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Treatment and Medication

Medications are usually needed for asthma, even if it’s mild asthma. New asthma medications are continually being discovered and there are several effective asthma drugs in the market that help get asthma under control.

There are two types of asthma medications: controllers and relievers.


Asthma Controllers

These are usually taken every day, even if you feel well. They help prevent asthma symptoms and asthma attacks. However, they do NOT help quickly during an asthma attack. Types of controller medications are listed below:

1. Inhaled steroids (corticosteroids)

Controller medications are daily inhalers that control the inflammation in the airways of your lungs. This type of medication is generally the most effective for controlling asthma long term. Examples include Alvesco, Arnuity, Flovent, Pulmicort, and Qvar.

Possible side effects of inhaled steroids:

  • Hoarseness and sore throat
  • Thrush or yeast infection – looks like a whitish layer on your tongue. You can help prevent thrush by rinsing your mouth after taking the medication and by using a spacer when using a metered dose inhaler.

Your doctor will adjust your dose so you get the best asthma control using the least amount of medication. For a full list of side effects, see your doctor or pharmacist. In most cases, inhaled corticosteroids have few side effects with the dose needed to control asthma.

2. Long-acting bronchodilators

These inhalers open up your lungs by relaxing the tiny bands of muscle that surround the airways. Since they can take longer to work than the reliever medications, they are not to be used to quickly relieve symptoms, such as during an asthma attack. Examples include Foradil, Onbrez, Oxeze, and Serevent.

Possible side effects of long-acting bronchodilators:

  • Increased heart rate
  • Anxiety
  • Tremors (shaking) in the hand

3. Leukotriene-receptor antagonists

Leukotriene-receptor antagonists are daily pills that help control inflammation in the airways. For people with mild asthma, doctors may prescribe leukotriene receptor antagonists alone, however they are generally not as effective as low dose inhaled corticosteroids. Doctors may also prescribe leukotriene receptor antagonists to people who are already taking inhaled corticosteroids to help further reduce symptoms or to help reduce the dose of corticosteroid. Examples include Singulair and Accolate.

Possible side effects of leukotriene-receptor antagonists:

  • Headache
  • Dizziness
  • Heartburn
  • Upset stomach

For a full list of side effects, see your doctor or pharmacist. In general, side effects from leukotriene receptor antagonists are uncommon.

4. Combination medications

Combination medications have two medications in one inhaler: an inhaled steroid and a long-acting bronchodilator. They are used when inhaled steroids alone do not fully control your symptoms. Examples include Advair (Flovent + Serevent), Breo (Fluticasone + Vilanterol), Symbicort (Pulmicort + Oxeze), and Zenhale (Mometasone + Formoterol).

5. Biologics

syringes

Biological medications, often called biologics, are a relatively new type of medication for asthma. Compared to most medications that are made using chemical reactions, biologics are made using living systems (e.g., bacterial/viral cells, plant or animal cells). An example of a common biologic is the flu vaccine, which is usually grown in chicken eggs.

Biologics are designed to inhibit certain components of the immune system that trigger inflammation—and it is inflammation in the airways that cause a lot of the asthma symptoms.

Biologics for treating asthma now include Xolair® (available since 2005), Cinqair™, Nucala™ and Fasenra®.

Xolair®
Medication class: IgE-neutralizing antibody (Anti-IgE)

Immunoglobulin E (IgE) is a type of protein that our bodies naturally make in small amounts. In allergic asthma the IgE increases abnormally, causing swelling and tightening of the airways. Anti-IgE therapy reduces the ability of IgE to cause symptoms.

If you are following all the correct steps in managing your asthma but are still having a hard time getting your asthma under control, then your health-care provider may decide to send you for Xolair® injections. Xolair® may be prescribed to reduce the symptoms of asthma due to allergic triggers for individuals aged 12 and older.

If you are sent for Xolair® injections, you will receive them every two to four weeks. You need to continue using all of your asthma medication as prescribed by your health-care provider.

Possible side effects should be explained to you by your health-care provider.

