Asthma Medicines to Help Control Inflammation and Ease Airway Constriction

Long-term asthma control can help your lungs breathe easier

It’s widely known that excessive exposure to the sun isn’t good for your skin. Doctors recommend that people wear sunscreen to prevent sunburn.

Similarly, asthma experts know that the persistent inflammation of asthma isn’t healthy. Doctors recommend that many people with persistent asthma focus on long-term control aimed at

Controlling persistent airway inflammation with anti-inflammatory medicine¹
Relaxing airway muscles and easing constriction with long-acting bronchodilator medicine²

Asthma Controller medications—also called maintenance or preventive medicines—are taken daily over the long term to decrease asthma symptoms and improve lung function over the long term. If these medicines are stopped, hypersensitivity and constriction in the airways may come back.

Controlling Persistent Asthma with Anti-inflammatory Medicine
Anti-inflammatory medicines are maintenance medicines that work to help decrease the airway swelling and inflammation, which may reduce the risk of lung damage caused by inflammation. However, it is unknown if any asthma medication prevents long-term damage to the lungs.

There are several major types of anti-inflammatory medications.

Corticosteroids: Corticosteroids are used long-term to treat or prevent asthma symptoms and attacks by reducing inflammation or swelling in the airways of the lungs. Corticosteroids are considered the most effective type of controller medicines for asthma. Inhaled forms are the most commonly used. Oral tablets might be used for very severe asthma or during sudden cases of worsening asthma symptoms. Corticosteroids are also available in syrup forms.

Mast cell stabilizers: Mast cell stabilizers are anti-inflammatory medicines that work on a particular allergy cell in the body to stop the allergic response from happening. These are used as preventive treatment prior to exercise or unavoidable exposure to known allergens.² Cromolyn sodium and nedocromil are examples of mast cell stabilizers that might be recommended as alternative medicine in patients with mild to moderate asthma.

Leukotriene modifiers: Leukotriene modifers block some chemicals in the body that cause airway inflammation and constriction. These are used either alone to treat mild persistent asthma or together with inhaled corticosteroids to treat moderate or severe asthma. This alternative medication does not help everyone and needs to be further studied.²

Asthma Maintenance or Controller Medications to Ease Airway Constriction

Long-acting beta₂-agonists: These medicines are bronchodilators that help relax the muscles around the airways of the lungs. They are used to help control moderate and severe asthma and to prevent nighttime symptoms. These are not anti-inflammatory drugs but are usually taken together with inhaled corticosteroid medicines.²

Methylxanthines: A long acting form of theophylline, which works as a mild to moderate bronchodilator to help keep the airways of the lungs open. These may have some mild anti-inflammatory effect and are used alone to treat mild persistent asthma or together with inhaled corticosteroids to treat moderate persistent asthma.² Due to their significant side effect profile and need for monitoring, they are not used frequently in this country.

Doctors may use other medications to help manage asthma, but the most effective long-term-control medications are generally those with anti-inflammatory effects that diminish chronic airway inflammation and airway hyperresponsiveness. Experts from the National Institutes of Health (NIH) recommend inhaled corticosteroids as the preferred treatment to reduce inflammation for people with persistent asthma.⁵ They reduce inflammation because they work in multiple ways to affect the inflammatory process.¹ Corticosteroids are completely different from anabolic steroids that have been abused by some athletes. Inhaled corticosteroids work in the lungs to reduce inflammation but have little effect outside of the lungs.

Inhaled corticosteroids are a common and effective option for controlling asthma. They are designed to be inhaled, not swallowed, so they go straight to the lungs, and work where the medicine is needed.

