Types of Asthma Medications

ANTI-INFLAMMATORY MEDICATIONS

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.

Parenteral:

Hydrocortisone

Methylprednisolone

Parenteral:

To be used only in the treatment of acute severe asthma.

(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

(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.

(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

(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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