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The Asthma Corner
: What different asthma medications are available?
UPDATED SEPTEMBER 20, 2004
Once diagnosed with asthma, your child will probably be prescribed
specific medication. Just as there are two main problems associated
with asthma: bronchoconstriction and inflammation - there are
two main types of asthma medications: bronchodilators and anti-inflammatories.
Bronchodilators
Bronchodilators usually come in the form of inhalers, or in liquid
form for young children. (Check out the section on asthma
medication delivery devices) Bronchodilators provide quick relief
by easing bronchial muscle tension and constriction. These are considered "Short acting" medications, as they work immedialty but thir effect lasts only for a few hours.
Tradenames
of commonly used bronchodilators include Ventolin, Alupent and
Bricanyl. Consult your health care professional for more details.
"Short acting" Bronchodilators should only be given as needed, for example during
a cold, or for shortness of breath, or wheezing. Children with
mild asthma symptoms can often be treated adequately with the
occasional use of bronchodilators alone. The need for these short acting bronchodilators
can act as a gauge of asthma control. Depending on the child's
particular condition, needing bronchodilator medication more than
3 or 4 times per week usually indicates the presence of inflammation
and inadequate asthma control. At least 25% of asthmatic children
have symptoms mainly due to inflammation. These children should
also take anti-inflammatory medications.
Long Acting Bronchodilators
Recently the "Long Acting Bronchodilators" have been made available for use in children.
These medications work in the same way as the short acting bronchodilators, but their
effect lasts longer; up to 12 hours. Currently these medications are Salmeterol(known as Serevent) and
Formoterol(known as Oxeze).
Long Acting Bronchodilator medications are reserved only for children who's asthma is not well controlled despite the maximum use of inhaled steroids and short acting bronchodilators.
When prescribed, these medications are given only in COMBINATION with an inhaled steroid and never alone.
As a matter of fact they are currently available in "combination" puffers or inhalers with inhaled steroids.
When taking a long acting bronchodilators the need for the short acting bronchodilators is almost zero and the control usually improves.
The use of short acting bronchodilators should be restricted to emergency(relief) use only.
Anti-inflammatory medications
Non-Steroidal
One category of anti-inflammatory medications are the non-steroids
which although are still available, are used less frequently than
inhaled steroids(see below). These include sodium cromoglycate,
know as Intal, and nedocromil sodium, known as Tilade, which are
inhaled - and ketotifen, known as Zaditen, which is swallowed.
Non-steroid anti-inflammatories can take longer to take effect
- up to 8 to 10 weeks - and have few side-effects. In general,
children with mild but frequent symptoms, may benefit from non-steroidal
anti-inflammatory medication.
Corticosteroids
Another category of anti-inflammatory medication includes corticosteroids.
Examples of corticosteroids given to children include: Prednisone
and Predilisone(Pediapred), both which are swallowed. Orally-administered
steroids are effective helping children with acute asthma. However,
prolonged or daily use can result in negative side-effects such
as growth delay.
Inhaled steroids such as fluticosone known as Flovent and budesonide,
known as Pulmicort, are effective treating children with chronic
asthma and are considered very safe. Indeed inhaled steroids are
considered much safer than orally-administered steroids. In general,
the goal of steroid treatment is to achieve as few symptoms as
possible with the lowest possible dose. Recent studies have confirmed
that inhaled steroids are safe in children and do not interfere
with growth.
Anti-Leukotrienes
Thanks to today's better understanding of asthma, scientists have
been able to develop medications that specifically target inflammation
at the molecular level. Leukotrienes, substances made during inflammation,
are thought to contribute to the development of asthma symptoms.
Zafirlukast(Accolate) and Montelukast(Singulair) are medications
which block leukotrienes (Anti-Leukotrienes). As they have recently
become available, there is not much experience with these in children.
Anti-Leukotrienes are taken by mouth (therefore easy to take,
without worrying about inhaler device technique) and are not corticosteroids.
Whether or not an asthmatic is prescribed these medications depends
entirely on the child's age and specific situation.
Medication use
For immediate or acute relief of asthma symptoms, bronchodilators
are the best option. In time, as airway inflammation is decreased
by preventative, anti-inflammatory medications, the occurrence
of acute attacks will be reduced, as will the need for bronchodilators.
However, regular use of anti-inflammatory medications may still
be required on an on-going, maintenance basis.
Prescribed anti-inflammatory medications should be tried for at
least 2 months, after which your child's condition will need to
be reevaluated. Some parents discontinue preventative anti-inflammatory
medications on their own because their child seems better. But
remember, your child is well because he or she has been taking
preventative medication. Unfortunately, when medications are stopped
too soon, symptoms may reappear. However, with the help of a healthy
environment, some children do outgrow their symptoms and their
need for medication. Do not discontinue medication unless advised
to do so by your child's doctor.
IMPORTANT MESSAGE:
THE NAMES OF THE MEDICATIONS AND AVAILABILTY MAY VARY DEPENDING ON THE COUNTRY YOU LIVE IN. PLEASE SPEAK WITH YOUR HEALTHCARE
PROFESSIONAL REGARDING THE AVAILABILTY OF THE MEDICATIONS IN YOUR COUNTRY.
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designed to be an educational aid only. It is not intended to
replace the advice and care of your child's physician, nor is
it intended to be used for medical diagnosis or treatment. If
you suspect that your child has a medical condition, always
consult a physician.
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