Long-term Controller Asthma Medications

1
Long-term Controller Asthma Medications

• Inhaled Corticosteroids
• These medications are used to control
  inflammation in the airways. They should be used
  daily, even if you are feeling well.
• Possible side effects include oral thrush (a
  yeast infection) rinsing your mouth with water
  and spitting it out after using your inhaler
  helps to prevent this.
• They include
• Alvesco
• Asmanex
• Flovent
• Pulmicort (budesonide)
• Qvar

2
Long-term Controller Asthma Medications

• Combination Medications
• These medications are a combination of an
  inhaled corticosteroid and a long-acting
  beta-agonist.
• They treat both the underlying inflammation in
  the airways and relax the muscles around the
  airways, making it easier to breathe.
• Possible side effects include thrush.
• They include
• Advair (fluticasone salmeterol)
• Dulera (mometasone formoterol)
• Symbicort (budesonide formoterol)

3
Long-term ControllerAsthma Medications

• Long Acting Beta Agonists
• These medications open the airways in the lungs
  by relaxing the muscles around the airways and
  last for 12 hours.
• They will NOT relieve your symptoms quickly,
  therefore they DO NOT replace your quick acting
  bronchodilator.
• They should be not be used as the sole asthma
  maintenance medication.
• They include
• Brovana
• Foradil
• Perforomist
• Serevent

4
Long-term ControllerAsthma Medications

• Leukotriene Modifiers
• These oral pills also work to control
  inflammation in the airway but not to the same
  extent as inhaled corticosteroids.
• Treatment with Zyflo requires regular liver
  function tests.
• They include
• Accolate
• Singulair
• Zyflo

5
Long-term ControllerAsthma Medications

• Anti-IgE or Immunomodulators
• This is an injectable medication prescribed to
  patients with allergic asthma that is not well
  controlled by their inhaled steroids. Skin
  testing and/or blood tests will confirm if you
  have allergic asthma.
• Possible side effects include anaphylaxis.
• They include
• Xolair

6
Long-term ControllerAsthma Medications

• Cromolyn (INTAL)
• These are long-term controller medications
  helpful in preventing asthma symptoms caused by
  exercise, cold air and allergies.
• This can be mixed with albuterol in a nebulizer.
• No longer available in a metered dose inhaler.
• Theophylline (UNIPHYL)
• These are a long-term controller medication but
  are not used as a first choice.
• Treatment with Theophylline requires regular
  blood tests to monitor the medication level.

7
Quick Relief Rescue Asthma Medications

• Short-Acting Beta-Agonists
• These medications act quickly to relax the
  muscles around the airways and make breathing
  easier.
• They should be used on an as needed basis and if
  you are needing them more than four times in a 24
  hour period, it is a sign your asthma is not well
  controlled.
• They can also be used 10-15 minutes before
  exercise.
• Possible side effects include feeling jittery
  and increased heart rate.
• They include
• Albuterol Combivent
• Maxair ProAir
• Proventil Ventolin
• Xopenex AccuNeb

8
Quick Relief Rescue Asthma Medications

• Anticholinergics
• These medications are slower acting than the
  short-acting beta-agonists and therefore are not
  considered a first-line rescue medication.
• They do have some muscle relaxant capability but
  the primary action is to decrease mucus
  production by drying the secretions.
• They are typically prescribed to patients with
  COPD.
• They include
• Ipratropium Bromide
• Atrovent
• Combivent
• DuoNeb
• Spiriva

9
Rescue Asthma Medications

• Oral Corticosteroids
• These medications are usually reserved to treat
  severe asthma flare ups and are used on a short
  term basis only.
• Short term side effects include stomach ache,
  increased appetite, fluid retention, or mood
  changes (increases in blood sugar?).
• They include
• Dexamethasone Prednisolone
• Methylprednisolone Orapred
• Medrol Prelone
• Cortisone Pediapred
• Hydrocortisone

10
Asthma tools

• Peak Flow Meters
• These are simple, portable, and inexpensive
  tools that, when used properly, measure your peak
  flow.
• The peak expiratory flow rate (PEFR) is a
  measurement of how fast a person can breathe out
  air. It is one of the many tests that measure
  how well the lungs are working.
• Home monitoring of you PEFR can help determine
  whether your asthma treatments are working and
  warn you when your asthma is getting worse.
• PEFR rates are not as accurate as the spirometry
  we do in our office and are very effort driven.
  Poor effort can poor results.

11
Asthma Tools

• Spacer devices/Valved Holding Chambers
• This is a holding chamber that attaches to your
  metered dose inhaler. It helps to deliver the
  medicine to the lungs instead of inside your
  mouth.
• Certain product lines offer pediatric and adult
  masks.
• Purchase of these devices require a
  prescription.
• They include
• Aerochamber
• Vortex
• Optichamber

12
Metered-Dose Inhalers (MDI)

• Metered-Dose Inhalers can be difficult to master
  the technique and we often recommend a spacer
  device.
• Since 2008, manufacturers have been replacing
  CFC inhalers (chlorofluorocarbons) with HFA
  (hydrofluoroalkane) inhalers because of CFCs
  damaging effects to the environment. Below are
  some of the differences you will notice
• HFAs puff feels warmer and softer then CFCs
• HFAs should be cleaned once a week (the exit
  port can get clogged easily)
• HFAs must be primed before use
• HFAs should never be immersed in water to test
  fullness.
• If at anytime you feel like you are not using
  your inhaler correctly, please feel free to call
  our office and schedule a demonstration.

13
Dry Powder Inhalers (DPI)

• Dry Powder Inhalers require the user to breathe
  in quickly in order to get the medication out.
  Spacer devices can not be used with these
  devices.
• Some devices are designed so that each dose has
  to be manually loaded into the device (see A and
  B above). These doses look like capsules but
  must NOT be taken orally like a pill.
• Some devices are designed to hold all the doses
  internally for easier dosing (see C, D and E
  above).
• The dry powder medication in these inhalers
  feels different in the mouth then a MDI and may
  have a sweet taste.

14
Compressors vs Nebulizers

• Nebulizers
• can not be purchased without a prescription,
• holds the medication and changes it from a
  liquid to a mist for easier inhalation,
• adult and pediatric masks are available upon
  request.

• Air Compressors
• can not be purchased without a prescription,
• are the motor behind the nebulizer,
• come in home (table top) or portable models
  small enough for travel,
• car adapters and extra batteries are available
  upon request for some models.