Therapy and Management | Treatment | Inhalation | Inhalation -Immediate

Reliever medications

Reliever medications are used to rapidly reduce bronchoconstriction and associated symptoms in acute exacerbations.

Rapid-acting β2-agonists are the treatment of choice in acute exacerbations of asthma and are useful for the pre-treatment of exercise-induced asthma. However frequent or regular administration of these substances do not control asthma adequately. Increased use of short-acting β2-agonists may indicate deterioration of asthma and the need to intensify anti-inflammatory therapy.

Compared with oral administration, which is only indicated in patients unable to use inhaled medication, inhaled β2-agonists cause fewer adverse effects like cardiovascular stimulation, skeletal muscle tremor or hypokalemia.

Anticholinergics produce bronchodilation by reducing intrinsic vagal cholinergic tone and blocking reflex bronchoconstriction. Compared to inhaled short-acting β2-agonists they are less potent bronchodilators and have a slower onset of action. Mostly they are applied in combination with β2-agonists. Additionally anticholinergics provide an alternative for patients experiencing adverse effects from β2-agonists like tachycardia or tremor.

After inhalation of anticholinergics dryness of the mouth or a bitter taste may occur. No adverse effect on mucus secretion has been observed.

Other orally applied medications like glucocorticosteroids or methylxanthines may also be indicated in the treatment of acute asthma exacerbations.

Literature:

O'Byrne P. GINA Executive Commitee. Global strategy for asthma management and prevention. 2004. National Institutes of Health. Publication No 02-3659

Rodrigo G, Rodrigo C, Burschtin O. A meta-analyis of the effects of ipratropium bromide in adults with acute asthma. 1999. American Journal of Medicine , 107: 363-370

Mode of action of inhaled drugs in acute asthma therapy

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