Asthma Medications

Over-the-counter asthma medications

There are several different types of over-the-counter (OTC) medications available for the treatment of asthma. Many individuals take these for temporary relief of mild asthma symptoms. All of these medications are bronchodilators, which relax muscles in the airways to make breathing easier, as well as make it easier to cough up mucus. There are two different forms of OTC asthma medications:

• Inhaled (inhaler). Contains epinephrine (adrenaline), and is used to quickly treat symptoms such as wheezing.
• Oral (caplets, tablets). Contains the stimulant ephedrine, and usually take 30 to 60 minutes to reach full effect.

There are several different concerns with the use of OTC asthma medications. While all of these medications sold in the United States have been approved by the U.S. Food and Drug Administration (FDA), the FDA recommends that an individual use these treatments only with a physician’s approval. Some of the specific concerns with OTC asthma medications include:

• By having symptoms relieved on a daily basis, an individual may fail to seek long-term treatment for a serious asthma condition – damaging their lungs.
• A physician cannot evaluate how much is being taken when it is distributed OTC.
• This type of medication is not suitable for every condition and individual. It can cause complications and can interfere with a number of conditions (e.g., high blood pressure, thyroid disease, heart disease, diabetes, enlarged prostate).
• These medications can cause several different side effects (e.g., nervousness, sleeplessness, anxiety, nausea, reduced appetite, rapid heartbeat, tremors).

Individuals should always inform their physician before taking any type of OTC asthma medication.

Conditions of concern with asthma medications

Patients with certain conditions may need to avoid some types of asthma medications. Conditions of concern include:

• Food allergies. Individuals with allergies to soy lecithin, soybeans or peanuts should avoid using anticholinergic inhalers.
• Abnormal heart rhythms (arrhythmias). Failure of the heart to beat at a normal, consistent pace. Theophylline, beta2 agonists and other bronchodilators may not be recommended. In addition, the use of mast cell stabilizers may not be advised.
• High blood pressure. Anticholinergics, theophylline, beta2 agonists and other bronchodilators may not be recommended. In addition, the use of mast cell stabilizers and corticosteroids may not be advised.
• High cholesterol. Corticosteroids may not be recommended.
• Cardiovascular disease. Anticholinergics, theophylline, beta2 agonists and other bronchodilators may not be recommended. Physicians may also advise against the use of mast cell stabilizers.
• Weak heart. Weakened heart muscle. Corticosteroids may not be recommended.
• Diabetes mellitus. A disorder in the body's ability to break down blood sugar (glucose). Theophylline and some types of corticosteroids may not be recommended.
• Glaucoma. A group of eye diseases that affect the optic nerve, which connects the eye to the brain. Anticholinergic inhalers, theophylline, beta2 agonists and other bronchodilators may not be recommended. In addition, the use of corticosteroids may not be advised.
• Hyperthyroidism. Excessive reaction of the thyroid organ, which normally regulates the metabolic rate. Anticholinergics, theophylline, beta2 agonists and other forms of bronchodilators may not be recommended.
• Hypothyroidism. Decreased production of thyroid hormone. Inhaled corticosteroids may not be recommended.
• Urinary disease or difficulty urinating. Anticholinergics and other bronchodilators may not be recommended.
• Bleeding disorders. Anticholinergics and leukotriene modifiers may not be recommended.
• Systemic fungal infection. Inflammatory condition affecting the entire body and caused by an infection to a fungus. Oral or intravenous corticosteroids may not be recommended.
• Strongyloides. Worm infestation. Corticosteroids may not be recommended.
• Amebiasis. Infection with an amoeba (one-celled organism). Some types of nasal corticosteroids may not be recommended.
• Seizures (epilepsy). Burst of abnormal electrical signals in the brain that interrupts normal brain function. Often characterized by convulsions. Theophylline may not be recommended.
• Phenylketonuria (PKU). An inherited metabolic disorder. Leukotriene modifiers may not be recommended.
• Peptic ulcer. Deep sore or break in the mucous membrane lining the digestive tract. Theophylline and corticosteroids may not be recommended.
• Hiatal hernia. The protrusion of a portion of the stomach into the chest cavity through a natural opening in the diaphragm. Anticholinergics may not be recommended.
• Intestinal blockage or other intestinal problems. Anticholinergics and corticosteroids may not be recommended.
• Ulcerative colitis. A disease involving ulcers of the large bowel. Anticholinergics and corticosteroids may not be recommended.
• Gastroesophageal reflux disease (GERD). Characterized by the backflow (reflux) of acid or stomach contents from the stomach to the esophagus. Theophylline may not be recommended.
• Liver disease. Anticholinergics, mast cell stabilizers, theophylline and leukotriene modifiers may not be recommended. In addition, the use of corticosteroids may not be advised.
• Kidney disease. Anticholinergics, corticosteroids, theophylline and mast cell stabilizers may not be recommended.
• Prostate problems. Anticholinergics may not be recommended.
• Osteoporosis. A disorder in which the bones lose mass and density. Inhaled corticosteroids may not be recommended.
• Chickenpox or measles. Corticosteroids may not be recommended.
• Acquired immune deficiency syndrome (AIDS). Viral disease that weakens the immune system. Corticosteroids may not be recommended.
• Eye infections. Mast cell stabilizer eye drops may not be recommended.
• Nasal polyps. Mast cell stabilizers nasal sprays may not be recommended.
• Fever. Anticholinergics may not be recommended.
• Pneumonia. An infection or inflammation of the lungs that results in the lungs’ air sacs becoming filled with fluid. Theophylline may not be recommended.
• Psychosis. A mental condition that causes people to lose touch with reality. Corticosteroids may not be recommended.
• Tuberculosis. Infectious disease causing rounded swelling to form on the mucous membranes in the lungs. Oral or intravenous corticosteroids may not be recommended.
• Myasthenia gravis. A neuromuscular disorder characterized by muscle weakness. Anticholinergics and corticosteroids may not be recommended.
• Downs syndrome. A genetic condition that causes developmental delays. Anticholinergics may not be recommended.
• Brain damage (in children). Anticholinergics may not be recommended.
• Spastic paralysis (in children). Anticholinergics may not be recommended.
• Pheochromocytoma. A rare and usually benign tumor that produces adrenaline, raising blood pressure and heart rate. Bronchodilators may not be recommended.

