Prophylactic Asthma Medications

Description

Asthma is an inflammatory disease that affects a person’s respiratory system, inflaming the airways, and causing symptoms including wheezing, coughing, shortness of breath, and tightness in the chest. Prophylactic asthma medications have a two-fold purpose: control or maintain symptoms, and prevent occurrences or recurrences of attacks. Unlike rescue inhalers that act immediately to relieve asthma symptoms when they flare up, prophylactic asthma medications are primarily preventative in nature, working to reduce airway inflammation, and prevent occurrences or recurrences of asthma symptoms and attacks.

_Fluticasone (Flovent® HFA)_

Uses, Benefits, Side Effects, and Risks of Prophylactic Asthma Medications

As stated previously, the dual purpose of prophylactic asthma medications is to manage symptoms and prevent occurrences or recurrences of asthma symptoms and attacks. This list of prophylactic asthma medications from Focus Information Technology includes only maintenance and preventative drugs, not fast-acting rescue drugs or inhalers intended to treat “acute asthma exacerbations” (although a few serve both purposes):

Beclomethasone (QVAR ®) This is an Inhaled Corticosteroid, typically used twice daily in varying dosages, dependent on the patient’s needs. It functions as a maintenance treatment and prophylactic (preventative) therapy. Potential common side effects of this medication include headache, throat inflammation, nausea, coughing, or hoarseness. *Potential risk includes thrush, a fungal infection of the mouth and throat.*

Budesonide (Pulmicort Flexhaler®)

This is an Inhaled Corticosteroid, typically used twice daily in varying dosages, dependent on the patient’s needs. It functions as a maintenance treatment and prophylactic (preventative) therapy. Potential common side effects of this medication include mild cough or wheezing, with occasional occurrences of hypersensitivity reactions, such as rash and contact dermatitis. *Potential risks include thrush, a fungal infection of the mouth and throat; high doses of the medicine may result in weakened bones and adrenal gland suppression. This medicine may not be appropriate for pregnant or nursing mothers.*

Cromolyn (Intal®) This is an Inhaler that inhibits the release of mediators from mast cells; typically used every six hours in varying dosages dependent on the patient’s needs. It functions as a maintenance treatment and prophylactic (preventative) therapy. This medication is also appropriate to treat bronchospasms resulting from exercise, or exposure to cold air or environmental agents. Potential common side effects of this medication include mild spasms in breathing tubes, cough, and throat irritation. *There are no significant risks associated with this medication.*

Fluticasone (Flovent® HFA) This is an Inhaled Corticosteroid, typically used twice daily in varying dosages dependent on the patient’s needs. It functions as a maintenance treatment and prophylactic (preventative) therapy. Potential common side effects of this medication include headache, throat infection, nasal irritation, sneezing, cough, nausea, vomiting, and nosebleeds. *Potential risks include hypersensitivity reactions such as skin rash, itching, facial swelling, and anaphylaxis. This medication may not be appropriate for pregnant or nursing mothers, unless absolutely necessary.*

Fluticasone with Salmeterol (Advair Diskus®) This is a Combination Inhaled Corticosteroid with long acting Beta-2 agonist bronchodilator; typically used twice daily in varying dosages dependent on the patient’s needs. It functions as a maintenance treatment and prophylactic (preventative) therapy. Potential common side effects of this medication include upper respiratory tract infections headaches, nausea, vomiting, diarrhea, mouth or throat candidiasis, and musculoskeletal pain. **Potential risk includes asthma-related death IF a patient uses this medication in conjunction with another containing salmeterol!** This medication may not be appropriate for pregnant women or nursing mothers.

Methylprednisolone (Medrol®) This is an Anti-inflammatory Systemic Corticosteroid, typically used once in the morning or as needed, in varying dosages dependent on the patient’s needs. It functions as a maintenance treatment , as well as treatment for acute asthma exacerbations. Potential common side effects of this medication include fluid retention, weight gain, high blood pressure, potassium loss, headache, muscle weakness, puffiness of the face, hair growth on the face, thinning and easy bruising of the skin.

