Asthma in Older Adults Medication

Updated: Oct 28, 2015
  • Author: Praveen Buddiga, MD; Chief Editor: Michael A Kaliner, MD  more...
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Medication

Beta2 agonists, rapid-acting

Class Summary

Rapid-acting, inhaled beta2 agonists are indicated for treatment of acute bronchospasm and prevention of exercise-induced asthma. Beta2-receptor activation leads to activation of adenylcyclase and increased intracellular cyclic AMP. This increase in cyclic AMP activates protein kinase A, which in turn inhibits myosin phosphorylation and lowers intracellular ionic calcium concentration, resulting in muscle relaxation.

Albuterol (Proventil HFA, Ventolin HFA, Proair HFA, AccuNeb)

Albuterol sulfate is a racemic salt of albuterol.

Levalbuterol (Xopenex HFA)

Levalbuterol tartrate is the (R)-enantiomer of albuterol.

Pirbuterol (Maxair)

Pirbuterol acetate is a racemic mixture of 2 optically active isomers.

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Corticosteroids, Inhalants

Class Summary

Inhaled corticosteroids are the primary maintenance treatment for persistent asthma. These agents decreased the dose or need for oral corticosteroids. Not indicated for relief of acute bronchospasm.

Beclomethasone, inhaled (Qvar)

Available as an inhaled metered-dose aerosol.

Budesonide inhaled (Pulmicort Flexhaler, Pulmicort Respules)

Available as a dry powder metered-dose inhaler or suspension for inhalation.

Ciclesonide inhaled (Alvesco)

Nonhalogenated glucocorticoid available as an inhaled metered dose aerosol.

Flunisolide inhaled (Aerospan)

Fluorinated glucocorticoid available as an inhaled metered dose aerosol.

Fluticasone inhaled (Flovent Diskus, Flovent HFA)

Available as a powder for inhalation contained within the Diskus device or an aerosolized metered-dose inhaler.

Mometasone inhaled (Asmanex Twisthaler)

Available as dry powder inhaler.

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Beta2 agonists, long-acting

Class Summary

These agents may be added to a maintenance treatment regimen of inhaled corticosteroids in patients with moderate-to-severe persistent asthma. This drug regimen may allow for a reduced dose of inhaled corticosteroid.

Salmeterol (Serevent Diskus)

Salmeterol xinafoate is a racemic form of the 1-hydroxy-2-naphthoic acid salt of salmeterol. The active component is salmeterol base. Available as a powder for inhalation contained within the Diskus device.

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Respiratory Inhalant Combos

Class Summary

Inhalant combinations consisting of a long-acting beta2 agonist plus a corticosteroid may be considered for moderate-to-severe persistent asthma.

Budesonide/formoterol (Symbicort)

Available as a metered dose aerosol.

Mometasone inhaled/formoterol (Dulera)

Available as a metered dose aerosol.

Salmeterol/fluticasone inhaled (Advair Diskus, Advair HFA)

Available as a powder for inhalation contained within the Diskus device. Also available as an aerosolized inhaler.

Vilanterol/fluticasone furoate inhaled (Breo Ellipta)

Indicated for once-daily treatment of asthma for adults not adequately controlled on a long-term asthma control medication (eg, inhaled corticosteroid), or whose disease severity clearly warrants initiation of treatment with both an inhaled corticosteroid and a long-acting beta agonist (LABA). Use prescribe strength (25 mcg/100 mcg or 25 mcg/200 mcg per actuation) once daily via oral inhalation. Fluticasone furoate is a corticosteroid with anti-inflammatory activity. Vilanterol is a long-acting beta agonist (LABA) that stimulates intracellular adenyl cyclase (catalyzes the conversion of ATP to cyclic AMP). Increased cyclic AMP levels cause relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity from cells, especially from mast cells.

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Corticosteroids, Oral

Class Summary

Because of severe adverse effects with long-term use with systemic corticosteroids, the lowest possible dose should be used to control asthma, and necessary measures (ie, inhaled corticosteroids, additional medications) should be employed to decrease the dose or discontinue the oral corticosteroid.

Prednisone (Sterapred, Sterapred DS, Rayos)

Oral corticosteroid used for severe asthma and acute flairs.

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Leukotriene Receptor Antagonists

Class Summary

These agents areselective and competitive receptor antagonists of leukotrienes, which are components of slow-reacting substance of anaphylaxis (SRSA). Cysteinyl leukotriene production and receptor occupation have been correlated with the pathophysiology of asthma, including airway edema, smooth muscle constriction, and altered cellular activity associated with the inflammatory process, which contribute to the signs and symptoms of asthma.

Montelukast (Singulair)

Selectively blocks binding of leukotriene D4 at the CysLT1 receptor. It is indicated for prophylaxis and chronic treatment of asthma, and for prevention of exercise-induced bronchoconstriction.

Zafirlukast (Accolate)

Inhibits bronchoconstriction as competitive receptor antagonist of leukotrienes C4, D4, and E4. It is indicated for prophylaxis and chronic treatment of asthma.

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5-Lipoxygenase Inhibitors

Class Summary

These agents inhibit 5-lipoxygenase, the enzyme that catalyzes the formation of leukotrienes from arachidonic acid. Leukotrienes, which are components of slow-reacting substance of anaphylaxis (SRSA), are correlated with the pathophysiology of asthma, including airway edema, smooth muscle constriction, and altered cellular activity associated with the inflammatory process, which contribute to the signs and symptoms of asthma.

Zileuton (Zyflo Filmtab, Zyflo, Zyflo CR)

Inhibits leukotriene B4, C4, D4, and E4 formation. It is indicated for prophylaxis and chronic treatment of asthma.

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Monoclonal Antibody

Class Summary

Inhibits IgE binding to mast cells and basophils, thereby limiting the degree of release of allergic mediators.

Omalizumab (Xolair)

Recombinant humanized IgG1-kappa monoclonal antibody. It is indicated for moderate-to-severe persistent asthma in patients with a positive skin test or in vitro reactivity to a perennial aeroallergen and symptoms that are inadequately controlled with inhaled corticosteroids.

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