The Other Maintenance Meds

A few months back, I created the Steroid Question tab up there because I think parents of the newly diagnosed carry on an internal debate over maintenance steroids for kids more than any other aspect of asthma care.

Well I did, at least. The idea that inhaled steroids would actually help rather than hurt was an enormous hurdle for my brain to leap when my kid was little and desperately needed them.

But corticosteroids aren’t the only asthma maintenance meds. They’re just the most common, and they carry the best risk-benefit profile. There are a few other options, mostly prescribed for more severe and/or persistent asthma when inhaled steroids won’t do the job by themselves.

Leukotriene Inhibitors

These oral meds block leukotrienes, or chemicals that produce allergic inflammation. Singulair’s (montelukast) the most common, but Accolate (zafirlukast) and Zyflo (zileuton) are options, too. The FDA approved Singulair as an asthma preventative in 1998 and, two years later it approved low dosages for infants under age two. Singulair is very popular as a maintenance medicine, both in conjunction with a corticosteroid or on its own. In fact, some asthma patients have been able to decrease their use of corticosteroids while on Singulair.

Recently, though, it’s come under scrutiny for a possible link to suicides, mood swings, and suicidal behavior. In any case, many patients experience little or no side effects while others don’t seem able to tolerate it. Like any medicine, it will depend on the patient.
(Read more about the Singulair controversy here and here.

Long-Acting Beta-Agonists

They’re just what they sound like, bronchodilators that relax the smooth muscles around the bronchial tubes to open airways the way albuterol does, only they take more time to do it. Albuterol, on the other hand, takes around 5 to 20 minutes for immediate relief.

So long-acting beta-agonists (LABA’s) will not stop an asthma flare. Although they are bronchodilators, their longer action means they work as maintenance meds rather than relievers. Serevent (salmeterol), Advair, and Foradil are approved for children over the age of 4 and adults, but doctors only prescribe them for moderate to severe persistent asthma that isn’t responding well to other controller meds. LABA’s are an *add-on* treatment, and doctors like inhaled corticosteroids and/or leukotriene modifiers best for prevention.

As with all beta agonists, LABA’s can cause rapid heartbeat, shakiness, and dizziness. A very small number of patients may experience adverse reactions, hospitalizations, and even death, explaining these prescriptions’ black box warnings. In fact, the FDA recently reviewed the pediatric use of LABA’s and recommended stronger black box language about their risk, although they’re unquestionably lifesaving medications for many asthmatics.
(Read more about the decision here.)

Monoclonal Antibodies

Xolair (omalizumab) is the newest maintenance option in the asthma arsenal. It’s a shot that blocks IgE (immunoglobulin E), the substance that causes allergies. It’s an add-on treatment for persistent allergic asthma sufferers aged 12 and older whose symptoms are not under good control even with corticosteroids. Xolair’s been approved since 2003, and short term side effects include swelling/irritation at the injection site, increased viral and respiratory infections and sinusitis, sore throats, and headaches.

Xolair also carries a black box warning, since 0.2% of patients have experienced anaphylaxis after an injection. Plus, during development, researchers noted a very slight increase in breast, skin, and prostate cancers after long-term Xolair use. The connection between the two is unclear.
(Read more here.

Any questions? Always ask your doctor first.

Starting today, you can find this information through the search box, under post categories, and on the steroid tab at the top of the page.

One response to “The Other Maintenance Meds”

  1. Asthmagirl says:

    Good article. I’ve tried everything except the Xolair and so far the inhaled steroid seem to be my best friend!