ASTHMA

Treatment

In general, three types of medical treatments are available for asthma: medications that acutely relieve symptoms or prevent flare-ups, medications that suppress airway inflammation over days, weeks or months, and immunotherapy or allergy desensitization shots.

Symptom relief

Bronchodilators are medications that open up constricted airways and provide temporary relief of asthma symptoms. They include:

• Beta-2 agonists. This medication falls into two general categories: short acting and long acting. Short-acting beta-2 agonists begin working within minutes and last 2 to 4 hours. Long-acting beta-2 agonists last up to 12 hours. The short-acting medications are typically prescribed for relief or prevention of asthma symptoms or flare-ups. The most common drugs, such as albuterol (Proventil, Ventolin) and pirbuterol (Maxair), act quickly to relieve symptoms and can be used as a prevention measure before you exercise or breathe cold air. Prescribed "as needed," they may relieve your symptoms for up to 6 hours. Inhaled beta-2 agonists won't correct underlying inflammation, however, and can easily be overused.

• Salmeterol (Serevent) and formoterol (Foradil). These long-acting bronchodilators relieve airway constriction for up to 12 hours. They're generally used to prevent symptoms, especially at night. They aren't recommended as a "rescue" medication that can be used for immediate relief during an asthma attack. You usually use salmeterol or formoterol with an anti-inflammatory medication such as inhaled cortisone.

• Theophylline (Slo-Bid, Theo-Dur). This type of bronchodilator is taken in pill form every day. It's especially helpful for relieving nighttime symptoms of asthma. But theophylline may cause side effects, including nausea and vomiting, severe abdominal pain, diarrhea, confusion, fast or irregular heartbeat, and nervousness. It can also promote GERD or acid reflux by relaxing the lower esophageal sphincter muscle. If you're taking theophylline, you should get regular blood tests to make sure you're getting the correct dosage.

• Ipratropium (Atrovent). This bronchodilator is an anticholinergic that isn't typically recommended for the immediate relief of asthma symptoms.

Long-term treatment

Anti-inflammatory drugs are the mainstay medications for asthma. These drugs are taken continually to prevent attacks. Anti-inflammatory drugs reduce inflammation in your airways and prevent blood vessels from leaking fluid into airway tissues. The most widely used of these drugs include:

• Corticosteroids. These drugs are the most effective medications for asthma. They are completely different from the steroids that some athletes abuse. Different kinds of corticosteroids include prednisone, prednisolone, cortisone, triamcinolone, hydrocortisone and others. They help decrease the frequency of attacks and lower the dosage of other medications needed to calm symptoms. Long-term use of oral or intravenous corticosteroids can cause serious side effects, however, including decreased resistance to infection, loss of bone mineral (osteoporosis), muscle weakness, high blood pressure, and thinning of the skin. Inhaled corticosteroids deliver medication directly to your airways and so have fewer side effects. They're also very effective at controlling most forms of asthma. These medications may include beclomethasone (Vanceril, Beclovent, Qvar), fluticasone (Flovent), budesonide (Pulmicort), and flunisolide (Aerobid). Advair Diskus is a combination inhaler containing fluticasone and salmeterol. If you're using a metered-dose inhaler form of inhaled corticosteroids, be sure to use a spacer and gargle with water after use to rinse your mouth out. It's important to then spit out this water. This helps reduce the amount of drug that is swallowed and absorbed into the body by way of the stomach. It also reduces side effects such as mouth and throat irritation and oral yeast infections (thrush). Also, because inhaled corticosteroids may affect some children's growth, children taking these medications should have their growth rate regularly monitored. Long-term use of inhaled corticosteroids may increase the risk of cataracts.

• Leukotriene modifiers. Introduced in 1996, leukotriene modifiers were the first new class of prescription asthma medications to become available in 20 years. They include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo). These drugs work by reducing the production, or blocking the action, of leukotrienes - substances released by cells in your lungs during an asthma attack. Leukotrienes cause the lining of your airways to become inflamed, which in turn leads to wheezing, shortness of breath and mucus production. By themselves, leukotriene modifiers are about as effective as theophylline and cromolyn, but used in conjunction with other medications, they may help prevent more attacks. Although generally not as effective as inhaled corticosterioids, leukotriene modifiers are an option.

• Other drugs. Although they're not effective for everyone, daily use of inhaled cromolyn (Intal) or nedocromil (Tilade) may help prevent attacks of mild to moderate asthma. In some cases they may also help prevent asthma triggered by exercise if taken an hour before any vigorous activity.

Immunotherapy

If you have allergic asthma that can't be easily controlled by avoiding triggers and using medication, allergy desensitization shots (immunotherapy) may help. You'll have skin tests to determine the allergens that cause you the most trouble, followed by a series of injections containing small doses of those allergens. Injections are generally given once a week for a few months, then once a month for a period of 3 to 5 years. Over time, you should lose your sensitivity to the allergens. Immunotherapy isn't for everyone, however. You're most likely to benefit if it's clear you have allergic asthma. In addition, immunotherapy carries the risk of an allergic reaction to the shot. Life-threatening reactions are rare but can occur.