Types of Asthma Medications
ANTI-INFLAMMATORY MEDICATIONS |
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Drug class |
Generic names |
Side effects |
Remarks |
(i) Corticosteroids |
Inhaled: Beclomethasone Budesonide Fluticasone |
Inhaled: Oral candidiasis and dysphonia. More than 1 mg a day may be associated with skin thinning, easy bruising, adrenal suppression and cataracts. |
Inhaled: Potential but small risk of side effects is outweighed by efficacy. Spacer devices and mouth washing after inhalation decreases oral candidiasis |
Oral: Prednisolone Dexamethasone |
Oral: Long-term use may lead to osteopororsis, hypertension, diabetes, cataracts, adrenal suppression, obesity, skin thinning and myopathy. |
Oral: If used long term, alternate day morning dosing produces less toxicity. For short-term use, a 3 to 10 day course is effective for gaining control. |
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Parenteral: Hydrocortisone Methylprednisolone |
Parenteral: To be used only in the treatment of acute severe asthma. |
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(ii) Cromones |
Sodium cromoglycate |
None or minimal |
May take 4-6 weeks to achieve maximum effect. |
(iii) Anti-leukotrienes |
Montelukast |
Possible elevation of liver enzymes and bilirubin |
Possible role as an alternative to low dose inhaled corticosteroids an as add-on therapy to inhaled corticosteroids. |
LONG-ACTING BRONCHODILATORS |
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(i) Long-acting beta2-agonists |
Inhaled: Formoterol Salmeterol |
Inhaled: Beta2-agonists have fewer side effects than oral formulations. |
Inhaled: These formulations are not to be used to treat acute attacks with the exception of formoterol. |
Oral: Bambuterol Salbutamol SR Terbutaline SR Clenbuterol |
Oral: Oral beta2-agonists may cause tachycardia, palpitations, tremors, anxiety, headache and hypokalaemia. |
Should always be used in combination with inhaled corticosteroids. |
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(ii) Long-acting methylxanthines |
Sustained-release theophyllin |
Nausea, vomiting, headache, tremor and insomnia. Serious side effects such as seizures and arrhythmias can occur especially at higher serum concentrations. |
Serum theophylline levels should be monitored when high doses are used and in special circumstances, e. liver failure and cardiac failure. Interactions with other drugs such as cimetidine, macrolides and rifampicin can occur. |
SHORT-ACTING BRONCHODILATORS |
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(i) Short-acting beta2-agonists |
Salbutamol Terbutalin Fenoterol |
Beta2-agonists may cause tachycardia, tremor and irritability. Inhaled beta2-agonists have fewer side effects than oral and parenteral preparations. |
Drugs of choice for relief of acute bronchospasm. Inhaled route has faster onset and is more effective than oral route. Parenteral salbutamol or terbutaline may be used in acute severe attacks. |
(ii) Anti-cholinergics |
Ipratropium bromide |
Minimal mouth dryness |
May provide additive effect to beta2-agonists. Onset of action is slower. |
(iii) Short-acting methylxanthines |
Short acting theophylline |
Nausea, vomiting headache, tremor and insomnia. Serious side effects such as seizures and arrhythmias can occur especially at higher serum concentrations. |
May be used if beta2-agonists are not available. |
(iv) Nonselective adrenergic agonists |
Adrenaline/epinephrine injection |
Similar but more significant side effects than beta2-agonists |
Not recommended for treating asthma attacks if beta2-agonists are available. |
Drug delivery
The inhaled route is preferred for beta2-agonists and steroids as it produces the same benefit with fewer side effects as compared to the oral route. In addition, inhaled medications exert their effects at lower doses. The pressurised metered dose inhaler (MDI) is suitable for most patients as long as the inhalation technique is correct.
For patients with poor coordination, alternative methods for drug inhalation include spacer devices, dry powder inhalers and breath-actuated pressurised MDI.
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