Poorly controlled asthma can seriously affect the quality of many people’s lives. Interrupted sleep, time lost from school and work, and limited involvement in physical as well as social activities are just a few of the many possible consequences of being diagnosed with asthma. Asthma-related concerns contribute to a huge number of doctor visits and emergency department trips and are a tremendous cost to many families. Fortunately, experts have found ways to effectively control chronic asthma because of the recent medical discoveries about controller medications and their effectiveness in preventing airway inflammation.
The Role of Inflammation in Chronic Asthma
Not too long ago, medical professionals were focusing entirely on narrowing of the airways due to the contraction of the muscles of bronchial tubes during an asthma attack. Recently, however, there had been a growing emphasis on the role of inflammation in chronic asthma along with the importance of controller drugs in the prevention of asthma episodes.
Inflammation is the body’s way of defending itself against things that it perceives as foreign and harmful. Some types of inflammation last only for a short time (e.g. sunburn) while others can last for years or even a lifetime (e.g. psoriasis). It has been a known fact that acute inflammation of the bronchial tubes occurs during asthma attacks. Fairly recently, however, it was discovered by experts that some inflammation is present in the airways of asthmatic individuals even when they feel completely fine. The cause of this chronic inflammation remains unknown, although in many instances things point out to an allergic type of reaction.
The Use of Controller Medications in People with Chronic Asthma
The medications used in asthma management can be categorized into two: relievers and controllers. Between these two, controller drugs are considered the cornerstone of asthma prevention and therapy. Generally taken every day, these drugs reduce airway inflammation and prevent asthma attacks from developing.
Unfortunately, not many people with persistent, chronic asthma use controller medications despite strong evidence that their regular use can significantly improve control of the disease. According to some studies, a large number of asthmatic individuals don’t use them at all, while others use them less than prescribed. There is also good evidence that daily use of controllers can help stop asthma exacerbations and lessen hospital admissions. Despite their proven benefits on health, many people with asthma are not being prescribed, or do not take, controllers for their problem.
At present, there are generally two types of medications available for the prevention of asthma: inhaled corticosteroids (fluticasone, budesonide, mometasone, ciclesonide, flunisolide, and beclomethasone) and anti-allergics/mast cell stabilizers (cromolyn and nedocromil).
The Importance of Inhaled Corticosteroids
Inhaled corticosteroids have become the mainstay of asthma treatment for chronic asthma. These medications have been proven effective in preventing inflammation of the airways. For individuals with mild, moderate, or severe chronic asthma, doctors usually prescribe the daily use of inhaled corticosteroids to prevent asthma episodes. They come in various strengths and are generally used once or twice daily. The following are some of the more popular brands of steroid inhalers:
• Fluticasone (Flovent Diskus, Flonase)
• Budesonide (Pulmicort, Rhinocort)
• Mometasone (Nasonex, Asmanex Twisthaler)
• Cicelesonide (Alvesco, Omnaris)
• Triamcinolone (Azmacort)
• Flunisolide (Aerobid, Aerospan HFA)
• Beclomethasone (Qvar, Qnasl)
Aside from preventing inflammation, these medications have also been proven to reduce airway hypersensitivity, lower ER visits and hospitalizations, and improve a patient’s overall quality of life.
The Role of Anti-allergics/Mast Cell Stabilizers
Cromolyn sodium (Intal) and nedocromil (Tilade) are used as add-on controller medications and alternative treatment options for asthma management. These medications work by blocking the release of antihistamine from mast cells, thereby preventing asthma flare ups. Remember, however, that although these medications prevent the inflammatory response, they cannot reverse inflammation once the chemical mediators have been released by the mast cells. Because these drugs are not as effective as inhaled corticosteroids in controlling asthma symptoms, they remain an alternative, but not preferred, treatment for manyt asthma patients. Nevertheless, Intal and Tilade can effectively keep inflammation at a minimum, especially for asthma cases that have strong allergy component.
There is yet no permanent cure for asthma, but regular use of controller medicines can make the risk of a major asthma attack far less likely.