- Email: [email protected]
An extensive resource for asthma and allergy medications
An Extensive Resource for A s t h m a and Allergy Medications by Rachel E. Butler
or many
y e a r s , t h e r e w a s lit-
chm(*e9 ~ in the types, of asthma and allergy medications a~ailable. But that era is behind us now. As more Americans have been developing asthma and allergies, pharmaceutical companies have been investing more money into the research and development of drugs that can help treat these conditions. This investment has begun to pay off-in the last few years as we have seen a number of new and different medications for the treatment of asthma and allergies hit the market. This is great news, for we now have more and better choices for treatment. As with most chronic conditions, asthma and allergies can only be effectively managed when you, the patient, are an informed and compliant partner with your health care provider. Now, with a broader array of treatments, there is more for you to learn. You need information about what medications are available, their benetle
fits, potential side effects and, most
6
ASTHMA MAGAZINE
to
subscribe
call
1.800.527.3284
important, how the medications are to be used. To help you navigate your way through tile many medications out there, Ast/amaMagazi,ee presents its Asthma and Allergy Drug Guide. This is an extensive listing of the medications available to treat asthma and respiratory allergies and guidance for their use. Quick-Relief Medications
Asthma
Quick-relief medications have been the mainstay asthma treatment since the early 1900s. The adrenaline-type drugs were the first in a class called bronchodilators. Bronchodilators relax the smooth muscle surrounding the bronchial tubes, which tighten and cause the tubes to narrow during an asthma episode, allowing less space for air to pass through. The early quickrelief medications were taken orally (swallowed); however, aerosol forms of medication were later developed, allowing it to be inhaled to target the
lungs directly and take effect more quickly. Inhaled medications also minimize side effects. The first medication available in an aerosol form was epinephrine. Treatment improved again with the advent of beta2-agonists in the 1960s. These are also bronchodilators, but they target the lungs more specifically. As a result, these medications are more effective and have fewer unwanted side effects, such as increased heart rate and blood pressure. Today's short-acting bronchodilators (or rescue medications) act quickly--within 30 minutes and often in as little as a minute or two. They open narrowed airways and relieve symptoms of coughing, wheezing and chest
tightness, with relief typically lasting about four hours. They are available in metered dose inhalers (MDIs), dry powder inhalers (DPIs) and nebulizer solutions. Quick-relief medication available without a prescription, such as Primatene Mist, is not recommended for use. Primatine Mist is adrenaline in an inhaled form. As noted above, this causes side effects, such as an increased heart rate, and its effects also last a much shorter period than the prescription bronchodilators--typically just twenty minutes or so. Another quick-relief medication is ipratropium bromide, sold under the brand name Atrovent. It acts as a bronchodilator and is often used in conjunction with beta2-agonists in an
urgent care setting to help bring breathing under control during an acute asthma episode. Finally, corticosteroids that are taken orally are considered a quickrelief medication. Although these do not work as quickly as inhaled medications, they take effect within several hours and are a key tool in bringing an acute asthma episode under control and preventing a recurrence. Long-Term Control Asthma Medications
The goal of long-term control medications, also known as "controllers" or "preventers," is to prevent asthma symptoms from occurring in the first place. These medications must be taken on a regular basis over an
*Due to space constraints, some availab/e medications may not appear in chart.
A S ' { H M A MAG,~XZINE t o
subscribe
call
1.800.527.3284
7
extended period of time. They fall into three categories: anti-inflammatory medications, long-acting bronchodilators and the new antileukotriene medications.
Anti-inflammatory Medications Corticosteroids control inflammation in the lungs--the root cause of asthma symptoms. Inhaled corticosteroids are the most effective inhaled antiinflammatory medications available. They are used extensively by people with persistent asthma. Inhaled corticosteroids must be taken every day. It can take up to several weeks for them to begin to have an effect. The oral form of corticosteroids, taken over a long period of time, is used only for severe cases of asthma where other long-term control medications have failed to control the person's asthma. (As noted under "QuickR eli~'F M P A i e ' ~ r i n n ~
"
steroidal, inhaled anti-inflammatory medications available. These are cromolyn sodium and nedocromil. They do not work for everyone, and tend to work best for people with mild to moderate asthma. They are considered to be extremely safe and, for some people, provide a viable alternative to inhaled corticosteroids. Nedocromil is sometimes used in conjunction with an inhaled corticosteroid, with the goal of allowing a reduction in the amount of corticosteroid needed,
Long-Acting Bronchodilators Long-acting bronchodilators are the only bronchodilators considered to be long-term control medications. They are used to prevent asthma symptoms, especially at night. They are often added to anti-inflammatory therapy to increase control or to be able to reduce the amount of anti-inflammatory medication required. They can also be used as pre-treatment one hour to 90 minutes prior to exercise to control symptoms of exerciseinduced asthma. Note: Long-acting bronchodilators do not offer immediate relief; they should not be used to treat acute symptoms. For immediate relief of symptoms, you must use a quick-relief medication.
