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Asthma Controller Drugs
Can we control asthma?
Why should we control asthma?
Sodium cromoglycate
Inhaled steroids
Long acting beta agonists
Slow release theophylline
Leukotrienne antagonists
Oral steroids
Ketotifen
These are the drugs that control a child's asthma. Children with mild, intermittent asthma do not
need any controller therapy; all children with more severe forms of asthma should be on
controller therapy. This therapy is aimed at keeping the asthma under control, thus protecting
the lungs from irreversible damage and allowing the child a normal life.
Since these drugs have to be taken for a long time, safety is more than ordinarily important.
Acceptance by the child is also essential - the best therapy will fail if the child doesn't take it.
Factors that promote acceptance are low number of daily doses, no need for doses at school,
low incidence of side effects, and proper understanding of the requirement of therapy.
This drug is believed to reduce the inflammation in the airways and so reduce the acute attacks of asthma. The safest of all anti asthma drugs. It is often taken by children for years, and side effects are
rare. The onset of action takes some weeks, and many patients do not benefit at all. Cromoglycate is the
drug of choice for initiating treatment in mild asthma.
It is also useful as pretreatment in children who suffer from exercise induced asthma. A puff of this drug, taken before participating in games, will protect the child.
Problems with the drug include dosing four times a day, and cost significantly higher than corticosteroids.
The mainstay of asthma control today. The steroids used for inhalation have some properties in common - they act on the surface of the airways, and they are rapidly inactivated by the liver. This latter property prevents side effects. The three drugs available in India are beclomethasone,
budesonide, and fluticasone.
These drugs are reliably effective in asthma. They reduce airway inflammation and bronchial
hyperresponsiveness, and prevent the deterioration in lung function that is an accompaniment of
asthma. Used regularly, they can allow the child to have a normal life. At low doses, and used
with precautions to reduce side effects, they have been found to be very safe at low doses. At
high doses, too, they are far safer than the doses of oral steroids that would be required to
maintain equivalent control of asthma.
Advantages of this class drugs is that they need to be taken only twice a day, thus eliminating
any need for medication in school. They are less expensive than cromoglycate, and more
effective Side effects include fungal infection of the mouth, hoarseness, and cough. At high
doses, they may also cause growth reduction, and suppression of the pituitary and adrenal
glands, though these effects are controversial. They may sometimes cause cataracts, and
thinning of the bones.
As with all treatment, the risks of a drug must be weighed against the risks of therapy. We are
used to think of asthma as a troublesome illness, but children die of asthma. Regular inhaled
steroid therapy has been shown to reduce asthma deaths. Even for mildre asthma, the small risks
of adverse effects are far outweighed by the benefits.
These drugs act on the airways to dilate them, and similar to salbutamol and terbutaline. They
are slower to act, but their action persists for 8-10 hours. This makes them good drugs for those
children who have symptoms at night, or who get breathless during games or physical education
in school. A single dose at bedtime or before school can control these problems.
However, long acting beta agonists are not recommended for solo use in the control of asthma.
They effectively relieve symptoms, giving a false sense of well being, while the asthma
progresses in the lungs, sometimes to a dangerous extent.
Their recommended use is as add ons to inhaled steroid therapy. Used thus, they reduce
symptoms and improve asthma control at lower levels of steroid dose. This steroid sparing
effect is valuable, as it reduces the adverse effects of steroid therapy.
Some children on inhaled steroid therapy are well controlled during the day, but have symptoms
during the night. Though theophylline has fallen out of favour in the treatment of acute asthma,
it is useful here. Slow release forms of theophylline maintain blood of the drug for 8-12 hours,
and single dose, given at night time, will control the nocturnal symptoms, and obviate the need
for a higher dose of steroid. This steroid sparing effect ...
Theophylline was earlier used to control asthma at higher doses round the clock. It had many
side effects including stomach upset, poor sleep, and deteriorating school performance. The
single night time dose is relatively safe.
The newest drugs in anti asthma therapy. So new, they aren't yet available in India. Zafirlukast
can only be used in children above 12 years, but Montelukast can be used in children as young
as 2 years. They are orally effective drugs, and may be of value in children who cannot (or will
not) take inhaled therapy.
These drugs reduce airway inflammation, improve asthma control, and are especially useful for
children who have exercise induced asthma. They are recommended as solo therapy only for
mild asthma; for all more severe forms of asthma, they are to be used as add ons to steroids.
Some children have severe asthma, with daily symptoms, a restricted lifestyle, and frequent hospitalisation, in spite of other
treatment at maximal doses. These children are candidates for oral steroid therapy. Oral steroids are very effective, but an unattractive option because of significant side effects.
Oral steroids can cause suppression of growth, suppression of the pituitary and adrenal glands,
thinning of the bones, obesity, cataracts, raised blood pressure, diabetes, muscle weakness, and
several other adverse effects. For this reason, oral steroid therapy requires careful monitoring by
an expert, and ongoing efforts to wean the child off it as soon as possible.
The drug most commonly used is prednisolone. Giving the entire daily requirement as a single
dose in the morning has been found to reduce side effects. Once control is achieved, it may be
possible to switch to an alternate day schedule.
Measures to reduce the dose of oral steroid include concomitant inhaled steroids, and avoidance
of dust and other trigger factors.
This drug was introduced some years ago as an oral drug that controlled asthma. Doesn't.
Last revision: July 30, 2010
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