Asthma, known as chronic inflammation of the lining of the airway, can be triggered by allergens such as trees, grasses, weeds, dust mites, and animal dander (allergic asthma) or irritants (non-allergic asthma).  The first step in treating allergic asthma is to avoid the aggravating allergens, and then treat with immunotherapy (allergy injections), if necessary.  Whether one has allergic or non-allergic asthma, most patients still need relief of wheezing, chest tightness, and/or shortness of breath, which may be treated with several medications.     There are three basic classes of asthma medications: short-acting bronchodilators, long-acting bronchodilators and anti-inflammatory medications.

Short-acting bronchodilators (quick-relief inhalants or rescue medication) work by rapidly relaxing muscles in the airway, causing the airway to open, usually within five minutes.  Drugs in this class include Albuterol (proventil), Levalbuterol (xoponex) and others.  Long-acting bronchodilators, such as inhaled salmeterol or formoterol, can dilate the airway for up to 12 hours per dose.  While long-acting bronchodilators are commonly used to prevent night-time and exercise-induced asthma, they require about 10 to 30 minutes to take effect, and four to six hours to reach full effect.  Therefore, they should not be used as a “rescue medication.”  Studies have shown that long-acting bronchodilators can enhance the anti-inflammatory properties of inhaled corticosteroids when used together, such as Advair (a combination of fluticasone with salmeterol), Symbicort (budesonide with formoterol), and Dulera (mometasone with formoterol).  Anti-inflammatory medication can decrease airway inflammation, and therefore lessen the frequency and severity of asthma attacks and airway damage.  Inhaled corticosteroids, which have few side effects, can provide the most effective long-term control for moderate to severe asthma.

Cromolyn sodium and Nedicromil, which are not as strong as corticosteroids, are widely prescribed to prevent or treat mild asthma because of their ability to stop the release of mast cells into the bronchial tissue.  Leukotriene blockers, such as Singulair (montelukast) and Accolate (zafirlukast), can relieve asthma and allergic rhinitis, but not as effectively as inhaled corticosteroids.  Still, leukotriene blockers are a good choice for patients with mild allergic rhinitis and asthma.

During moderate to severe episode of asthma, one may require a short course of oral corticosteroids to rapidly gain control over worsening symptoms.  In such cases, oral corticosteroids can help quick-relief medications work more effectively, resulting in a more rapid reversal or reduction of airway inflammation.  Asthma episodes can be well controlled and even prevented with the use of bronchodilators and anti-inflammatory drugs.  Furthermore, a ground-breaking anti-IgE therapy called Xolair can offer new hope for severe allergic asthmatics.

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