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Other Long-Term Control Medications


Lt Col Reynolds
Long-term control medicines are anti-inflammatory, meaning that they help control airway inflammation. Dr. Flemings, can you tell us about this kind of medicine?

Dr. Flemings
Of course, Dr. Reynolds. Long-term control medications are generally taken every day to reduce the occurrence of asthma attacks. The full effects of these medicines are felt after taking them for several weeks. People with persistent asthma need to take long-term control medicines, usually for an extended period of time.

In some cases, oral steroids are used for short periods of time to bring asthma under control. The tablet or liquid form may also be used to control severe asthma.

In addition to inhaled corticosteroids, which are the preferred medicine for controlling persistent asthma, other long-term control medicines include:

  • Inhaled long-acting beta-agonists
  • Leukotriene modifiers
  • Mast cell stabilizers
  • Methylxanthines
  • Immunotherapy or allergy shots
  • Anti-IgE therapy, and
  • Anti-IL-5 therapy

Many people with asthma need both a short-acting bronchodilator to use when symptoms get worse, and long-term daily asthma control medicines to treat the ongoing inflammation. If you stop taking long-term control medicines, your asthma will probably get worse, so be sure to consult with your provider before making medication changes.

Over time, your provider may need to make changes in your asthma medicine. You may need to change your dose or try a combination of medicines. Be sure to work with your provider to find the best treatment for your asthma. The goal is to use the least amount of medicine necessary to control your asthma symptoms.

Inhaled long-acting beta-agonists
These medicines are bronchodilators, or muscle relaxers, not anti-inflammatory drugs. They are used on a daily scheduled basis to help control moderate and severe asthma and to prevent nighttime symptoms. Long-acting beta-agonists should not be used to relieve acute asthma symptoms or provide immediate rescue from an asthma attack.

Long-acting beta-agonists are usually taken together with inhaled corticosteroid medicines. In fact, a black box warning on long-acting beta-agonist medications has been issued and recommends that they not be used without an inhaled steroid. When used in combination, studies suggest there is no increase in risk for adverse events. Talk to your provider to determine the best medication regimen for you.

Leukotriene modifiers
These medications (for example, montelukast, zafirlukast, zileuton) are used either alone to treat mild persistent asthma or together with inhaled corticosteroids to treat moderate or severe persistent asthma. They also may be helpful in treating allergies and exercise-induced asthma in some patients.

Mast cell stabilizers
These medications (for example, cromolyn, nedocromil) are non-steroidal anti-inflammatory medications that may be used to treat asthma.

These medications (for example, theophylline) can also be used to treat asthma. People who take theophylline should talk to their provider about side effects and potential interactions with other drugs. In addition, they should have their blood levels checked to be sure the dose is appropriate.

Immunotherapy or allergy shots
These may be used to reduce asthma symptoms caused by allergens in certain individuals. This form of treatment may help decrease symptoms of allergies and asthma by lowering a patient’s sensitivity to specific allergens.

Anti-IgE therapy
This form of treatment may be used for patients with moderate to severe persistent allergic asthma. IgE is an antibody that binds to allergens such as dust mites, mold, animal dander, and pollen. The binding of IgE to allergens results in allergic symptoms in some people. Anti-IgE therapy can reduce free IgE in the body and may result in reduced allergy and asthma symptoms.

Anti-IL-5 therapy
This form of treatment may be used for patients with moderate to severe asthma. It targets an inflammatory marker in the body that can cause airway inflammation of the lungs.