**Potential more serious side effects and risks at higher doses for longer durations includes glaucoma, cataracts, peptic ulceration, worsening of diabetes, irregular menses, growth retardation in children, convulsions, and psychic disturbances which may include depression, euphoria, insomnia, mood swings, personality changes, and even psychotic behavior. Prolonged use at high doses can also increase the risk of masking signs of infection and impairing the body’s natural immune response to infection, as well as depressing the body’s adrenal glands, and impairing calcium absorption and new bone formation. This medication may also not be appropriate for pregnant women and nursing mothers.**

[Continued on page 2].

Uses, Benefits, Side Effects, and Risks of Prophylactic Asthma Medications (continued)

This section continues the list of prophylactic asthma medications.

Montelukast (Singulair®) This is a Leukotriene Receptor Antagonist, typically taken once daily in 10 mg tablets. It functions as a maintenance treatment for both asthma and allergic rhinitis. Potential common side effects of this medication include headache, dizziness, abdominal pain, sore throat, and rhinitis. *There are no significant risks associated with this medication. This medication may not be appropriate for pregnant women and nursing mothers.*

Prednisone (Deltasone®) This is a Systemic Corticosteroid, typically used once daily or as needed in varying dosages dependent on the patient’s needs. It functions as a maintenance treatment, as well as treatment for acute asthma exacerbations. Potential common side effects of this medication include retention of sodium and fluid, weight gain, high blood pressure, loss of potassium, headache, muscle weakness, puffiness of the face, growth of facial hair, and thinning and easy bruising of the skin.

**Potential risks include impaired wound healing, glaucoma, cataracts, ulcers in the stomach and duodenum, worsening of diabetes, irregular menses, rounding of the upper back, obesity, retardation of growth in children, convulsions, and psychiatric disturbances that may include depression, euphoria, insomnia, mood swings, personality changes, and even psychotic behavior. Prolonged use at high doses can also increase the risk of suppression of the immune system, increasing the frequency or severity of infections, as well as decreasing the effectiveness of vaccines and antibiotics. Prednisone may cause osteoporosis, resulting in bone fractures. An additional serious complication of long-term use is aseptic necrosis (death and degeneration of the hip bone) of the hip joints. This medication is NOT appropriate for pregnant women and nursing mothers.**

Prednisolone (Delta-Cortef®) This is a Systemic Corticosteroid, typically used once daily or as needed in varying dosages, dependent on the patient’s needs. It functions as a maintenance treatment, as well as treatment for acute asthma exacerbations. Potential common side effects of this medication include retention of sodium (salt) and fluid, weight gain, high blood pressure, loss of potassium, headache, muscle weakness, puffiness of the face, growth of facial hair, and thinning and easy bruising of the skin.

**Potential risks include impaired wound healing, glaucoma, cataracts, ulcers in the stomach and duodenum, worsening of diabetes, irregular menses, rounding of the upper back, obesity, retardation of growth in children, convulsions, and psychiatric disturbances that may include depression, euphoria, insomnia, mood swings, personality changes, and even psychotic behavior. Prolonged use at high doses can also impair calcium absorption and new bone formation, and increase the risk of suppression of the immune system; this in turn increases the frequency or severity of infections, as well as decreases the effectiveness of vaccines and antibiotics. It can also interfere with the tuberculin skin test and cause false negative results in patients with tuberculosis infection. This medication may not be appropriate for pregnant women and nursing mothers.**

Theophylline sustained release (Theophylline ER) This is a Methylxanthine bronchodilator, typically taken once daily in varying progressively increased dosages (up to the prescribed maximum), dependent on the patient’s needs. Potential common side effects of this medication include stomach pain/cramping, nausea, vomiting, diarrhea, loss of appetite, headache, trouble sleeping, irritability, restlessness, nervousness, shaking, flushing, and increased urination.

**More serious side effects may include confusion, dizziness, mental/mood changes, muscle twitching/pain/tenderness, weakness, or rapid breathing. Potential but rare risks may include fainting, fast/slow/irregular heartbeat, vomit that looks like coffee grounds, dark/tarry stools, seizures, or rare but very serious allergic reactions such as rash, red/scaly skin, itching/swelling (especially of the face/tongue/throat), severe dizziness, or trouble breathing. This medication may not be appropriate for pregnant women and nursing mothers.**

[Continued on page 3].

