Key Points - Medications
{"Image DocumentName": "Key Points - Medications", "Image ImageDescription": "2 general classes: Long-term control medications. Quick-Relief medications. Controller medications: Corticosteroids. Long Acting Beta Agonists (LABA\u2019s) Leukotriene modifiers (LTRA) Cromolyn & Nedocromil. Methylxanthines: (Sustained-release theophylline) Medications for asthma are categorized into two general classes: long-term control medications. used to achieve and maintain control of persistent asthma and quick-relief medications used to. treat acute symptoms and exacerbations. Long-term control medications (listed in alphabetical order) C. corticosteroids: Block late-phase reaction to allergen, reduce airway. hyperresponsiveness, and inhibit inflammatory cell migration and activation. They are the most potent and effective anti-inflammatory medication currently available (Evidence A). ICSs are used in the long-term control of asthma. Short courses of oral systemic. corticosteroids are often used to gain prompt control of the disease when initiating long-term therapy; long-term oral systemic corticosteroid is used for severe persistent asthma. Cromolyn sodium and nedocromil: Stabilize mast cells and interfere with chloride channel function. They are used as alternative, but not preferred, medication for the treatment of mild persistent asthma (Evidence A). They can also be used as preventive. treatment prior to exercise or unavoidable exposure to known allergens. Immunomodulators: Omalizumab (anti-IgE) is a monoclonal antibody that prevents binding of IgE to the high-affinity receptors on basophils and mast cells. Omalizumab is used as adjunctive therapy for patients 12 years of age who have allergies and severe. persistent asthma (Evidence B). Clinicians who administer omalizumab should be prepared and equipped to identify and treat anaphylaxis that may occur (see discussion in text). Leukotriene modifiers: Include LTRAs and a 5-lipoxygenase inhibitor. Two LTRAs are available\u2014montelukast (for patients >1 year of age) and zafirlukast (for patients 7 years of age). The 5-lipoxygenase pathway inhibitor zileuton is available for patients 12 years of age; liver function monitoring is essential. LTRAs are alternative, but not preferred, therapy for the treatment of mild persistent asthma (Step 2 care) (Evidence A). LTRAs can also be used as adjunctive therapy with ICSs, but for youths 12 years of age and adults they are not the preferred adjunctive therapy compared to the addition of LABAs (Evidence A). Zileuton can be used as alternative but not preferred adjunctive therapy in adults (Evidence D). LABAs: Salmeterol and formoterol are bronchodilators that have a duration of bronchodilation of at least 12 hours after a single dose. LABAs are not to be used as monotherapy for long-term control of asthma (Evidence A). \u2014 LABAs are used in combination with ICSs for long-term control and prevention of. symptoms in moderate or severe persistent asthma (step 3 care or higher in children 5 years of age and adults) (Evidence A for 12 years of age, Evidence B for 5\u201311 years. of age). Of the adjunctive therapies available, LABA is the preferred therapy to combine with ICS. in youths 12 years of age and adults (Evidence A). \u2014 In the opinion of the Expert Panel, the beneficial effects of LABA in combination therapy. for the great majority of patients who require more therapy than low-dose ICS alone to. control asthma (i.e., require step 3 care or higher) should be weighed against the. increased risk of severe exacerbations, although uncommon, associated with the daily. use of LABAs (see discussion in text). For patients 5 years of age who have moderate persistent asthma or asthma. inadequately controlled on low-dose ICS, the option to increase the ICS dose should. be given equal weight to the option of adding LABA. For patients 5 years of age who have severe persistent asthma or asthma. inadequately controlled on step 3 care, the combination of LABA and ICS is the. preferred therapy. \u2014 LABA may be used before exercise to prevent EIB (Evidence A), but duration of action. does not exceed 5 hours with chronic regular use. Frequent and chronic use of LABA. for EIB is discouraged, because this use may disguise poorly controlled persistent. asthma (Evidence D). \u2014 In the opinion of the Expert Panel, the use of LABA for the treatment of acute symptoms. or exacerbations is not currently recommended (Evidence D). Methylxanthines: Sustained-release theophylline is a mild to moderate bronchodilator. used as alternative, not preferred, adjunctive therapy with ICS (Evidence A). Theophylline. may have mild anti-inflammatory effects. Monitoring of serum theophylline concentration is. essential August 28, Section 3, Component 4: Medications. \u2014 Of the adjunctive therapies available, LABA is the preferred therapy to combine with ICS.", "Image XResolution": "37", "Image YResolution": "37", "Image ResolutionUnit": "Pixels/Centimeter", "Image Software": "SlidePlayer", "Image YCbCrPositioning": "Centered"}