Asthma medicines: now they are ranked

Kind of in the fashion of a fun sports column, I recently had a little fun ranking asthma medicines.

The Top 10 Asthma Medicines

By Rick Frea, Wednesday August 4, 2010, @ MyAsthmaCentral.com

It would be neat if asthma was like a sport. Instead of writing dry, humorless posts, we could write exciting and entertaining posts about our theories and herald new inventions like the new vaccine that's supposed to cure allergies.

Another thing sports writers do that's fun is make fake rankings like this. They have fun writing these, and we have fun reading them. So I thought, for the fun of it, to rank 10 asthma medicines from worst to best (in my humble opinion of course).

So with sports on our minds, let's have a little fun with ranking common asthma medicines. How do your meds stack up?

10. Non-steroidal anti-inflammatory drugs (NSAIDS). Sorry to say it, but this one time classic team, which included Cromolyn and Tilade, has served its purpose and now finds its way in the trash heap of no-longer-used asthma medicines. If you find yourself on these medicines still, chances are you have been, or will soon be, forced to try more modern medicines. You may even find out the newer medicines allow you for even better asthma control.

9. Long-acting Beta Adrenergic (LABA): Powered by Serevent and Formoterol, these inhalers help asthmatics control bronchospasm long term and were one time top prospects in the asthma medicine farm system. Yet things just never panned out for LABAs, as most studies show while these inhalers treat the symptoms, they don't control the underlying chronic inflammation present in most asthmatic lungs. So asthma experts now contend if you need this medicine, you best be getting it in conjunction with an inhaled corticosteroid. Or, better yet, you should check out #1 on this list.

8. Oral steroids: Yes, prednisone and solumedrol hit homeruns in those desperate situations when you need to gain control of inflammation in your lungs. Yet, due to side effects, these meds are best avoided unless you really need them. The best way to avoid this team is by obtaining and maintaining good asthma control, which is best achieved by being compliant with meds one to three on this list.

7. Oral Bronchodilators: Fifteen years ago this was #2 on this list. It was a powerhouse team led by Theophylline that lead many asthmatics to improved asthma control. Yet now its usefulness has pretty much run out, and the old veteran was forced to retire. It was a great bronchodilator in its day, but the risks and side effects are far greater than newer medicines used to control asthma.

6. Immunomodulator: Here we have the latest trend in asthma medicines -- the young prospect like Xolair -- the IgE inhibitors. This is an expensive and one time injection that works to prevent asthma symptoms when you're exposed to your asthma triggers. This is basically only used for those with severe asthma not controlled with other meds on this list. Yet for some, I bet this medicine may be their #1 asthma medicines. Until further studies show better results, we had better subdue our expectations, hence the low ranking.

5. Xopenex: This Albuterol copycat was once believed to be stronger and have fewer side effects than Albuterol; yet new studies question that wisdom. Yes, it's now available in inhaler format, yet the added benefit to cost ratio may not make this medicine worth it (at least for the time being).

4. Albuterol: Ah, so you thought I'd rank this classic asthma medicine #1. After all, it's helped many an asthmatic breathe better on the spot. Perhaps that would have been the case, say, ten years ago. Today, however, chances are if you need this medicine often, your asthma is not under control. Every asthmatic should have this medicine on hand, yet it should be needed seldom. So there.

3. Inhaled Corticosteroids: This team is chock full of talent. We have Flovent, QVAR, Asthmanex and Pulmicort as the big boys hitting in the middle of the lineup, followed by some older veterans that appear to be mostly washed up. Use of one of these inhalers is the best proven method of treating chronic inflammation in your airways. Yet new research shows that if these don't work, #1 on this list may be better options.

2. Leukotriene modifiers: This team is closing in on the top spot, and includes some top hitters, such as Singulair and Accolate. This medicine works well on it's own for some patients by blocking the allergic response and controlling inflammation. Yet often it's used in conjunction with, ahem, the #1 asthma medicine on this list. Until I started taking this medicine spring hay fever season was miserable. Not anymore. For this reason alone, I have to rank this team near the top.

1. Combination inhalers: Ah, a rare leader at the top. The combination of Flovent and Serevent in one inhaler called Advair, and Formoterol and Pulmicort in another called Symbicort, creates a lineup like no other in the history of asthma medicine. Too many people are scared away from these meds because of FDA warnings and poor education. Yet I contend, and so does every study I've seen, that these combination inhalers greatly improve asthma control in most asthmatics that use them. If you have poorly controlled asthma, this team may be a big hit for you too.

With new wisdom, and the asthma and allergy genes isolated, newer medicines are just around the corner. In fact, just the other day we scouted the Lebron James of asthma medicine, the allergy vaccine that might just cure allergies.

For now it's in the farm system getting tested. So stay tuned: these power rankings may be set to change real soon.