Anti-Leukotriene Medications The first anti-leukotriene medication became available in 1997. This was the first new class of asthma medications to be developed in 25 years. These medications are used for longterm control of symptoms in people with persistent asthma. They work to reduce inflammation and also have some bronchodilating effect. As with other long-term control medications, anti-leukotriene medications are often added to a treatment plan that includes inhaled corticosteroids to gain better control and to then potentially allow a "step down" in the dose of corticosteroids needed.
! call
1.800.527.3284
Allergy Medications Many people with asthma also have respiratory allergies. These allergies can occur seasonally or year-round. They can cause reactions that include red, itchy eyes and upper-respiratory symptoms, such as nasal congestion, a runny nose and itchy throat. These allergies can also trigger asthma. Upper-respiratory allergies are known as allergic rhinitis, or "hay fever." There are a number of medications that act to relieve the symptoms of allergic rhinitis. It is believed that by controlling upper-respiratory symptoms, you may also be better able to control allergic asthma. The medications used to treat allergic rhinitis fall into four categories: antihistamines, decongestants, steroid nasal sprays and non-steroidal nasal sprays.
Antihistamines Antihistamines are medications taken orally or intranasally to prevent or reduce allergic symptoms. They work by blocking the effects of histamine, a potent chemical in the body that triggers allergic symptoms. Antihistamines, depending on the preparation, can have effects that last anywhere from four to 24 hours, There are many antihistamines on the market, available both with and without a prescription.
Decongestants Decongestants are medications that work to dry up the nasal passages and reduce the swelling of the nasal membranes. They can be taken orally or in the form of nasal sprays or drops. Some oral medications combine both antihistamines and decongestants in one preparation. Decongestants in the form of nasal sprays or drops should not be used for more than five days in a row. ~nnen they are overused, they can cause something called "rebound congestion," where congestion actually worsens. If you need the medication
*Due to space contra/nts, some available medications r?~ay not appear/n cha~
for longer than is recommendcd, call your health care provider regarding an alternative treatment.
Corticosteroid Nasal Sprays Nasal sprays containing corticosteroids reduce inflammation in the
nasal passages just as inhaled ~orticosteroid asthma medications reduce inflammation in tile lungs. Because the et'fects of corticosteroids are not immediate, it is best to begin using these medications at least one week prior to the known onset of seasonal
AS'ItIMA
MAGAZINE
to
allergy symptoms.
No~l-3"teroidal Nasal ,Spr~, Cromolyn sodium is a non-steroidal nasal spray that reduces int]ammation in the nasal passages. It is now sold without a prescription under the subscribe
call
1.800.527.3284
I
S
* Due to the large number of antihistamines available, this guide only includes a sampling of these on the market.
brand name Nasalcrom. Ahhough it does not work for everyone, for some it effectively controls the symptoms of allergic rhinitis. As with the cromolyn-type drugs used for asthma, Nasalcrom has few side effects. It is important to remember that asthma and allergies can be well-managed. Everyone who suffers from asth-
ma or allergic rhinitis should see a health care provider regularly and have a personalized, written treatment plan. This plan should outline steps to avoid asthma and allergy triggers and direct the use of appropriate medications to treat, and in some cases prevent, the symptoms of asthma and allergic rhinitis. Medications are typi-
*Due to space contraints, some available medications may not appear in chart.
10
ASTHMA
MAG,',ZINE
to
subscribe
call
1.800,527.3284
cally the cornerstone of asthma and allergy management. Arming yourself with the vital information about the medications you are taking will help you be an active and informed partner in the management of your health.
