There is no one-size-fits-all approach when it comes to treating asthma. The key to successful management of the disease is developing a customized 2-part treatment plan designed for each unique patient, which in itself is a delicate mix of science and art. It is reviewed on a regular basis, altered and fine-tuned. A strong patient-doctor relationship, in which both sides share information and offer feedback, is the foundation of an effective plan.
There are two major causes of airway narrowing: inflammation and muscle constriction. Medical therapy is targeted at one or both of these. Steroids and other anti-inflammatory drugs decrease airway inflammation and sensitivity to triggers, while bronchodilators relax airway muscles and make it easier to breath. In both cases, they fall into two categories: quick-relief (or rescue) and long-term control (or maintenance).
albuterol (generic), accuneb, maxair, proair, proventil, ventolin, xopenex
Medicines that are fast-acting and used to treat acute asthma symptoms, an asthma "attack" or episode are called quick-relief medications. Short-acting beta-antagonists provide fast relief of symptoms, relaxing muscles that constrict airways, opening them up and easing breathing. Inhalers should be used at the first sign of symptoms, and doctors may also recommend patients take them before exercise - even if no symptoms are present. Over-reliance on quick-relief medications may be dangerous for two reasons: they give patients a false sense of security that their asthma is under control; and they can act as a cardiac stimulant if used in excessive amounts. If a child is using rescue medication more than three times a week, his/her asthma is not under control and re-evaluation is strongly advised.
Daily medicines that maintain control of the ongoing condition (usually used in cases where symptoms occur more than twice a week and a child or teen suffers frequent asthma attacks), which can be taken individually or combined to treat various levels of severity.
Inhaled corticosteroids
asmanex, azmacort, flovent, pulmicort, qvar
Inhaled corticosteroids (ICS) are the most common, most effective type of long-term asthma meds, helping to decrease airway inflammation and reduce the frequency and severity of attacks. Inhaled corticosteroids are deposited directly onto the airway surface and work locally. Some of the medicine is swallowed and is absorbed through the gastrointestinal tract but most of that is broken down by the liver. Some of the more common side effects of ICS are thrush (white coating on tongue or roof of the mouth, caused by a fungus). This is a much less common side effect if a child rinses well each time after ICS use. It is easily treatable in the event that it does occur. There has been considerable debate about the impact of steroids on growth in children. Most research indicates that while the rate of a child's growth may be slowed, predicted height is not likely to be impacted by more than a quarter to a half-inch, if at all. Other studies show that there is often "catch-up growth" that occurs when a child is weaned off the medication. This is a small price to pay for breathing easy.
Systemic steroids
decadron, deltasone, medrol, orapred, pediapred, prelone, solumedrol
Medications that fall under this category enter not just the lungs but the bloodstream. They can be given orally, intravenously or by injection. Often used in conjunction with other medication, they help people control sudden, severe attacks and long-term conditions that have not been brought under control with other medications alone. Side effects including acne, weight gain, mood changes, upset stomach, bone loss, eye changes and growth slowing have been linked to systemic steroids, but not over short-term usage.
Long-acting beta-agonists (LABA), alone or with inhaled corticosteroids (ICS)
LABA: foradil, serevent
LABA/ICS: advair, symbicort
Alone, a long-acting beta-agonist which relaxes the muscle around the airway, dilates the airways for up to 12 hours; it is sometimes used for 30 minutes before prolonged exercise in athletes with EIA. When used in combination with inhaled corticosteroids, the benefit of an enhanced anti-inflammatory effect as well. Combination medications are control, maintenance medications and should be used, as all control medicines should, on a consistent, long-term basis.
Leukotriene Modifiers
accolate, singulair
Taken daily in pill form, leukotriene modifiers improve airflow and reduce airway constriction and mucus by blocking the bodies' chemical and inflammatory reaction to triggers. They generally are not as effective as inhaled corticosteroids but may be used in conjunction with them. Side effects include nausea, headaches and rash.
Mast Cell Stabilizers
intal, tilade
Daily inhaled medications that reduce symptoms by preventing the body's immune cells from releasing irritating and inflammatory substances. Other than dry throat and bad taste, there are few side effects.
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