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Asthma medications are categorized by their actions which are targeted at the two main physiologic effects of asthma: hyperresponsiveness and inflammation. There are two separate phases of asthma management:

• Management of acute exacerbations of asthma ("asthma attacks")
• Long-term asthma management or maintenance therapy

Management of Acute Exacerbations of Asthma

Quick-relief medications, known as "reliever" or "rescue" medications, are used for the management of acute exacerbations or asthma attacks. These medications include:

• Inhaled Bronchodilators

  • bronchodilators are medications that cause the smooth muscles of the airways to relax and, thereby, open up the airways to make breathing easier.
  • inhaled bronchodilators know as short-acting Beta-adrenergic agonists are often used to provide quick relief for acute asthma attacks because they can:
    • improve airflow to the lungs
    • improve control of asthma symptoms
    • reduce the likelihood of emergency visits and hospitalization from acute asthma attacks
  • examples of short-acting Beta-adrenergic agnonists include:
    • albuterol (Proventil; AccuNeb; Ventonil)
    • levalbuterol (Xopenex).
  • inhaled short-acting Beta-adrenergic bronchodilators share the following characteristics:
    • rapid onset of action: act within 5 minutes
    • maximum effect is observed in about 30 minutes
    • effective for up to 4 hours with a single inhalation dose
    • most common side-effects are heart palpitations and tremor

• Anticholinergic bronchodilators

  • ipratropium bromide (Atrovent)is a short-acting inhaled anticholinergic bronchodilator that works within 15 minutes to relieve bronchospasm and its effect lasts for up to 6 hours.
  • studies have shown that the addition of ipratropium bromide to an inhaled short-acting Beta-adrenergic agonist is more effective than the short-acting Beta-adrenergic agonists alone for the treatment of acute asthma attacks in children.

• Systemic Corticosteroids

  • corticosteroids are powerful antiinflammatory medications that are used for the treatment of a wide range of conditions where inflammation plays a major role in the disase process.
  • corticosteroids may be administered either systemically (orally; intramuscular injection; intravenous injection) or by inhalation.
  • systemic corticosteroids are effective for the treatment of acute asthma attacks in children
  • examples of systemic corticosteroids include:
    
    
    • methylprednisolone (Medrol)
    • prednisolone (Delta-Cortef)
    • prednisone (Deltasone; Liquid Pred; Orasone)

Oxygen may need to be administered during an acute attack for some children.

Long-Term Asthma Management

The following medications, known as "controller" or "maintenance" medications, are used for the long-term management of asthma:

• Inhaled Bronchodilators

  • bronchodilators are medications that cause the smooth muscles of the airways to relax and, thereby, open up the airways to make breathing easier.
  • inhaled bronchodilators know as long-acting Beta-adrenergic agonists are often used for the long-term management of asthma symptoms.
  • examples of long-acting Beta adrenergic agonists include:
    • salmeterol (Serevent)
    • formoterol (Foradil)
    • fluticasone/salmeterol (Advair) - an inhaled medication that contains both an inhaled corticosteroid (fluticasone) and a long-acting Beta adrenergic agonist (salmeterol)
  • inhaled long-acting Beta-adrenergic bronchodilators share the following characteristics:
    • onset of action - about 30 minutes
    • maximum effect is observed in about 2 hours
    • effective for up to 8-12 hours with a single inhalation dose
    • most common side-effects are heart palpitations and tremor

• Inhaled Corticosteroids

  • corticosteroids are powerful antiinflammatory medications that are used for the treatment of a wide range of conditions where inflammation plays a major role in the disase process.