Long-Term Control Medicine

Long-term controller medicines are used daily to maintain control of your asthma and prevent symptoms. These medicines help to reduce constriction (narrowing of the airways in the lungs) and/or inflammation (underlying swelling and irritation in the airways of your lungs). Some people need to take more than one controller medicine to control their asthma.

Inhaled Corticosteroids
Oral Corticosteroids
Leukotriene Modifiers
Long-acting B2-Agonists
Cromolyn Sodium/Nedocromil Sodium
Methylzanthines (Theophylline)

INHALED CORTICOSTEROIDS
When you hear the word "steroid" you might think of the steroids used by athletes. This may worry you if you have heard about the side effects and problems associated with these steroids. But corticosteroids are not the same steroids used by athletes to build muscles and do not have the same side effects. They are the most potent and consistently effective long-term anti-inflammatory medications for asthma. They also have fewer side effects than oral corticosteroids.

How do they work?

• Inhaled corticosteroids go directly to the airways to help reduce inflammation and irritation.
• Inhaled corticosteroids help to improve lung function, prevent asthma symptoms, and reduce the need for quick relief medication.

When are they used?

• Used for management of persistent asthma at all levels of severity (severe persistent, moderate persistent, and mild persistent) to improve symptoms of pulmonary function.
• For the long-term prevention of symptoms, they control and reverse inflammation.
• Therefore they reduce the need for quick-relief medications and are used to help prevent asthma attacks from starting.

How are they taken?

• Available as a metered dose inhaler (MDI) and dry powder inhaler (DPI).
• Using a spacer (valved-holding chamber) device with metered dose inhalers and washing your mouth out after inhalation decreases the risk of side effects.

Possible side effects:

• Cough, hoarseness
• Thrush (a fungal infection in the mouth). Washing your mouth out with water after each inhalation may decrease the risk of this side effect.

Brand names:

• AeroBid
• Azmacort
• Beclovent
• Flovent
• Pulmicort Turbuhaler
• Vanceril

ORAL CORTICOSTEROIDS

How do they work?

• Oral corticosteroids open the airways by reducing the swelling of the airway lining.
• Oral corticosteroids decrease mucus production.
• Oral corticosteroids improve the response of airways to beta2-agonist medicines.
• Oral corticosteroids help reverse airway inflammation and speed recovery when symptoms flare up. They are for short-term, daily use to bring asthma back under control but they do not bring fast relief.

When are they used?

• Often used to gain quick control of poorly controlled persistent asthma, or when starting long-term therapy.
• Used, as needed, for patients with severe persistent asthma.
• They can be used for:
  • Short-term (3-10 days) for broad anti-inflammatory effects.
  • For long-term prevention of symptoms in severe persistent asthma - they control, reverse, and keep the inflammation down.

How are they taken?

• Taken as tablets or syrup
• It is recommended that oral corticosteroids be taken at lowest effective dose.

Possible side effects:

• The side effects are related to how much, how often, and how long the medicine is taken.
• When oral corticosteroids are taken on a short-term basis, they can lead to reversible side effects. These side effects are very rare, but can occur. They will go away as soon as you stop taking the medications, but DO NOT stop taking the medication before talking to your health care provider. These short term side effects may include:
  • feeling hungry all of the time
  • making your body hold onto extra water so that you look puffy
  • making your face look round or swollen
  • weight gain
  • making you very happy, very sad, or very mad
  • increased blood pressure.
• When oral corticosteroids are used for a very long time (years), they may have some other side effects. These are also very rare, but may include:
  • high blood pressure
  • making bones weak and easier to break
  • cataracts
  • weakness of the muscles
  • slowing how fast children grow

Brand names:

• Medrol
• Pediapred
• Prelone
• Prednisone (generic)

LEUKOTRIENE MODIFIERS

How do they work?

• They help prevent asthma symptoms by blocking an early part of the asthma reaction (chemical reactions that cause airway inflammation).

When are they used?

• Used as an alternative therapy for patients with moderate persistent or mild persistent asthma.
• They improve symptoms and pulmonary function.
• They reduce the need for quick-relief medications.

