If you have been diagnosed with Asthma, COPD (Emphysema), Chronic Bronchitis, and or Reactive Airways (RAD) you know what it feels like to gasp for air, have a chronic cough, and to hear wheezing from your chest, or feel tightness in your chest. The goal of asthma medications is to prevent symptoms like these from happening.
There are two general classes of asthma medications: quick-relief and long-term control medications. Controller asthma medications are meant to be used daily to keep your airways healthy, even if you are not experiencing symptoms. With inhaled medications, the medicine is delivered directly to your bronchial tubes, helping to open your airways. These medicines have fewer side effects compared to others that are taken by mouth or by injection.
There are several asthma medications available in inhaled form. The medicines prescribed are known as inhaled corticosteroids, also referred to as topical corticosteroids or glucocorticosteroids. These are anti-inflammatory medications that have been used successfully to treat asthma for over 50 years. These types of steroids are very different from the ones abused by some athletes to enhance their performance. These asthma medications reduce many forms of airway inflammation. Treating inflammation is the hallmark to controlling and improving your symptoms. By decreasing how much mucus you produce, airway hypersensitivity, swelling and tightening of your bronchial tubes you will breathe easier.
Your asthma management plan may include taking inhaled corticosteroids even when you feel well. This is because the medications can prevent you from having an asthma flare-up or prevent your symptoms from becoming worse.
Examples of inhaled corticosteroids are beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, mometasone and triamcinolone. It is important to rinse, gargle and spit with water after each dose of inhaled steroids.
Bronchodilators are non-steroid medications that help open up your airways by relaxing small muscles that tighten them. Some bronchodilators are rapid-acting, and some are long-acting.
The rapid-acting bronchodilators are used as “rescue” medications to immediately relieve your asthma symptoms, and include albuterol, levalbuterol, pirbuterol, terbutaline and ipratropium. Although they make you feel better and breathe easier in the short term, these drugs commonly do not solve the underlying problems that lead your asthma symptoms to appear.
If you regularly need these “rescue” medications more than two times per week, your asthma isn’t being properly controlled or there is something else going on that is causing your airways to be blocked. See your allergist to discuss your treatment.
Salmeterol and formoterol are long-acting beta 2-agonist bronchodilators (also known as LABAs) that are ordinarily meant to be used together with an anti-inflammatory medication on a regular (daily), rather than as-needed, basis. Each of these long-acting bronchodilators is available in combination with a corticosteroid within one inhaler, or by themselves in the nebulized form.
Non-steroid anti-inflammatory medications, such as cromolyn or nedocromil, reduce inflammation and can help prevent asthma symptoms. These drugs are extremely safe but are less effective than inhaled corticosteroids.
Types of Inhalation Devices
There are three basic types of devices that deliver inhaled medications. The most common is the metered dose inhaler (MDI), which uses a chemical propellant to push the medication out of the inhaler. Nebulizers deliver fine liquid mists of medication through a tube or a “mask” that fits over the nose and mouth, using air or oxygen under pressure. Dry powder inhalers (DPIs) deliver medication without using chemical propellants, but they require a strong and fast inhalation.
Regardless of the type of device you use, getting the medication to your lower airways is essential for the medication to work. For all devices, education and training on how to correctly use them is very important.
A device called a spacer may be prescribed if you’re having trouble getting the medicine to your airways with an MDI. Spacers help you coordinate your inhaled breath with the release of the medication from the MDI canister. With many MDIs, the spacer also makes the medication droplets smaller, so they can more easily get into your lower airways where they are needed. There are also MDIs where the medicine is released automatically when you breathe in from the inhaler, and there are MDIs with built-in spacers.
Using a dry powder inhaler is very different than an MDI. A lever may need to be pressed, a button squeezed, a cap removed or a dial twisted before inhalation. Dry powder inhalers need a stronger, faster inhalation and are not used with spacers.
Nebulizers deliver asthma medications in a fine mist through mouthpieces or masks. You can breathe normally and there is no special coordination required. Nebulizers are useful for young children and some patients with more severe or acute asthma who are unable to use a MDI or a DPI. Using a nebulizer can be more time-consuming, and may take 10-15 minutes to complete.