People with asthma generally require medications to control their disease. Current guidelines recommend medications based on four severity classifications. The four classifications are mild intermittent, mild persistent, moderate persistent, and severe. Students with only mild intermittent asthma disease typically require asthma medication on an as needed basis. The two types of medications used to control asthma are quick-relief medications and long-term controller medications.
Quick-Relief Asthma Medication
Quick-relief (or rescue) medications are known for their rapid bronchodilator action. They work by relaxing the muscle bands that tighten around the airways and opening constricted airways during an acute asthma attack. They have a rapid onset of action and begin to work within minutes. These medications can last up to four to six hours. Every student with asthma should carry a quick-relief medication at all times if authorized to do so by his or her health care provider.
Students usually take this medication five to15 minutes before beginning an exercise routine. Due to the rapid onset of this class of medications, a student should have immediate relief (usually within six minutes) following use of the medication. For exercise-induced asthma, quick-relief medications should be limited. A student resorting to frequent use of the quick-relief medication has poor control over asthma and should consult their health care provider. Generally, good control over asthma is demonstrated when a patient refills his/her quick-relief medication only once or twice a year (7)
The most common quick-relief medication is albuterol (Proventil,Ventolin). Other quick-relief products include metaproterenol (Alupent, Metaprel), pirbuterol (Maxair), or albuterol and ipratropium bromide (Combivent).
Long-term Controller Medications
These medications reduce inflammation and/or prevent airway muscle constriction. These are ineffective in relieving acute symptoms and should not be used for “rescue/quick-relief’ Students with persistent asthma should have one or more long-term controller medications. Yet, these powerful medications are often under-prescribed.
Inhaled corticosteroids are one type of long-term controller medication and have excellent anti-inflammatory properties in the lung tissue. Inhaled corticosteroids prevent permanent lung
damage. Some common examples of inhaled corticosteroids are budesonide (Pulmicort), triamcinolone (Azmacort), flunisolide (AeroBid), and flucticasone (Flovent). Long-acting beta agonist bronchodilators are another class of medications used to achieve asthma control. One dose lasts about 12 hours and is effective for nighttime symptoms. If used daily, these agents are effective for EIA. Two examples of long-acting beta 2 agonists are salmeterol (Serevent) and formoterol (Foradil). There is one controller medication for asthma which contains both an inhaled corticosteroid and a long-acting beta agonist bronchodilator. This medicine, Advair, is used for people with moderate persistent asthma and severe persistent asthma. (3, 7)
Leukotriene modifiers are another class of controller medication. These agents work primarily on specific chemical messengers to reduce inflammation. Montelukast (Singulair) and zafirlukast (Accolate) may be beneficial in EIA and prevention of asthma attacks. Leukotriene modifiers are most effective when used together with an inhaled corticosteroid, or the combination of an inhaled corticosteroid and a long-acting beta agonist bronchodilator. (3, 7)
Daily use of long-term controller medication can significantly reduce a student’s need for quick-relief medication.The long-term controller medications can prevent inflammation associated with asthma and increase quality of life.
All students with asthma should have a written asthma action plan that is available to school nurses and coaches. The asthma action plan should identify which medications the student with asthma should be taking and when. For more information, see Asthma Action Plans.