Rachel E. Butler is an asthmatic, and ed#or-in-chief of Asthma Magazine.
or many
y e a r s , t h e r e w a s lit-
chm(*e9 ~ in the types, of asthma and allergy medications a~ailable. But that era is behind us now. As more Americans have been developing asthma and allergies, pharmaceutical companies have been investing more money into the research and development of drugs that can help treat these conditions. This investment has begun to pay off-in the last few years as we have seen a number of new and different medications for the treatment of asthma and allergies hit the market. This is great news, for we now have more and better choices for treatment. As with most chronic conditions, asthma and allergies can only be effectively managed when you, the patient, are an informed and compliant partner with your health care provider. Now, with a broader array of treatments, there is more for you to learn. You need information about what medications are available, their benetle
fits, potential side effects and, most
6
ASTHMA MAGAZINE
to
subscribe
call
1.800.527.3284
important, how the medications are to be used. To help you navigate your way through tile many medications out there, Ast/amaMagazi,ee presents its Asthma and Allergy Drug Guide. This is an extensive listing of the medications available to treat asthma and respiratory allergies and guidance for their use. Quick-Relief Medications
Asthma
Quick-relief medications have been the mainstay asthma treatment since the early 1900s. The adrenaline-type drugs were the first in a class called bronchodilators. Bronchodilators relax the smooth muscle surrounding the bronchial tubes, which tighten and cause the tubes to narrow during an asthma episode, allowing less space for air to pass through. The early quickrelief medications were taken orally (swallowed); however, aerosol forms of medication were later developed, allowing it to be inhaled to target the
lungs directly and take effect more quickly. Inhaled medications also minimize side effects. The first medication available in an aerosol form was epinephrine. Treatment improved again with the advent of beta2-agonists in the 1960s. These are also bronchodilators, but they target the lungs more specifically. As a result, these medications are more effective and have fewer unwanted side effects, such as increased heart rate and blood pressure. Today's short-acting bronchodilators (or rescue medications) act quickly--within 30 minutes and often in as little as a minute or two. They open narrowed airways and relieve symptoms of coughing, wheezing and chest
tightness, with relief typically lasting about four hours. They are available in metered dose inhalers (MDIs), dry powder inhalers (DPIs) and nebulizer solutions. Quick-relief medication available without a prescription, such as Primatene Mist, is not recommended for use. Primatine Mist is adrenaline in an inhaled form. As noted above, this causes side effects, such as an increased heart rate, and its effects also last a much shorter period than the prescription bronchodilators--typically just twenty minutes or so. Another quick-relief medication is ipratropium bromide, sold under the brand name Atrovent. It acts as a bronchodilator and is often used in conjunction with beta2-agonists in an
urgent care setting to help bring breathing under control during an acute asthma episode. Finally, corticosteroids that are taken orally are considered a quickrelief medication. Although these do not work as quickly as inhaled medications, they take effect within several hours and are a key tool in bringing an acute asthma episode under control and preventing a recurrence. Long-Term Control Asthma Medications
The goal of long-term control medications, also known as "controllers" or "preventers," is to prevent asthma symptoms from occurring in the first place. These medications must be taken on a regular basis over an
*Due to space constraints, some availab/e medications may not appear in chart.
A S ' { H M A MAG,~XZINE t o
subscribe
call
1.800.527.3284
7
extended period of time. They fall into three categories: anti-inflammatory medications, long-acting bronchodilators and the new antileukotriene medications.
Anti-inflammatory Medications Corticosteroids control inflammation in the lungs--the root cause of asthma symptoms. Inhaled corticosteroids are the most effective inhaled antiinflammatory medications available. They are used extensively by people with persistent asthma. Inhaled corticosteroids must be taken every day. It can take up to several weeks for them to begin to have an effect. The oral form of corticosteroids, taken over a long period of time, is used only for severe cases of asthma where other long-term control medications have failed to control the person's asthma. (As noted under "QuickR eli~'F M P A i e ' ~ r i n n ~
"
steroidal, inhaled anti-inflammatory medications available. These are cromolyn sodium and nedocromil. They do not work for everyone, and tend to work best for people with mild to moderate asthma. They are considered to be extremely safe and, for some people, provide a viable alternative to inhaled corticosteroids. Nedocromil is sometimes used in conjunction with an inhaled corticosteroid, with the goal of allowing a reduction in the amount of corticosteroid needed,
Long-Acting Bronchodilators Long-acting bronchodilators are the only bronchodilators considered to be long-term control medications. They are used to prevent asthma symptoms, especially at night. They are often added to anti-inflammatory therapy to increase control or to be able to reduce the amount of anti-inflammatory medication required. They can also be used as pre-treatment one hour to 90 minutes prior to exercise to control symptoms of exerciseinduced asthma. Note: Long-acting bronchodilators do not offer immediate relief; they should not be used to treat acute symptoms. For immediate relief of symptoms, you must use a quick-relief medication.