How are they taken?

• Available as tablets. Tablets should be taken at least one hour before or two hours after meals for best results. Also available as chewable children's tablets.

Possible side effects:

• May cause diarrhea, nausea, headache and other effects.
• Elevations of liver enzymes have been reported with zileuton in some patients.

Brand names:

• Accolate
• Singulair
• Zyflo
• Filmtab

LONG-ACTING B2-AGONISTS

How do they work?

• Starts working slower but lasts longer than short-acting b2-agonists.
• Relax muscles that tighten around airways.

When are they used?

• Used together with anti-inflammatory medications for long-term control of asthma symptoms, especially nighttime symptoms, for patients with severe persistent or moderate persistent asthma.
• Used to improve symptoms and reduce the need for quick-relief medications.
• Should not replace anti-inflammatory medications.
• Not used to treat acute symptoms or flare-ups.
• Sometimes used to prevent exercise-induced asthma.

How are they taken?

• Available as metered dose inhaler (MDI), dry powder inhaler (DPI) and tablets. The MDI and DPI work better than tablets.
• May provide better symptom control when added to standard doses of inhaled corticosteroids instead of increasing the corticosteroid dosage.

Possible side effects:

• Headache
• Increased heart rate
• Nausea
• Trembling and shakiness

Brand names:

• Serevent
• Foradil
• Proventil
• Volmax
  

CROMOLYN SODIUM/NEDOCROMIL SODIUM
These are mild to moderate anti-inflammatory medications. They are an alternative to low doses of corticosteroids for individuals with mild persistent asthma.

How does it work?

• Prevent asthma episodes by blocking the inflammation of the airways. They also keep the muscles around the airways from tightening.
• Can be used as a preventative treatment prior to exercise or exposure to allergens (including cold air, exercise, allergens) on an as-needed basis.
• Improves symptoms and pulmonary function and reduce need for quick-relief medications.

When are they used?

• Used as an alternative treatment to low-dose inhaled corticosteroids for patients with mild persistent asthma.
• Can also be used as a preventative treatment prior to exposure to known allergens (cold air, exercise, allergens) on an as-needed basis.
• Improves symptoms and pulmonary function.
• Reduces the need for quick relief medications.
• Cromolyn Sodium:
  • To prevent symptoms of chronic asthma. Must be taken every day.
  • Often takes one to four weeks to produce full effect.
  • Can be used for infants.
  • To prevent symptoms that occur with exercise or contact with an animal.
• Nedocromil:
  • To prevent symptoms of chronic asthma in older children and adults. Improvement can begin in as little as three days.

How are they taken?

• Must be taken regularly to be effective.
• The beneficial effects occur gradually over weeks and months with consistent use.
• Available as a metered-dose inhaler (MDI). Cromolyn sodium is also available as a nebulizer solution.

Possible side effects:

• 15 to 20 percent of patients experience an unpleasant aftertaste from nedocromil.
• Cough and bronchospasm may occur with cromolyn. May cause irritated or dry throat.

Brand Names:

• Intal
• Tilade

METHYLZANTHINES (THEOPHYLLINE)

How do they work?

• Relaxes muscles that tighten around airways.
• They open the airways, slow mucus production, and clear mucus from airways.
• Helps prevent symptoms by keeping the airways open for up to 12 hours.

When are they used?

• For long-term control and prevention of symptoms, especially at night.
• An alternative, but not preferred, therapy for moderate persistent and mild persistent asthma.
• Major use is to boost effects of inhaled corticosteroids.
• It will not provide quick relief during an asthma episode.

How are they taken?

• Available as time-release tablets and capsules.
• They are taken every 8 to 12 hours.

Possible side effects:

• Sleeplessness
• Upset stomach
• Hyperactivity in some children
• Side effects increase with increasing level of medication in the body.
• Can cause a toxic effect if you have a high fever, a virus infection, or are taking certain medications.

Brand names:

• Aerolate SR
• Respbid
• Slo-bid
• Theo-Dur
• Theo-24
• Uniphyl

Back to Medications