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First Line Agents for Asthma



What should be first line agents for asthmatic control in patients who are hypersensitive to Salbutamol and related drugs?


Asthmatics who have asthma symptoms more than twice a week during the day or twice a month at night need to be on a "controller" asthma medicine.  "Controller" asthma medicines help control the inflammation (swelling) in the breathing tubes.  The inhaled steroids are considered "first line" or preferred controller medicines.  Some examples of inhaled steroids include: Aerobid, Asmanex, Azmacort, Flovent, Pulmicort and QVAR.  However, in mild asthma, your doctor may use cromolyn, leukotriene modifier, nedocromil or theophylline in place of the inhaled steroid. 

If your asthma is not controlled on an inhaled steroid another medicine is needed.  The preferred treatment is to give an inhaled steroid with a "long acting bronchodilator" medicine.  Examples of long acting bronchodilators include: Serevent (salmeterol) or Foradil (formoterol).  Advair is a mixture of inhaled steroid (fluticasone) and long acting bronchodilator(salmeterol).

Some people cannot tolerate the long acting bronchodilator or their doctor believes alternative medicines would be better.  In this case, a leukotriene modifier like Singulair or Accolate; or theophylline may be added to the inhaled steroid.

All asthma patients should have a "rescue" medicine to use if they develop sudden breathing problems.  "Rescue" medicines are short-acting bronchodilators that open the breathing tubes quickly.  Some examples of "rescue" medicines include: Proventil (albuterol), Ventolin (albuterol), Maxair (pirbuterol) or Xopenex.

If you have difficulty with any of your asthma medicines or your asthma is not controlled it is important to talk to your doctor about your concerns before stopping the medicine.

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Response by:

Cathy   Benninger, RN, MS, APRN, C-AE Cathy Benninger, RN, MS, APRN, C-AE
Clinical Assistant Professor
Director, OSU Asthma Center Educational Program
College of Medicine
The Ohio State University