Anti-Leukotriene Medications The first anti-leukotriene medication became available in 1997. This was the first new class of asthma medications to be developed in 25 years. These medications are used for longterm control of symptoms in people with persistent asthma. They work to reduce inflammation and also have some bronchodilating effect. As with other long-term control medications, anti-leukotriene medications are often added to a treatment plan that includes inhaled corticosteroids to gain better control and to then potentially allow a "step down" in the dose of corticosteroids needed.
! call
1.800.527.3284
Allergy Medications Many people with asthma also have respiratory allergies. These allergies can occur seasonally or year-round. They can cause reactions that include red, itchy eyes and upper-respiratory symptoms, such as nasal congestion, a runny nose and itchy throat. These allergies can also trigger asthma. Upper-respiratory allergies are known as allergic rhinitis, or "hay fever." There are a number of medications that act to relieve the symptoms of allergic rhinitis. It is believed that by controlling upper-respiratory symptoms, you may also be better able to control allergic asthma. The medications used to treat allergic rhinitis fall into four categories: antihistamines, decongestants, steroid nasal sprays and non-steroidal nasal sprays.
Antihistamines Antihistamines are medications taken orally or intranasally to prevent or reduce allergic symptoms. They work by blocking the effects of histamine, a potent chemical in the body that triggers allergic symptoms. Antihistamines, depending on the preparation, can have effects that last anywhere from four to 24 hours, There are many antihistamines on the market, available both with and without a prescription.
Decongestants Decongestants are medications that work to dry up the nasal passages and reduce the swelling of the nasal membranes. They can be taken orally or in the form of nasal sprays or drops. Some oral medications combine both antihistamines and decongestants in one preparation. Decongestants in the form of nasal sprays or drops should not be used for more than five days in a row. ~nnen they are overused, they can cause something called "rebound congestion," where congestion actually worsens. If you need the medication
*Due to space contra/nts, some available medications r?~ay not appear/n cha~
for longer than is recommendcd, call your health care provider regarding an alternative treatment.
Corticosteroid Nasal Sprays Nasal sprays containing corticosteroids reduce inflammation in the
nasal passages just as inhaled ~orticosteroid asthma medications reduce inflammation in tile lungs. Because the et'fects of corticosteroids are not immediate, it is best to begin using these medications at least one week prior to the known onset of seasonal
AS'ItIMA
MAGAZINE
to
allergy symptoms.
No~l-3"teroidal Nasal ,Spr~, Cromolyn sodium is a non-steroidal nasal spray that reduces int]ammation in the nasal passages. It is now sold without a prescription under the subscribe
call
1.800.527.3284
I
S
* Due to the large number of antihistamines available, this guide only includes a sampling of these on the market.
brand name Nasalcrom. Ahhough it does not work for everyone, for some it effectively controls the symptoms of allergic rhinitis. As with the cromolyn-type drugs used for asthma, Nasalcrom has few side effects. It is important to remember that asthma and allergies can be well-managed. Everyone who suffers from asth-
ma or allergic rhinitis should see a health care provider regularly and have a personalized, written treatment plan. This plan should outline steps to avoid asthma and allergy triggers and direct the use of appropriate medications to treat, and in some cases prevent, the symptoms of asthma and allergic rhinitis. Medications are typi-
*Due to space contraints, some available medications may not appear in chart.
10
ASTHMA
MAG,',ZINE
to
subscribe
call
1.800,527.3284
cally the cornerstone of asthma and allergy management. Arming yourself with the vital information about the medications you are taking will help you be an active and informed partner in the management of your health.
Rachel E. Butler is an asthmatic, and ed#or-in-chief of Asthma Magazine.