Cinqair™, Nucala™
Medication class: Interleukin-5 (IL-5) inhibitor

Cinqair™ is given by intravenous infusion every four weeks.

Nucala™ is given by subcutaneous injection every four weeks.

IL-5 inhibitors are sometimes prescribed for the maintenance treatment of severe asthma in patients aged 18 years or older. It may be added when someone’s asthma is not under control despite using medium to high doses of inhaled corticosteroids plus another controller medication.

IL-5 inhibitors are only effective for people who have a certain level of eosinophil, a type of white blood cell in your blood. Your health-care provider will check your blood eosinophil level before prescribing the medication.

Possible side effects should be explained to you by your health-care provider.

Fasenra®
Medication class: Anti-eosinophil (anti-interleukin-5 receptor alpha monoclonal antibody)

Fasenra is used in addition to other asthma medicines for the maintenance treatment of adult patients with severe eosinophilic asthma, whose asthma is not controlled with their current asthma medicines. Severe eosinophilic asthma is a type of asthma where patients have increased eosinophils in the blood or lungs. Eosinophils are a type of white blood cell that are associated with inflammation of the airways that can cause your asthma to get worse or can increase the number of asthma attacks.

Fasenra works by reducing the number of eosinophils in the blood and lungs and helps reduce the number of asthma attacks that you experience.

Fasenra is given to you as an injection just under the skin (subcutaneously) by a healthcare professional. The injection is given every 4 weeks for the first 3 injections, and then every 8 weeks thereafter.

Possible side effects should be explained to you by your health-care provider.


Asthma Relievers (Fast-acting Bronchodilators)

These are usually only taken when needed for quick relief or for an asthma attack. They help open up your lungs by relaxing the muscles that surround the airways.

Reliever medications are sometimes called “rescue” medications or “quick relief” medications, since they start working quickly (usually within a few minutes). This is the inhaler you use when you have an asthma attack. It is also used for less severe symptoms, or before you exercise. These medications are not useful for long-term control of asthma since they do not control the inflammation in your lungs. If you need this medication more than three times a week, see your doctor. Examples include Ventolin, Salbutamol, Bricanyl, and Airomir.

Possible side effects of reliever medications:

  • Trembling
  • Nervousness
  • Flushing
  • Increased heart rate

1. Spacer (Holding chamber)

This is a plastic device that is used with pressurized inhalers (the kind that spray the medication out) to better deliver medication to your lungs. It makes it easier to coordinate inhaling the medication from the inhaler. You get more medication in your lungs and less in your mouth and throat.

2. Corticosteroid Pills

Sometimes, the swelling in people’s airways is severe – this may be because they have a chest infection or for some other reason. In cases of severe airway swelling, the doctor may prescribe corticosteroid pills to reduce the swelling, redness, and mucus in the airways. Corticosteroid pills basically do the same thing as inhaled corticosteroids, but they are more powerful. Doctors often prescribe these pills for a short time to get the swelling under control. Examples of corticosteroid pills include Prednisone, Prednisolone (PediaPred®), and Dexamethasone (Decadron®).

For a full list of side effects, see your doctor or pharmacist. In the short term (e.g., 7-10 days) side effects of corticosteroid pills may include:

  • Increased appetite
  • Mood changes
  • Water retention
  • Hyperactivity in children

In the long-term (prescriptions that last many weeks or months) side effects of corticosteroid pills may include:

  • Increased appetite
  • Weight gain
  • Stomach irritation
  • Bone thinning
  • Dependency: your body can go into withdrawal if you stop taking prednisone all of a sudden. Your doctor may ask you to taper off your dose slowly.


Where to Learn More

Your doctor, pharmacist, or Certified Respiratory Educator can:

  • Explain how each of your asthma medications work
  • Discuss any concerns about potential side effects
  • Show you how to use your medication inhalation advice

Ontario residents can reach our Certified Respiratory Educators through our toll-free Lung Health Information Line at 1-888-344-LUNG (5864) or info@lungontario.ca.