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 adenylyl cyclase and increased intracellular cyclic adenosine monophosphate (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.
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 HFA, Flovent Diskus)
Available as a powder for inhalation contained within the Diskus device or an aerosolized metered-dose inhaler.
Mometasone inhaled (Asmanex HFA, Asmanex Twisthaler)
Mometasone is a corticosteroid for inhalation. It is indicated for asthma as prophylactic therapy.
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.
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.
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.
Leukotriene Receptor Antagonists
Class Summary
These agents are selective 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.
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.
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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Asthma in older adults. Lung tissue normal versus constricted.
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Asthma in older adults. Airway histology and pathology.
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Asthma in older adults. Allergic and nonallergic triggers.
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Asthma in older adults. Spirometric data plot. Pre-bronchodilator forced expiratory volume-one second (FEV1) = 1.77 L, post-bronchodilator FEV1 = 3.11 L, approximating a 75% change or airway reversibility.
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There has been an upward trend in the prevalence of asthma across all age groups since 2001. Courtesy of the CDC (https://www.cdc.gov/asthma/data-visualizations/prevalence.htm).
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Asthma prevalence by age, 2017. Courtesy of the CDC (https://www.cdc.gov/asthma/data-visualizations/prevalence.htm).
