Asthma

Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath. Symptoms can be prevented by avoiding triggers, such as allergens and irritants, and by inhaling corticosteroids.

Signs and symptoms

Common symptoms of asthma include wheezing, shortness of breath, chest tightness and coughing. Symptoms are often worse at night or in the early morning, or in response to exercise or cold air.
Gastro-esophageal reflux disease coexists with asthma in 80% of people with asthma, with similar symptoms. This is due to increased lung pressures, promoting bronchoconstriction, and through chronic aspiration.

Medications

Medications used to treat asthma are divided into two general classes:

• Fast acting
• Long term control

Fast acting

• Beta2-adrenoceptor agonists , such as salbutamol are the first line treatment for asthma symptoms.

Salbutamol (Albuterol , Ventolin)
Levalbuterol
Terbutaline (Bricanyl)
Pirbuterol (Maxair)
Procaterol
Metaproterenol (Alupent)
Fenoterol
Bitolterol mesylate
Ritodrine
Salmeterol (Serevent Diskus)
Formoterol (Foradil)
Bambuterol
Clenbuterol
Indacaterol

• Anticholinergic medications, such as ipratropium bromide provide addition benefit when used in combination with Beta2-adrenoceptor agonists in those with moderate or severe symptoms.

Ipratropium
Tiotropium

• Older, less selective adrenergic agonists, such as inhaled epinephrine, have similar efficacy to Beta2-adrenoceptor agonists.

Long term control

• Glucocorticoids are the most effective treatment available for long term control.

Beclomethasone
Budesonide
Ciclesonide
Fluticasone
Mometasone
Flunisolide
Betamethasone
Triamcinolone

• Long acting beta-adrenoceptor agonists have at least a 12-hour effect. They are however not to be used without a steroid due to an increased risk of severe symptoms.
• Leukotriene antagonists ( such as zafirlukast) are an alternative to inhaled glucocorticoids, but are not preferred.

Montelukast
Pranlukast
Zafirlukast

• Mast cell stabilizers (such as cromolyn sodium) are another non-preferred alternative to glucocorticoids.

Cromoglicate
Nedocromil

• Combination products

Fluticasone / salmeterol ( Advair )
Budesonide / formoterol ( Symbicort )
Ipratropium / salbutamol ( Combivent )