|
Quick-Relief Medications Used to Treat Asthma
Quick-relief medications give fast relief for tight, narrowed airways and
the symptoms of coughing, wheezing, and chest
tightness that happen with asthma.
Examples of quick-relief medications: Brethine, Proventil,
Albuterol, Xopenex
Click here for a complete
listing of asthma medications.
Short-acting
b2-agonists
Inhaled short-acting b2-agonists are the drug of choice for
treating acute asthma symptoms and attacks, or flare-ups.
When is it
used?
-
For relief
of acute symptoms and prevent exercise-induced bronchospasm.
How does
it work?
- Bronchodilation:
relax bronchial smooth muscle following adenylate
cyclase activation and increase in cyclic AMP producting
functional antagonism of bronchocontriction., usually within 5
to 10 minutes of administration (opens up the airways by
working on a cellular level).
Possible
side effects:
-
Increased heart rate,
shakiness, hypokalemia, increased lactic acid,
headache, high blood sugar. Inhaled route, in general, causes few
side effects.
- Patients
who already have heart disease, especially the
elderly, may have harmful cardiovascular reactions with
inhaled therapy.
Other
information about using this type of medication:
- Inhaled
route starts working faster, has fewer side effects, and works
better than oral medication. The less b2-selective
agents (isoproterenol, metaproterenol, isoetharine, and
epinephrine) are not recommended due to their potential for
excessive cardiac stimulation, especially in high doses.
Albuterol liquid is not recommended.
- For
patients with mild intermittent asthma, regularly scheduled
daily use neither harms nor benefits asthma control. Regularly
scheduled daily use is not generally recommended.
-
If the medication does not seem to be working, or if it needs to
be used too often (more than 1 canister/month)
means that the asthma is not under control, and a doctor needs to evaluate and possibly increase (or start)
long-term control therapy. Use of greater than 2
canisters/month poses additional adverse risks.
Oral (systemic)
corticosteroids
Used for moderate-to-severe exacerbations to speed recovery
and prevent recurrence of exacerbations.
When is it
used?
- Usually
requires short-term (3-10 days) “burst”, broad
anti-inflammatory effects.
- Broad
anti-inflammatory effects- to stop an asthma flare-up, reverse inflammation, speed recovery and reduce
rate of relapse.
How does
it work?
- Anti-inflammatory.
Blocks late reaction to allergen and reduce airway
sensitivity. Inhibit cytokine production, adhesion
protein activation, and inflammatory cell migration and
activation at the cellular level.
- Reverse
b2-receptor down-regulation. Inhibit microvascular leakage.
Possible
side effects:
- Short-term
use: reversible changes in sugar metabolism, increased
appetite, fluid retention, weight gain, mood alteration,
hypertension, peptic ulcer, and rarely aseptic necrosis of
femur.
- Consideration
should be given to coexisting conditions that could be
worsened by systemic corticosteroids, such as herpes virus
infections, varicella, tuberculosis, hypertension, peptic
ulcer, and Strongyloides.
Other
information about using this type of medication:
- Short-term
therapy should continue until patient achieves 80% Peak Expiratory Flow
personal best or symptoms resolve. This usually requires 3 to
10 days, but may require longer.
There is no evidence
that tapering the dose following improvement prevents relapse.
Anticholinergics
(ipratropium bromide)
May provide some additive benefit to inhaled b2-agonists in
severe asthma attacks. May be an alternative bronchodilator for
patients who do not tolerate inhaled b2-agonists.
When is it
used?
How does
it work?
-
Bronchodilation.
Competitive inhibition of muscarinic cholinergic receptors
(opens the airways by working at the cellular level).
-
Reduces
intrinsic vagal tone to the airways. May block reflex
bronchoconstriction secondary to irritants or to reflux
esophagitis.
-
May
decrease mucus gland secretion (so body makes less mucus).
Possible
side effects:
- Drying
of mouth and respiratory secretions, increased wheezing in
some people, blurred vision if sprayed in eyes.
Other
information about using this type of medication:
- Reverses
only cholinergically mediated bronchospasm; does not modify
reaction to antigen. Does not block exercise-induced
bronchospasm.
- May
provide additive effects to b2-agonist but has slower onset
of action.
- Is
an alternative for patients with intolerance to b2-agonists.
- Treatment
of choice for bronchospasm due to beta-blocker medication.
A
Adapted from the Guidelines
for the Diagnosis and Management of Asthma,
National Asthma
Education
and Prevention
Program, National Institutes of Health, 1997
|