Asthma is a disorder that affects the lungs and is characterized by repeated wheezing, breathlessness, chest tightness, and early morning or nighttime coughing. During an asthma attack, the airways become swollen and inflamed, airway muscles tighten, and a reduced amount of air passes in and out of the lungs. Mucus may also block the airways. Attacks of asthma can be triggered by secondhand smoke, dust mites, air pollution, and pets, among other causes. Asthma can be subcategorized depending on symptoms, sensitivities, and triggers.
Acute asthma is a rapid onset, short and severe exacerbation of wheezing that is unresponsive to usually effective treatment and requires emergency room intervention. Acute asthma attacks are characterized by airway inflammation and narrowing, hyperinflation of the airways, pulmonary dysfunction, alterations in ventilation, and low levels of oxygen in the blood. Symptoms are those of an asthma attack such as wheezing, coughing, and shortness of breath; however, these sudden symptoms are persistent and can worsen.
Commonly Prescribed (On-Label) Drugs: Betamethasone, Methylprednisolone
Off-Label Prescription Drugs Breakthrough Options: Furosemide, Ipratropium
Allergen-induced asthma, also referred to as allergic asthma, is characterized by airway obstruction associated with allergies and is triggered by substances called allergens. Allergen triggers that can induce allergic asthma include molds, animal dander, airborne pollens, house dust mites, and cockroach droppings. Exposure to the above-mentioned allergens, among others, can prompt an allergic reaction causing asthma symptoms such as wheezing, coughing, and airway obstruction. Investigators estimate that 90% of all asthma sufferers have allergic asthma as at least a portion of their disease.
Commonly Prescribed (On-Label) Drugs: Montelukast
Off-Label Prescription Drugs Breakthrough Options: Cyclosporine, Furosemide
In about 3–5% of persons with asthma, aspirin use can cause asthma to worsen and prompt a severe and sudden asthma attack. In these people, aspirin can cause the body to produce excess amounts of chemicals known as leukotrienes; however, the complete mechanism by which aspirin induces an asthma attack is not fully known. Leukotrienes (a group of hormones that causes the symptoms of hayfever and asthma) makes the muscles around the bronchial tubes contract and results in shortness of breath and wheezing. Experiencing a negative reaction to aspirin is the only way to uncover if you have asthma sensitive to this drug. Most doctors recommend avoidance of aspirin for those with asthma.
Commonly Prescribed (On-Label) Drugs: Montelukast, Zileuton
Off-Label Prescription Drug Breakthrough Option: Furosemide
Some people have occasional asthma attacks; however, a larger group of patients develops more long-lasting, recurrent symptoms of asthma such as coughing, shortness of breath, and wheezing on every day or most days. This syndrome is known as chronic asthma. In people with chronic asthma, several medications on a regular schedule are required daily. Continued exposure to antigens (substances that cause the immune system to produce antibodies) results in a chronic state of airway inflammation. Chronic asthma requires maintenance treatment to control asthma exacerbations.
Commonly Prescribed (On-Label) Drugs: Montelukast, Pirbuterol
Off-Label Prescription Drugs Breakthrough Options: Furosemide, Ipratropium
Exercise-induced bronchospasm (EIB) occurs when the airways shrink during or after exercise. In people with EIB, exercising for more than 30 minutes can be challenging. Symptoms of EIB typically occur after five to 20 minutes of nonstop exercise, and include wheezing, difficulty breathing, coughing, chest tightness, or chest pain. EIB may be triggered by breathing in air that is cooler and drier compared with the air in the lungs. Your doctor may prescribe certain medications called “controllers” to prevent EIB.
Commonly Prescribed (On-Label) Drugs: Albuterol, Formoterol, Salmeterol
Off-Label Prescription Drugs Breakthrough Options: Furosemide, Ipratropium, Nedocromil
Steroids help to regulate a number of body functions, including inflammation. In patients with asthma, the use of steroids helps open up the airways by reducing inflammation in airway walls. With the positive benefits of steroids there are also some negative effects. If steroids are taken for a long time, the body may stop making its own supply, and in turn, steroid drugs become necessary. In instances of severe asthma, some patients may become steroid-dependent if they take steroids for an extended period of time.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Cyclosporine, Furosemide, Methotrexate
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