Preventers

• Inhaled Corticosteroids
• Oral Corticosteroids (Steroid Tablets)
• Theophylline and Aminophylline
• Cromones
• Anticholinergics
• Leukotrine Receptor Antagonists

Inhaled Corticosteroids

These have very good anti-inflammatory effects, and must be taken regularly every day. It takes 7 to 14 days for the beneficial effects to be built up, and 6 weeks for maximum benefit.

Examples of ‘standard dose’ inhaled corticosteroids (given through metered dose inhaler) are:

Beclometasone dipropionate or Budesonide at 100 to less than 400 micrograms twice daily (that is less than 800 micrograms per day).

or

Fluticasone propionate (which is twice as potent) at 50 to less than 200 micrograms twice daily.

Examples of ‘high-dose’ inhaled corticosteroid (given through metered dose inhaler) are:

Beclometasone dipropionate or Budesonide at 0.8 to 2 mg daily (in divided doses).

or

Fluticasone propionate at 0.4 to 1 mg daily (in divided doses).

Inhaled corticosteroids have considerably fewer side effects on the body than steroids in tablet form, but prolonged high doses can cause complications.

Side effects include:

• Glaucoma
• Cataracts
• Osteoporosis
• Thrush in the mouth, (but the use of a spacer device reduces the incidence of this).

• List of "Preventer" medication.

Oral Corticosteroids (Steroid Tablets)

Prednisolone is the treatment of choice, and it is used to treat exacerbations. This is because of the action of suppression of inflammatory and allergic disorders of the body.

They are given as a single daily dose usually in the morning.

Side effects include:

• Osteoporosis
• Suppression of adrenal glands
• Weight gain
• Increased susceptibility to infection
• Psychological effects
• Cataracts
• Bruising
• Dyspepsia / ulcers

Dose

Around 40 mg per day for severe asthma, which can usually be reduced after a few days.

"Frequent" use is considered to be 2 or 3 courses a year.

The following should be monitored in frequent or continued use of steroid tablets:

• Blood pressure
• Urine for sugar
• State of the bones (osteoporosis)
• State of eyes (cataracts)
• Growth in children, who should be measured regularly

Short course

Short courses of oral corticosteroids are used to treat acute attacks of asthma.

A high dose of prednisolone (40 – 50 mg/day) is used for a few days. The dose can be stopped abruptly in a mild exacerbation of asthma but should be reduced gradually in those with poorer asthma control, to reduce the possibility of serious relapse.

Long – term courses (maintenance dose)

In chronic asthma longer term administration of oral corticosteroids may be necessary, as well as continuing high doses of an inhaled corticosteroid.

Oral corticosteroids would normally be taken as a single dose in the morning, and the lowest dose possible is used to control symptoms.

Corticosteroids are very effective in asthma, but many patients with chronic obstructive pulmonary disease may show little or no response to corticosteroids. However, higher doses of inhaled corticosteroids may reduce symptoms and exacerbations slightly in patients with more severe COPD.

Therefore, a trial of corticosteroids can distinguish patients who have asthma from those who have COPD."

Theophylline and Aminophylline

These are bronchodilators used for asthma. Aminophylline can be used as an intravenous injection in an emergency. Modified release preparations work for a 12 hour period and are useful for asthma, which occurs at night and early morning.

Side effects

• Fast heart beat
• Palpitations
• Nausea

• List of Theophylline / Aminophylline Products

Cromones

They may be of value in asthma with an allergic basis therefore, would come into the context of “preventers”. They may not help some people. They are of value in the prevention of exercise-induced asthma, being used, in inhaler form, half an hour before, but are generally not felt to be as effective as inhaled steroids.

Sodium cromoglycate (5mg per metered dose). Usual dose being 10mg 4 times per day.

Intal (Sodium cromoglycate).

Nedocromil Sodium (Tilade) 2mg per metered dose.

Side effects:

• Coughing
• Wheeze
• Throat irritation from the powder

Anticholinergics

These medications are bronchodilators, and are used more in chronic obstructive pulmonary disease, than asthma. They can be used in inhaled or nebulized form.

Ipratropium Bromide (Atrovent) 20 to 40 micrograms 3 to 4 times daily.

Oxitropium Bromide (Oxivent) 200 micrograms 2 to 3 times daily.

Side effects:

• Glaucoma in susceptible people
• Dry mouth
• Constipation

Leukotrine Receptor Antagonists

These medications act to a degree in modifying part of the complex inflammatory process leading to the clinical manifestation of asthma.

They may be less effective than inhaled steroids in the management of mild asthma, but, because the two drugs appear to have an additive effect, they are often used in conjunction with inhaled steroids, in exercise- induced asthma, and in those with rhinitis.

They are less effective for patients with severe asthma, who are on high doses of other drugs.

• Montelukast "Singulair" 10mg daily in the evening.
• Zafirlukast "Accolate" 20mg twice daily.

Side effects:

• Churg - Strauss Syndrome (following reduction or withdrawal of oral corticosteroid therapy)
• Headache
• Gastrointestinal disturbances

• Asthma Medication

More information about this condition:

• Devices used in Asthma

Amended December 2012