Potential side effects of asthma medications

The most common side effects associated with asthma drugs include:

• High blood pressure
• Skin rash, itchiness or hives
• Mouth and throat irritation
• Rapid heartbeat
• Heart palpitations (an awareness of a strong, fast, irregular or "galloping" heartbeat)
• Stomach ulcer
• Heartburn, upset stomach or loss of appetite
• Headache
• Nervousness or restlessness
• Irritability
• Insomnia
• Dizziness
• Loose bowel movements
• Abdominal pain
• Coughing
• Bad taste in the mouth
• Sneezing
• Wheezing
• Nausea
• Vomiting
• Fluid retention
• Earache
• Dry mouth
• Respiratory infections
• Thinning of the skin which can lead to easy bruising
• Chest tightness
• Difficulty breathing
• Tremors
• Muscle twitching
• Swollen hands or face
• Obesity
• Blurred vision

Other potential side effects include:

• Oral yeast infection (thrush)
• Decreased growth in children
• Seizures
• Severe weakness or confusion
• A stinging sensation in the nose or nosebleeds
• Increased risk of infection from chickenpox or measles
• Increased risk of osteoporosis (a disorder in which the bones lose mass and density)
• Increased risk of glaucoma (a group of eye diseases that affect the optic nerve, which connects the eye to the brain) or cataracts (a clouding of the eye's lens) if used long–term

Drug or other interactions

Patients should consult their physicians before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. Of particular concern to individuals taking asthma medications are:

• Drugs that suppress the immune system (e.g., cyclosporine). Can interfere with the function of oral and intravenous corticosteroids.
• High-doses of aspirin or anticoagulants (medications that inhibit the blood’s ability to clot) can increase the risk of stomach bleeding or ulcers when used with oral corticosteroids. However, aspirin should not be used by anyone with asthma, unless they have a physician's approval, because the drug can trigger an asthma attack in some asthmatic individuals.
• Diabetic medications (e.g., insulin). Can interfere with the function of oral and intravenous corticosteroids, requiring changes in dosage.
• Large amounts of caffeine. Can increase the side effects of theophylline.
• Seizure medications. Phenytoin can decrease the effectiveness of oral and intravenous corticosteroids and decrease blood levels of theophylline. Carbamazepine can decrease theophylline blood levels.
• Phenobarbital (a sedative). Can decrease the effectiveness of oral and intravenous corticosteroids.
• Rifampin (used to treat tuberculosis). Can decrease the effectiveness of oral and intravenous corticosteroids.
• Ketoconazole (used to treat fungal infections). Can lead to a build up of oral and intravenous corticosteroids in the blood, increasing toxicity.
• Erythromycin and ciprofloxacin (antibiotics). Erythromycin can increase the blood levels and toxicity of oral and intravenous corticosteroids. Erythromycin and ciprofloxacin can lead to a build up of theophylline in the blood, increasing toxicity.
• Cimetidine (used to treat ulcers). Can lead to a build up of theophylline in the blood, increasing toxicity.

