Long-term Controller Asthma

Medications

Inhaled Corticosteroids• These medications are used to control inflammation in the airways. They should be used daily, even if you are feeling well.• Possible side effects include: oral thrush (a yeast infection) – rinsing your mouth with water and spitting it out after using your inhaler helps to prevent this.

They include:Alvesco®Asmanex®Flovent®Pulmicort® (budesonide)Qvar®

Long-term Controller Asthma

Medications

Combination Medications • These medications are a combination of an inhaled corticosteroid and a long-acting beta-agonist. • They treat both the underlying inflammation in the airways and relax the muscles around the airways, making it easier to breathe.• Possible side effects include: thrush.

They include:

Advair® (fluticasone + salmeterol)

Dulera® (mometasone + formoterol)

Symbicort® (budesonide + formoterol)

Long-term ControllerAsthma

Medications

Long Acting Beta Agonists • These medications open the airways in the lungs by relaxing the muscles around the airways and last for 12 hours. • They will NOT relieve your symptoms quickly, therefore they DO NOT replace your quick acting bronchodilator. • They should be not be used as the sole asthma maintenance medication.

They include:Brovana®Foradil®Perforomist®Serevent®

Long-term ControllerAsthma

Medications

Leukotriene Modifiers• These oral pills also work to control inflammation in the airway but not to the same extent as inhaled corticosteroids.• Treatment with Zyflo requires regular liver function tests.

They include:Accolate®Singulair®Zyflo®

Long-term ControllerAsthma

Medications

Anti-IgE or Immunomodulators• This is an injectable medication prescribed to patients with allergic asthma that is not well controlled by their inhaled steroids. Skin testing and/or blood tests will confirm if you have allergic asthma. • Possible side effects include: anaphylaxis.

They include:Xolair®

Long-term ControllerAsthma

Medications

Cromolyn (INTAL®)• These are long-term controller medications helpful in preventing asthma symptoms caused by exercise, cold air and allergies.• This can be mixed with albuterol in a nebulizer.• No longer available in a metered dose inhaler.

Theophylline (UNIPHYL®)• These are a long-term controller medication but are not used as a first choice.• Treatment with Theophylline requires regular blood tests to monitor the medication level.

Quick Relief Rescue Asthma

Medications

Short-Acting Beta-Agonists• These medications act quickly to relax the muscles around the airways and make breathing easier. • They should be used on an as needed basis and if you are needing them more than four times in a 24 hour period, it is a sign your asthma is not well controlled.• They can also be used 10-15 minutes before exercise.• Possible side effects include: feeling jittery and increased heart rate.

They include:Albuterol Combivent®Maxair® ProAir®Proventil® Ventolin®Xopenex® AccuNeb®

Quick Relief Rescue Asthma

Medications

Anticholinergics • These medications are slower acting than the short-acting beta-agonists and therefore are not considered a first-line rescue medication.• They do have some muscle relaxant capability but the primary action is to decrease mucus production by drying the secretions.• They are typically prescribed to patients with COPD.

They include:Ipratropium BromideAtrovent®Combivent®DuoNeb®Spiriva®

Rescue Asthma

Medications

Oral Corticosteroids• These medications are usually reserved to treat severe asthma flare ups and are used on a short term basis only.• Short term side effects include stomach ache, increased appetite, fluid retention, or mood changes (increases in blood sugar?).

They include:Dexamethasone PrednisoloneMethylprednisolone Orapred®Medrol® Prelone®Cortisone Pediapred®Hydrocortisone

Asthma tools

Peak Flow Meters• These are simple, portable, and inexpensive tools that, when used properly, measure your peak flow.• The peak expiratory flow rate (PEFR) is a measurement of how fast a person can breathe out air. It is one of the many tests that measure how well the lungs are working.• Home monitoring of you PEFR can help determine whether your asthma treatments are working and warn you when your asthma is getting worse.• PEFR rates are not as accurate as the spirometry we do in our office and are very effort driven. Poor effort can = poor results.

Asthma Tools

Spacer devices/Valved Holding Chambers• This is a holding chamber that attaches to your metered dose inhaler. It helps to deliver the medicine to the lungs instead of inside your mouth.• Certain product lines offer pediatric and adult masks.• Purchase of these devices require a prescription.

They include:Aerochamber®Vortex®Optichamber®

Metered-Dose Inhalers (MDI)

• Metered-Dose Inhalers can be difficult to master the technique and we often recommend a spacer device. • Since 2008, manufacturers have been replacing CFC inhalers (chlorofluorocarbons) with HFA (hydrofluoroalkane) inhalers because of CFCs damaging effects to the environment. Below are some of the differences you will notice:HFA’s puff feels warmer and softer then CFCsHFA’s should be cleaned once a week (the exit port can get clogged easily)HFA’s must be “primed” before useHFA’s should never be immersed in water to test fullness.• If at anytime you feel like you are not using your inhaler correctly, please feel free to call our office and schedule a demonstration.

Dry Powder Inhalers (DPI)

• Dry Powder Inhalers require the user to breathe in quickly in order to get the medication out. Spacer devices can not be used with these devices. • Some devices are designed so that each dose has to be manually loaded into the device (see A and B above). These doses look like capsules but must NOT be taken orally like a pill.• Some devices are designed to hold all the doses internally for easier dosing (see C, D and E above).• The dry powder medication in these inhalers feels different in the mouth then a MDI and may have a sweet taste.

Compressors vs Nebulizers

Air Compressors• can not be purchased without a prescription,

• are the motor behind the nebulizer,

• come in home (table top) or portable models small enough for travel,

• car adapters and extra batteries are available upon request for some models.

Nebulizers• can not be purchased without a prescription,

• holds the medication and changes it from a liquid to a mist for easier inhalation,

• adult and pediatric masks are available upon request.