Inhaled corticosteroids are proven to

Reduce inflammation and swelling in the lining of the airways for easier breathing
Reduce how often asthma symptoms occur
Reduce how often rescue medications are used
Reduce the chances of going to the hospital for asthma attacks

Appropriate use of inhaled corticosteroids can improve asthma control and normalize lung function to help you do things you want to do without the limitations of asthma.⁵ It is likely that most people with persistent asthma will continue to benefit from daily medication to suppress underlying airway inflammation.⁵ Your doctor will evaluate the severity of your asthma and the impact it is having on your daily life. Your doctor will then determine if treatment with an inhaled corticosteroid is right for you.

When your asthma is controlled, you should be able to do more of what you want to do without your asthma symptoms getting in the way.

Relaxing Airway Muscles and Easing Constriction with Long-Acting Bronchodilator Medicine
Bronchodilators are medicines that relieve brochospasm by relaxing the airway muscles of the lungs.² This allows the airways to open more fully, and in turn makes air movement easier. Long-acting bronchodilators can play an important role in long-term asthma control to reduce the risk of sudden asthma symptoms.³

Long-acting beta-agonists (LABAs) are a type of bronchodilator used for long-term control. They play an important role in long-term asthma control. These medicines can decrease the likelihood of bronchospasm by preventing airway constriction and appear to decrease some of the effects of inflammation, too.³ Clinical research indicates that the addition of LABAs to inhaled corticosteroid therapy can improve the way the lungs work and decrease asthma symptoms.¹ You may have heard or read on a product label or ad that "medicines containing LABAs may increase the chance of asthma-related death." Talk to your doctor and pharmacist about any concerns you may have about your medication or your asthma symptoms. That is the best way to fully understand the benefits and any associated risks of your asthma therapy.

(Note: Short-acting bronchodilators and short-acting beta-agonists are not used for prevention or control of asthma. These are quick-acting relief medicines, also called rescue medicine, designed to relieve asthma symptoms during sudden attacks.They work by relaxing the smooth muscles of the bronchial tubes and ease constriction but only work for a short period of time.)

Combination Therapy with
Anti-inflammatory & Long-Acting Bronchodilator Medicine
Some people can control their asthma with a single-ingredient asthma-control medicine such as an inhaled corticosteroid. For others, a single-ingredient medicine isn’t enough. People with moderate to severe persistent asthma may need to take a combination of asthma medications to gain proper control of their asthma.^1,2,4

Stopping An Asthma Attack with Quick-Relief Medicine (Short-acting Bronchodilators)
Quick-relief or rescue medicines are used at the first sign of an asthma attack to provide immediate relief.² These medicines are short-acting bronchodilators that relieve symptoms caused by the sudden spasm or narrowing of the small airways (bronchospasm). Today, short-acting beta-agonists are the top recommended type of quick-relief medicine.¹

If asthma is properly controlled, a person should need to use their quick-relief (rescue) medicines less often. Frequent use of quick-relief medicines may indicate poor asthma control and may highlight the need for long-term controller therapy. If you find you are using your quick-relief medicine more than two times per week, you should talk to your doctor as you may need a change in your treatment. Using your rescue inhaler more than twice a week suggests your asthma is not under control.

If you would like to learn more about treatment to control persistent asthma, select an option below for you or the person who may need treatment:

Talk to your doctor about the treatment option that’s right for you or your child.

References

National Heart, Lung, and Blood Institute. Quick Reference: NAEPP Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma – Update on Selected Topics 2002. Bethesda, MD: National Institutes of Health; June 2002. NIH Publication 02-5075.
National Heart, Lung, and Blood Institute. Disease and condition index: How is asthma treated? Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_Treatments.html. Accessed October 24, 2006.
Strek ME. Difficult asthma.Proc Am Thorac Soc. 2006;3:116-123.
Schatz M, Ziegler RS, Vollmer WM, et al. The controller-to-total asthma medication ratio is associated with patient-centered as well as utilization outcomes. Chest. 2006; 130:43-50.
National Heart, Lung, and Blood Institute. NAEPP Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD:National Institutes of Health; July 1997. NIH Publication 97-4051

This information is intended for US residents only.

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