Updated 12 April 2019

The daily, long-term treatment of asthma

Corticosteroids (inhaled with a spacer), cromolyns and leukotriene inhibitors are the medications that can be used for asthma treatment.

Corticosteroids, cromolyns and leukotriene inhibitors are long-term control medications that control and prevent inflammation in the lining of the bronchi and help stop or reduce swelling and mucus build-up in the airways.

These drugs will take about 10 to 14 days to become effective, so you can't expect an immediate improvement. After one to two weeks, however, you should experience a reduction in the number of asthma symptoms. This medication won't work unless you take them every day, even when you are feeling well.

All about corticosteroids
Steroids are a wide range of chemicals made by the body and produced in laboratories. One group of steroids, the corticosteroids, is used to treat asthma. Don't confuse corticosteroids with anabolic steroids, which are abused by athletes to enhance their performance! They are completely different substances.

Corticosteroids are the strongest inhaled "anti-inflammatory" and are used to treat moderate and severe cases of asthma. Be sure to consult your doctor about the dosage and don't make any adjustments to your treatment without his or her help. Steroids can be inhaled, swallowed (tablet or syrup form) or given intravenously in acute cases.

Inhaled steroids (chemical names include: beclomethasone, budesonide and fluticasone)

  • Inhalation is the preferred route because the drug goes straight to the target organ - the lungs, with much less being deposited in the mouth and swallowed.
  • Because of the direct application, the smallest dose can be used and this results in fewer side effects.
  • Inhaled steroids work by damping down the immune system. This helps reduce swelling and mucus production.

Possible side effects

  • A hoarse voice or oral thrush, both of which can be prevented by rinsing your mouth with water after inhalation. It's always best to use a spacer, as this reduces side effects.
  • Growth retardation: the dosages are in actual fact very small and lower than the body's natural production of corticosteroids, but effective because it is delivered straight in the lungs. Corticosteroids may have a growth inhibiting effect.

Oral steroids (chemical names include: prednisolone, betamethasone and prednisone)

  • These are more powerful than inhaled steroids and are usually used to treat emergencies and severe cases.
  • They are available as syrup or as tablets and are usually only taken for five to ten days when you need to gain quick control of persistent asthma.
  • Many patients keep a course at home for emergencies when their asthma worsens significantly.

Possible side effects

  • Oral steroids can cause an increase in appetite, mood changes, fluid retention, slight weight gain and elevated cholesterol.
  • Stunted growth in children, brittle bones, high blood pressure, diabetes and cataracts may occur, but only with continuous use.

Injected steroids
These are usually given in hospital and are reserved for severe asthma attacks when patients are unable to swallow oral steroids.

Cromolyns (chemical names include nedocromil sodium and sodium cromoglycate)
Non-steroid treatment to reduce the chronic inflammation are used in people with mild intermittent asthma. This medication may be taken as a powder inhaler (spincaps), nebuliser solution or aerosol.

Children seem to respond better to this drug than adults, but it will take two weeks of continuous treatment to experience the benefits. The use of cromolyns alone should be restricted to mild intermittent asthma, and exercise-induced asthma symptoms.

If, with exercise, there's little relief or if persistent asthma symptoms develop, the role of cromolyns should be restricted to add-on therapy to the gold standard of inhaled corticosteroids.

Possible side-effects

  • The side-effects of non-steroid, anti-inflammatory drugs are mild and rare, but may include mild headaches and nausea.
  • You may also experience irritation of the throat, hoarseness and dry mouth.

Leukotriene inhibitors (chemical names include: montelukast sodium and zafrilukast)
Leukotriene inhibitors are the latest drugs developed to treat asthma. They are currently used as add-on therapy to inhaled corticosteroids, when single therapy with the inhaled corticosteroids is insufficient to gain symptom control. Leukotriene inhibitors may also help treat patients with allergic rhinitis, exercise-induced asthma or ASA (aspirin sensitive asthma). Being a tablet (some taken once a day, some twice a day) makes it easier to give to very young and very old patients - or to those with poor spacer co-ordination.

Leukotriene inhibitors work by blocking the action of leukotrienes, one of the many potent chemical classes which promote the damaging airway inflammation characteristic of asthma.

Leukotriene inhibitors may reduce the need for high doses of inhaled or oral corticosteroids, and with better control, you will experience a reduced need to use your reliever medication.

Be warned!
Don’t try to reduce your inhaled steroids without the guidance of your doctor.

Possible side effects

  • Leukotriene inhibitors are not recommended if you're pregnant or breast-feeding and the safety and efficacy hasn't been established in children under two years old.
  • Side effects may include fatigue, abdominal pain and fever.
  • Like many other drugs, they may react with certain drugs. Just tell your doctor if you are taking any other medication.

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Professor Keertan Dheda has received of several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others.Read his full biography at the University of Cape Town Lung Institute

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