Medical Disease: Medicines and Devices

Asthma medications are generally considered to fall into two classes: bronchodilators, which stop asthma attacks after they've started and help prevent attacks, and anti-inflammatories, which control the airway inflammation and prevent asthma attacks from starting.

Although these medicines come in several brand names and various forms such as sprays, pills, powders, liquids and shots, your physician will determine the one which is best for you.

Bronchodilators

Bronchodilators provide relief during an asthma attack. They relax muscles in your air tubes, forcing them to open up and allowing you to breathe. Bronchodilators also may help clear mucus from the lungs, allowing it to move more freely and be more easily coughed out.

Some examples of bronchodilators include short-acting beta-agonists (usually used to prevent exercise-induced asthma), anticholinergics (usually used in addition to or as an alternative to short-acting beta-agonists, and theophylline (a long-acting drug used to treat difficult-to-control or severe asthma).

Anti-Inflammatories

Anti-inflammatories prevent asthma attacks by keeping air tubes open all of the time. They are designed to reduce swelling in the air tubes and decrease the amount of mucus. Cromolyn and nedocromil are two examples of anti-inflammatory medicines.

Corticosteroids are the most popular class of anti-inflammatories and are the drug of choice for persistent asthma. Other anti-inflammatories include mast cell stabilizers.

Side Effects

There is always a risk of side effects associated with taking medicine. These may include sore throat, nervousness, nausea, rapid heartbeat, loss of appetite, or staying awake. A doctor may need to modify your treatment plan if side effects become severe.

Allergy-related

Asthma sufferers with allergies may receive hyposensitization therapy or allergy shots. The shots may help prevent asthma attacks, but experts do not agree about their usefulness.

Over-The-Counter

Over-the-counter asthma drugs such as "Primatene Mist" and "Bronkaid" are widely available bronchodilators that provide short term relief. These medicines, however, do not control long-term asthma and should not be used every day to relieve asthma symptoms. Check with a physician before using over-the-counter medicines.

Metered-Dose Inhalers

The most common device used to deliver medicine to the lungs of asthmatics is the metered-dose inhaler. Inhalers have two parts: 1) a canister consisting of a propellant, the medicine, and stabilizers, and 2) an actuator or mouthpiece consisting of a discharge nozzle and a dust cap. Inhalers are easily used by pressing down the top of the canister and inhaling the gas that is released. Usually the medicine administered by metered-dose inhalers is a bronchodilator, corticosteroid, or a mast cell stabilizer.

Dry Powder Inhalers

As an alternative to the aerosol-based metered-dose inhalers, dry powder inhalers deliver medicine from a capsule in powder form. These devices require the patient to inhale forcefully to pull the powder from the device into the lungs and can be more complicated to use than metered-dose inhalers.

Nebulizer

Medication may also be administered using a nebulizer, providing a larger, continuous dose. Nebulizers vaporize a dose of medication in a saline solution into a steady stream of foggy vapor that is inhaled by the patient. Nebulizers are more common in hospital settings for patients who have difficulty using a metered-dose inhaler.

Asthma Spacer

Asthma spacers are attachments that can be added to metered-dose inhalers. The spacer goes between the patient's mouth and the mouthpiece of the inhaler, and it acts as a reservoir that briefly holds the medication. Spacers allow a patient to inhale the medicine without having to coordinate the breathing and mechanical actions needed to use an inhaler. Spacers also help patients deliver the medication directly to the lungs, avoiding medicine on the side of the mouth and the condition known as "thrush".