Uses, Benefits, Side Effects, and Risks of Prophylactic Asthma Medications (continued)

This section concludes the list of prophylactic asthma medications.

Triamcinolone (Azmacort®) This is an Inhaled Corticosteroid, typically used two to four times daily, up to a maximum of 16 inhalations daily. It functions as a maintenance treatment. Potential common side effects of this medication include headache, pharyngitis (inflammation of the throat), vomiting, dry mouth, hoarseness, cough, or wheezing due to chemical irritation. *Potential risk includes thrush, a fungal infection of the mouth and throat. More serious risks at higher doses may cause suppression of the body’s ability to make its own natural glucocorticoid in the adrenal glands, and may include decreased formation and increased breakdown of bone, leading to weak bones and fractures. This medication may not be appropriate for pregnant women and nursing mothers.*

Zafirlukast (Accolate®) This is a Leukotriene Receptor Antagonist, typically taken twice daily in varying dosages, dependent on the patient’s needs. It functions as a maintenance treatment for both asthma and allergic rhinitis. Potential common side effects of this medication include headache, dizziness, abdominal pain, sore throat, and rhinitis. *There are no significant risks associated with this medication. This medication is NOT appropriate for pregnant women and nursing mothers.*

The most important functions for prophylactic asthma medications are to maintain or control asthma symptoms, and prevent occurrences or recurrences of asthma symptoms and attacks. Labored breathing and asthma attacks are both frustrating and frightening. Using the proper and most effective prophylactic asthma medication for you is essential in maintaining and treating your asthma. Always consult with your doctor for the appropriate medication, as well as to ensure that you understand how to use it.

References, Resources, & Image Permission

Please check out the relevant references for this article, as well as helpful resources to expand your knowledge on this topic. The article’s image permission is also below.

References

[1] KidsHealth from Nemours. What’s the Difference Between Rescue and Controller Medications? Retrieved from https://kidshealth.org/parent/medical/asthma/rescue_controller.html#a_Controller_Medications

[2] Focus Information Technology. Asthma medications. Retrieved from https://www.perinatology.com/Reference/OBPharmacopoeia-Public/Antiasthma.htm

[3] MedicineNet.com. Beclomethasone inhaler. Retrieved from https://www.medicinenet.com/beclomethasone_hfa-oral_aerosol_inhaler/article.htm

[4] MedicineNet.com. Budesenide inhaler. Retrieved from https://www.medicinenet.com/budesonide_inhaler/article.htm

[5] MedicineNet.com. Cromolyn. Retrieved from https://www.medicinenet.com/cromolyn/article.htm

[6] MedicineNet.com. Fluticasone propionate nasal inhaler spray. Retrieved from https://www.medicinenet.com/fluticasone_propionate_nasal_inhaler-spray/article.htm

[7] MedicineNet.com. Fluticasone and salmeterol oral inhaler, Advair Diskus. Retrieved from https://www.medicinenet.com/fluticasone_and_salmeterol_oral_inhaler/article.htm

[8] MedicineNet.com. Methylprednisolone_._ Retrieved from https://www.medicinenet.com/methylprednisolone/article.htm

[9] MedicineNet.com. Montelukast, singulair_._ Retrieved from https://www.medicinenet.com/montelukast/article.htm

[10] MedicineNet.com. Prednisone. Retrieved from https://www.medicinenet.com/prednisone/article.htm

[11] MedicineNet.com. Prednisolone. Retrieved from https://www.medicinenet.com/prednisolone/article.htm

[12]MedicineNet.com. Theophylline sustained release. Retrieved from https://www.medicinenet.com/theophylline_sustained_release-oral/article.htm

[13] MedicineNet.com. Triamcinolone acetonide inhaler. Retrieved from https://www.medicinenet.com/ triamcinolone_acetonide_inhaler /article.htm

[14] MedicineNet.com. Zafirlukast. Retrieved from https://www.medicinenet.com/zafirlukast/article.htm

Resource

Times Free Press. Health: Why are different kinds of drugs needed to manage asthma? Retrieved from https://health.timesfreepress.com/TextItem.aspx?id=1189

Image Permission

Flovent image – Wikimedia Commons