Introduction
A number of different drugs are used to treat asthma. These are prescribed according to the severity of the asthma, based on a graduated scheme. A distinction can be made between those containing cortisone, anti-inflammatory drugs and those that work by dilating the airways.
Drug groups for bronchial asthma
Glucocorticoids are one of the most important groups of drugs used to treat asthma. Cortisone belongs to the glucocorticoids. They have a strong anti-inflammatory effect and are therefore very effective.
On the one hand, glucocorticoids can be taken by inhalation and thus help in acute attacks. On the other hand, they can also be taken as tablets and thus prevent attacks. Another important group of drugs in the treatment of asthma are bronchodilators.
They dilate the bronchial tubes and are therefore mainly used by inhalation. Bronchodilators include three other groups: Preferred inhaled glucocorticoids and LABA are used in asthma therapy and SABA in acute attacks. Leukotriene receptor antagonists are used as an alternative if the standard therapy does not work or is not tolerated.
- First there are the beta2 sympathomimetics, which in turn are divided into the fast acting and the longer acting beta2 sympathomimetics (SABA and LABA). SABA are used for immediate therapy in acute attacks, while LABA are only used in advanced stages of asthma. – Bronchodilators also include anticholinergics and theophylline derivatives.
However, these are not used so frequently in Germany. – The third group of drugs used are leukotriene receptor antagonists. Like glucocorticoids, they have an anti-inflammatory effect. However, they cannot be used for the acute therapy of a seizure, but only prophylactically.
Typical asthma medication
Various drugs containing cortisone are used to treat bronchial asthma. The main active ingredients are:
- Beclometasone
- Budesonide
- Ciclesonide
- Fluticasone
- Mometasone
Beclomethasone dipropionate can be used to treat bronchial asthma of all degrees of severity as well as COPD. It is inhaled as a powder or solution.
The dosage for adults ranges from 0.2 to 0.8 mg per day depending on the severity of the disease. The daily dose can either be taken at once in the morning or in the evening or divided into 2 intakes. The maximum daily dose of 0.8 mg should not be exceeded by adults in the long term.
For children the maximum daily dose is 0.2 mg. Studies have shown that inhaled amounts of 1.6 – 2.0 mg beclomethasone proprionate impair the function of the adrenal cortex and thus reduce the body’s own cortisone production. If necessary, consultation with the doctor treating the patient should be sought. Budesonide is also intended for the treatment of bronchial asthma of all degrees of severity and COPD.
Budesonide preparations are available for inhalation as powders, suspensions (finest active ingredient particles in solution) or solutions. The powder for inhalation may lead to fungal infection in the oral cavity, so this dosage form is not intended for long-term treatment. For long-term treatment of asthma, the daily dose of budesonide for adults should not exceed 0.8 mg. At the beginning of the therapy, until the symptoms are reduced, maximum daily doses of up to 1.6 mg are permissible.
In children, the maximum daily dose should not exceed 0.8 mg. The effect can occur within 1-2 days, but is only optimal after about 2 weeks. Compared to the other active ingredients listed here, budesonide has the lower depot effect.
A typical drug combining budesonide with a beta-agonist is e.g. Symbicort. Ciclesonide has been approved on the German market since 2006 for the basic treatment of mild to severe bronchial asthma. It is applied with a metered dose inhaler (pumping action from the inhaler) once a day, either in the morning or evening.
The recommended daily dosage is 80 – 160 μg. An initial improvement occurs within 24 hours. It is therefore not an emergency medication.
For the time being, preparations with Ciclesonide are only approved for patients older than 18 years, as there is not yet sufficient experience for the treatment of asthma in children. Fluticasone proprionate is inhaled as a powder or suspension. It is only available in combination with salmeterol.
This is a long-acting ß2-sympathomimetic; a class of drugs that is also used in asthma therapy. In severe asthma, the administration of cortisone alone is sometimes not sufficient. For this reason, long-acting ß2-sympathomimetics are given additionally, which are best taken at the same time as the cortisone preparation.
In the past, the patient needed an inhaler for each preparation. Combination preparations of glucocorticoids and ß2-sympathomimetics, also called fixed preparations, facilitate the application. Mometasone furoate has been on the market since 2003 as a drug for severe asthma and COPD.
It is taken as a powder for inhalation. It is also used as an ointment for various skin diseases. The maximum daily dose is 800 μg and is recommended only for severe asthma.
In the long term, a daily dose of 400 μg is recommended, either all at once or divided into 2 intakes of 200 μg inhaled morning and evening. Mometasone furoroat is not recommended for the treatment of children. Studies have shown that high doses increase the incidence of fungal infections in the mouth and throat.
Therefore, especially with asthma therapy, you should make sure to rinse your mouth after inhalation. In addition, long-term high doses > 800 μg can impair the function of the adrenal cortex. The active ingredient of the drug Spiriva® is tiotropium.
Spiriva® is used in the context of so-called COPD (chronic obstructive pulmonary disease). The main symptoms of this disease are a chronic cough and increasing difficulty in breathing. It is therefore not a drug for asthma, but is used for the accompanying asthma component in COPD. Spiriva® dilates the bronchial tubes and alleviates shortness of breath and, when taken regularly, also reduces the occurrence of acute exacerbations of the disease.
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