September 23, 2014
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Asthma

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Controller medications

Long-lasting bronchodilators

Long-lasting bronchodilators are also called long-acting bronchodilators. These controller or maintenance medications are used regularly to prevent asthma symptoms. They are used when asthma symptoms continue despite the proper use of inhaled corticosteroids. They should never be used without concomitant inhaled steroids.

Long-lasting bronchodilators, like fast-acting bronchodilators, work by opening up the airways, making it easier to breathe. As their name suggests, they are effective for longer periods of time.

Most long-lasting bronchodilators start working within 10 to 20 minutes (others may take up to 2 hours) and their effects last for 12 to 24 hours. Generally, long-lasting bronchodilators are not used as reliever medications.

However, formoterol can be used as both a controller and a reliever. This is because it is both a fast-acting and a long-lasting bronchodilator. It starts working within 1 to 3 minutes and its effects last about 12 hours.

Long-lasting bronchodilators open up the airways, making it easier to breathe.

Long-lasting bronchodilators for asthma available in Canada are:

beta agonists:

theophylline products:

Most bronchodilators are given by inhalation using an asthma inhaler (puffer), which is a handheld device that delivers the medication when you inhale so that it goes directly to the lungs. Some are also available in liquids that can be delivered through a nebulizer (a machine that vaporizes the medications so they can be inhaled through a mask). Oxtriphylline is available as a tablet, and aminophylline and theophylline are available as tablets and as injections.

Bronchodilator side effects include:

  • for beta agonists: nervousness, shaking, fast heartbeat, and palpitations
  • for theophylline products: nausea, vomiting, headache, palpitations, and stomach cramps

Not everyone will experience these side effects, and other side effects not listed here may also occur. If you have questions about side effects, you should talk to your pharmacist.. Contact your doctor if you notice any side effects that bother you

Corticosteroids (inhaled, oral, and injected)

Corticosteroids (steroids) work by reducing inflammation in the airways, which makes the airways less sensitive to asthma triggers. They may be taken with inhalers, by mouth (in tablet form), or by injection. Unlike anabolic steroids, which are sometimes misused by some athletes, corticosteroids do not build muscle or enhance physical performance.

Corticosteroids work by reducing inflammation in the airways.

Inhaled corticosteroids are controller medications used on a regular basis to relieve inflammation and prevent asthma symptoms. Your doctor may recommend that you increase the amount of inhaled steroid you use when your asthma gets worse. Oral (tablets) and injectable corticosteroids are used during and after severe asthma attacks.

Oral corticosteroids can start to work within 10 to 12 hours. Some inhaled corticosteroids may take a few days before benefits are noticed.

Common corticosteroids used for asthma in Canada are:

inhaled corticosteroids:

oral tablet corticosteroids:

Side effects of corticosteroids include:

  • inhaled: sore mouth or throat, loss of voice, oral thrush (a fungal infection of the mouth and throat - to reduce the risk, rinse the mouth with water after using the inhaler), reduced bone density, and increased eye pressure
  • oral tablets, if used for a short time: weight gain, mood changes, increased blood sugar
  • oral tablets, if used for a long time: osteoporosis (thinning bones), high blood pressure, glaucoma, cataracts, muscle damage, growth suppression in children, unwanted hair growth, acne, slower wound healing
  • injectable: similar to oral

Not everyone will experience these side effects, and other side effects not listed here may also occur. If you have questions about side effects, you should talk to your pharmacist. Contact your doctor if you notice any side effects that bother you.

Leukotriene receptor antagonists (leukotriene antagonists)

This group of medications works by reducing inflammation, blocking mucous production, and preventing bronchoconstriction (narrowing of the airways). They are controller medications used on a regular daily basis to manage asthma. They do not open the airways and should not be used to relieve asthma attacks.

Leukotriene antagonists can begin to work within 2 hours after taking the medication.

Leukotriene antagonists available in Canada are:

Side effects of this group of medications include headache, nausea, diarrhea, and abdominal pain.

Not everyone will experience these side effects, and other side effects not listed here may also occur. If you have questions about side effects, you should talk to your pharmacist. Contact your doctor if you notice any side effects that bother you.

Sodium cromoglycate and ketotifen

Sodium cromoglycate (generics) and ketotifen (Zaditen®) work by blocking the body's response to allergens and by blocking bronchoconstriction (narrowing of the airways) in response to allergens. However, they do not open the airways and will not relieve asthma attacks. They are controller medications to be used regularly to prevent symptoms in patients with known allergies.

Sodium cromoglycate is inhaled and can be used by both adults and children. Ketotifen is given by mouth and used by children.

Side effects include:

  • sodium cromoglycate: throat irritation, bad taste, nausea, coughing, sneezing, hives, or rash
  • ketotifen: drowsiness, difficulty sleeping, weight gain, increased appetite, rash, or nosebleeds

Not everyone will experience these side effects, and other side effects not listed here may also occur. If you have questions about side effects, you should talk to your pharmacist.. Contact your doctor if you notice any side effects that bother you.

Omalizumab

Omalizumab (Xolair®) is used to treat moderate to severe asthma in people whose asthma is triggered by year-round allergens in the air and who continue to have asthma symptoms even though they are taking inhaled corticosteroids. It works by blocking the body's response to allergens. This controller medication is given as an injection under the skin by a doctor or nurse. It does not open the airways and should not be used as a reliever medication.

Side effects include pain, bruising, redness, or swelling in the area where the medication was injected, viral infections, upper respiratory tract infections, sinusitis (sinus infection), headache, and sore throat.

Not everyone will experience these side effects, and other side effects not listed here may also occur. If you have questions about side effects, you should talk to your pharmacist. Contact your doctor if you notice any side effects that bother you.


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