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Monday, August 10, 2009

A guide: Which asthma meds are best for you?

Since I didn't have an asthma post published last week at, I thought I'd take this opportunity to share with you a post written by fellow asthma expert Kathi MacNaughton called, "Which Asthma Medication Is Best?"

I think she outlined better than I ever could which asthma medicines work best. I highly recommend any person recently diagnosed with asthma to read this post. It also might be beneficial for any long time asthmatic to read this for a nice refresher course, as perhaps there are better asthma meds available for you that what you are currently on.

The first line of defense, she writes, per the asthma guidelines (and I humbly agree) are inhaled corticosteroids to reduce the chronic underlying inflammation of the air passages in your lungs.

Common corticosteroids are as follows:

She writes: "There are also steroid pills. Being on long-term steroids in pill form can have a number of bothersome or even serious side effects. The good news, though, is that inhaled steroids have very few of the same side effects, because they are mostly limited to acting in your airways, where they are most needed.

"Unfortunately, inhaled steroids are not always successful in controlling asthma for every person. They do work great for most of us, but people with severe asthma may need to try something additional or something different altogether."

Other choices are:

  1. Leukotriene modifiers: These medicines (Singulair and Accolate) block leukotrienes that are released when you are exposed to your allergens (asthma triggers) . Since leukotriences can cause bronchospasm, blocking them can help you control your asthma. This works well for some asthmatics.
  2. Combination asthma inhalers: These include Advair and Symbicort. These contain both a corticosteroid to help manage underlying inflammation, and long acting bronchodilator to to keep your air passages relaxed. These are used "When Singulair or an inhaled steroid alone don't adequately control asthma symptoms."

Other choices:

  1. Inhaled long acting bronchodilators: This would include medicines like Serevent and Foradil. Studies have found if asthmatics need long acting bronchodilators they should also be on an inhaled corticosteroid to control underlying inflammation. Using this medicine alone is no longer recommended by the FDA to control asthma.
  2. Oral bronchodilators: This would include theophylline. This was once the cornerstone of asthma therapy, but due to side effects and better medicines (as noted above), this is no longer used except for in cases of severe persistent asthma where front line medicines are lacking in controlling asthma.
  3. Oral steroids: These used to be used more often to treat chronic asthma, however due to side effects they are used less often today except for in cases of severe excacerbations, and usually only short term. A common oral steroid is prednisone.
  4. Mast Cell Stabilizers: This would include Intal and Tilade. These were very common in the 1980s, and have very few side effects. But due to better asthma medicines listed above, these are less often used today.

So, she writes, which asthma medicine is best for you. "Unfortunately, the only really correct answer to this question is, 'It depends...' Every pharmaceutical company will try to convince you that their drug is best. And if you talk with other asthmatics, chances are they'll tell you whatever they take is best. But the truth is, we are each of us different, with slightly different things going on in our bodies.

"So, how you will react to a specific asthma medication is not entirely predictable. Asthma treatment is very much a case of trial and error. Your doctor will prescribe something for you and wait to see how well it works."

Well stated.

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