Asthma: Over-the-Counter Treatment
George Schiffman, MD, FCCP
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
William C. Shiel Jr. MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Different Types of Asthma Medications
Many first-line controller and rescue medications are administered through asthma inhalers. Some of these inhalers are called metered-dose inhalers in which the inhaler itself propels the medication into the lungs. Other inhalers are activated by patients taking a breath, and these are called dry powder inhalers or breath-actuated inhalers. Different types of inhalers may work better for different individuals, but both types of inhalers are effective for asthma symptom control if used correctly.
Nebulizers are machines that allow asthma medications to be delivered in an aerosolized form, and the medications are then inhaled through a mouthpiece or mask. Nebulizers are often used for children who are unable to perform the proper technique required for inhalers. Some asthma medications are also available as pills. There are currently two injectable medications for asthma (omalizumab [Xolair] and mepolizumab [Nucala] see below), and these are administered in a health-care setting only. There is also an intravenous medication for asthma (reslizumab [Cinqair]; see below). Within the near future, there will likely be additional asthma medications that can be administered either by injection or intravenously.
Quick Guide Asthma Symptoms, Causes, and Medications
Asthma has often been characterized as a disease in which there is a brief, temporary narrowing of the airways in the lungs. referred to as bronchospasm. This is only part of the picture. It is now believed that the main problem in asthma involves inflammation and swelling of the airways. It is important to understand that the lungs have a series of tubes akin to branches of tree leading to each of the air sacs of the lungs. When these tubes become inflamed, the walls thicken and the opening of the tube narrows. This causes increased resistance for air to flow through. In addition, these changes make it easier for bronchospasm to occur. Both bronchospasm and thickened airway walls prevent air from moving in and out of the lungs easily. As a result, a patient with asthma has episodic difficulty breathing. An asthmatic episode can resolve spontaneously or may require treatment.
It is crucial to understand that over time the airway inflammation associated with asthma can result in permanent remodeling/scarring of the airways. When this occurs and lung function no longer returns normal when not having an attack, Asthma moves into the category of disease known as chronic obstructive pulmonary disease (COPD ). Therefore, if persistent symptoms of chest tightness, cough. wheezing. shortness of breath occur, it is imperative to be evaluated by a physician. Even mild symptoms, if long lasting, can reflect chronic inflammation and progress to COPD. The available over-the-counter (OTC) medications treat bronchospasm primarily and have little, if any, effect on airway inflammation. It is not advisable to use over-the-counter asthma medication unless instructed by a physician knowledgeable in the treatment of asthma. Airway inflammation is treated by prescription medications such as montelukast (Singulair ), zafirlukast (Accolate ), and inhaled corticosteroids (steroids).
Asthmatic patients and their physicians may select from a wide variety of prescription medications. This is not true for OTC medicines, which are limited to epinephrine (adrenaline) and ephedrine. In addition, many asthmatic patients should not use epinephrine or ephedrine because of their relatively weak effectiveness or side effects.
To decide whether or not an OTC epinephrine or ephedrine product may be useful, patients should understand:
- the abnormal conditions that exist in the airways of asthmatics;
- the effects of epinephrine and ephedrine;
- the specific factors that should be considered when choosing and using epinephrine and ephedrine; and
- the side effects of these drugs .
The advantages of using OTC medications for asthma include their affordability and accessibility (lack of need for a prescription and/or health insurance approval). Unfortunately, these medications are less effective at controlling asthma and sometimes can be more dangerous.
Recently, the FDA published safety concerns about the new medication Asthmanefrin and the EZ Breathe atomizer. They report complications such as chest pain. nausea and vomiting. increased blood pressure. increased heart rate, and coughing up blood. Even more disconcerting, they have reports of a choking hazard from a washer being dislodged during atomizer use.
Most pulmonary and allergy specialists would discourage the use of these OTC medications unless asthma symptoms are extremely mild and infrequent.
Medically Reviewed by a Doctor on 7/12/2017