muscles around the airways to make breathing easier. It's not used as often now as in past years.
Quick-relief medications
Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your doctor recommends it. Types of quick-relief medications include:
  • Short-acting beta agonists. These inhaled, quick-relief bronchodilators can rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA) and pirbuterol (Maxair Autohaler). These medications act within minutes, and effects last several hours.
  • Ipratropium (Atrovent). Your doctor might prescribe this inhaled medication for immediate relief of your symptoms. Like other bronchodilators, ipratropium relaxes the airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis, but it's sometimes used to treat asthma attacks.
  • Oral and intravenous corticosteroids. These medications relieve airway inflammation caused by severe asthma. Examples include prednisone and methylprednisolone. They can cause serious side effects when used long term, so they're used only on a short-term basis to treat severe asthma symptoms.
Treatment for allergy-induced asthma
If your asthma is triggered or worsened by allergies, you may benefit from allergy treatment as well. Allergy treatments include:
  • Allergy shots (immunotherapy). Immunotherapy injections are generally given once a week for a few months, then once a month for a period of three to five years. Over time, they gradually reduce your immune system reaction to specific allergens.
  • Omalizumab (Xolair). This medication is specifically for people who have allergies and severe asthma. It acts by altering the immune system. Omalizumab is delivered by injection every two to four weeks.
  • Allergy medications. These include oral and nasal spray antihistamines and decongestants as well as corticosteroid, cromolyn and ipratropium nasal sprays.
Don't rely on quick-relief medications
Long-term asthma control medications — such as inhaled corticosteroids — are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an asthma attack.
If you do have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your long-term control medications are working properly, you shouldn't need to use your quick-relief inhaler very often. Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more often than your doctor recommends, see your doctor. You probably need to adjust your long-term control medication. 

Bronchial thermoplasty
This treatment is used for severe asthma that doesn't improve with inhaled corticosteroids or other long-term asthma medications. Generally done in three outpatient visits, bronchial thermoplasty heats the insides of the airways in the lungs with an electrode, reducing the smooth muscle inside the airways. This limits the ability of the airways to tighten, making breathing easier and may reduce asthma attacks. Bronchial thermoplasty isn't widely available. More research is needed to determine whether the benefits of this treatment outweigh the possible risks and potential side effects. 

Treatment by severity for better control: A stepwise approach
Treatment based on asthma control can help you manage your asthma. Asthma treatment should be flexible and based on changes in symptoms, which should be assessed thoroughly each time you see your doctor. Then, treatment can be adjusted accordingly. For example, if your asthma is well controlled, your doctor may prescribe less medicine. If your asthma is not well controlled or getting worse, your doctor may increase your medication and recommend more frequent visits. 

Asthma action plan
Work with your doctor to create an asthma action plan that outlines in writing when to take certain medications, or when to increase or decrease the dose of your medications based on your symptoms. Your asthma action plan should also list your triggers and the steps you need to take to avoid them. Your asthma plan may also involve tracking your asthma symptoms or using a peak flow meter on a regular basis to monitor how well your treatment is controlling your asthma.

Lifestyle and home remedies

Although many people with asthma rely on medications to prevent and relieve symptoms, you can do several things on your own to maintain your health and lessen the possibility of asthma attacks.
Avoid your triggers
Taking steps to reduce your exposure to things that trigger asthma symptoms is a key part of asthma control. Here are some things that may help:
  • Use your air conditioner. Air conditioning reduces the amount of airborne pollen from trees, grasses and weeds that finds its way indoors. Air conditioning also lowers indoor humidity and can reduce your exposure to dust mites. If you don't have air conditioning, try to keep your windows closed during pollen season.

  • Decontaminate your decor. Minimize dust that may worsen nighttime symptoms by replacing certain items in your bedroom. For example, encase pillows, mattresses and box springs in dust-proof covers. Remove carpeting and install hardwood or linoleum flooring. Use washable curtains and blinds.

  • Maintain optimal humidity. If you live in a damp climate, talk to your doctor about using a dehumidifier.

  • Keep indoor air clean. Have a utility company check your air conditioner and furnace once a year. Change the filters in your furnace and air conditioner according to the manufacturer's instructions. Also consider installing a small-particle filter in your ventilation system. If you use a humidifier, change the water daily.

  • Reduce pet dander. If you're allergic to dander, avoid pets with fur or feathers. Having pets regularly bathed or groomed also may reduce the amount of dander in your surroundings.

  • Clean regularly. Clean your home at least once a week. If you're likely to stir up dust, wear a mask or have someone else do the cleaning.

  • If it's cold out, cover your face. If your asthma is worsened by cold, dry air, wearing a face mask can help.
Stay healthy
Taking care of yourself and treating other conditions linked to asthma will help keep your symptoms under control. A few things you can do include:
  • Get regular exercise. Having asthma doesn't mean you have to be less active. Treatment can prevent asthma attacks and control symptoms during activity. Regular exercise can strengthen your heart and lungs, which helps relieve asthma symptoms. Keep in mind that exercising in cold weather may trigger asthma symptoms. If you do exercise in cold temperatures, wear a face mask to warm the air you breathe.

  • Maintain a healthy weight. Being overweight can worsen asthma symptoms, and it puts you at higher risk of other health problems.

  • Eat fruits and vegetables. Eating plenty of fruits and vegetables may increase lung function and reduce asthma symptoms. These foods are rich in protective nutrients (antioxidants) that boost the immune system.
  • Control heartburn and gastroesophageal reflux disease (GERD). It's possible that the acid reflux that causes heartburn may damage lung airways and worsen asthma symptoms. If you have frequent or constant heartburn, talk to your doctor about treatment options. You may need treatment for GERD before your asthma symptoms improve.

Back- Complications                                          Next - Alternative medicine & Coping