There are no known drug or food interactions with the following asthma medications:

• Inhaled corticosteroids
• Leukotriene modifiers
• Beta2 agonists
• Inhaled anticholinergics
• Mast cell stabilizers

Pregnancy use issues with asthma medications

While physicians ideally recommend that all medications be avoided during pregnancy, this is often not possible – especially with an asthma condition. Because it is very important to maintain a healthy oxygen supply to the fetus, many women use medication to control their asthma symptoms. However, physicians recommend some asthma medications more than others for use during a pregnancy. There are two factors that most physicians consider when recommending an asthma medication:

• How long the medication has been available. The longer a medication has been used, the more data is available on its safety. Medications that have been around for years without showing pregnancy complications are generally considered safe by most physicians.
• How the medication is delivered. Inhaled medications are preferred, because less medication reaches the fetus, reducing the potential for a harmful reaction. Oral or intravenous treatments are usually more potent because the drugs have to travel further through the body to reach the problem area.

Specialists will work with a woman’s obstetrician to prescribe medications that are safe to use during pregnancy. They can also monitor the patient throughout the pregnancy to ensure that the treatments are effective and not causing undesired side effects.

Breastfeeding through the first twelve months after birth is considered by most physicians to be beneficial to a child. While any sort of medication taken during this period should be discussed with a physician first, generally most asthma medications will not adversely affect a nursing newborn or the mother’s milk production. Inhaled medications are considered the safest types of treatment, as they allow for very little medicine to pass into the breast milk.

Theophylline is occasionally associated with causing jitteriness, feeding difficulties or vomiting in nursing babies when taken by their mothers. However, this reaction is rare and the drug is passed on to the nursing child in only trace amounts. Theophylline is rarely prescribed in the United States.

Child and asthma medications

Children can use many types of asthma drugs as long as the dose has been adjusted for the child’s age and size. However, parents should be aware of important issues relating to some drugs. Children may experience more pronounced side effects than adults with some asthma medications. Never give a medication to a child before consulting a physician. Drugs and potential issues relevant to children include:

• Inhaled bronchodilators (e.g., beta2 agonists, anticholinergics). Many children with asthma use this kind of medication exclusively. Because of the few and mild side effects associated with these medications, some children tend to overuse the treatment. This type of medicine should never be used more often than prescribed (unless a physician directs otherwise). Overuse can worsen symptoms and interfere with the treatment of asthma symptoms. If a bronchodilator is unable to control asthma symptoms, a physician should be immediately notified.
• Mast cell stabilizers (e.g., cromolyn, nedocromil). These medications have been evaluated and considered safe for long-term use in children. They must be taken regularly to be effective. Some children take the medicines inconsistently, resulting in greatly diminished effectiveness. Parents should make sure their child understands how to properly take the medication or supervise each dose to make sure it is taken.
• Oral corticosteroids. There are a large number of side effects associated with these medications. Because side effects are often more intense in children, use of oral corticosteroids in children should be limited as much as possible. Extended use of this treatment has been associated with slower growth in some children. Many physicians favor an inhaled form of corticosteroids for this reason.

A device called a spacer allows many children younger than 3 to use metered dose inhalers. A spacer is a type of holding chamber that attaches to the mouthpiece of an inhaler. It makes it much easier to breath in an inhaler dose. Nebulizers

Nebulizers can make it easier for young children to receive some types of aerosol treatments – often inhaled bronchodilators. Nebulizers force air into liquid medication, aerosolizing the medicine and allowing it to be easily inhaled – often through a mask that fits over the nose and mouth. The use of a nebulizer ensures the maximum amount of medication reaches the lungs. The face mask also makes this a good treatment technique for infants. However, ultrasonic nebulizers should not be used with some medications, such as budesonide.

Children should always take their medications based on an asthma action plan that they have developed with their physician. This type of plan offers detailed, written information on when asthma medications should be taken, what types should be used, what dosages are best and what to do in the event of a severe reaction. Having a plan worked out in advance and posted where a child can easily read it can help a child understand when and how their medications should be taken. A copy of the plan can also be supplied to schools, daycare facilities or babysitters as needed.

Elderly use issues with asthma medications

Asthma medications, like all types of medications approved by the U.S. Food and Drug Administration (FDA), are required to include a separate “geriatric use” section on the labeling of the medication. Users of asthma medications aged 65 and older are encouraged to carefully read this information before taking any type of asthma medication.

Generally, the side effects of a medication are more pronounced in elderly users. This is usually a result of the body’s declining ability to efficiently process some medications. For example, the kidneys are often involved with eliminating certain types of drugs from the body, which limits or avoids the side effects of those drugs. However, kidney function commonly decreases with age, reducing the body’s ability to effectively dispose of those medications. A buildup of medications in the body increases the risk of side effects.

Older adults appear to have an increased risk of developing high blood pressure or osteoporosis (a disorder in which the bones lose mass and density) when taking corticosteroid drugs.