Guest Author - Amy Anaruk

Maintenance is one of the most important words you�ll encounter in the battle to gain control of asthma. Developing a maintenance plan involves reducing lung inflammation, avoiding triggers, working with a general practictioner and/or specialist to figure out the best treatment meds, and composing an Asthma Action Plan. This article is part one of the series Asthma Maintenance 101.

The first article in this series discusses ways to identify your asthma triggers. While you�re doing that, you can simultaneously work with your doctor to figure out which asthma medications you need.

Preventing flares in the first place is a lot easier and less dangerous than trying to treat them after the fact, so most doctors suggest a two-pronged medical platform. The prevailing method is to mount a good offense of preventative medicine first and to strike hard against flares second. There are several good options for controller meds, and these are the most common.

The first class, inhaled corticosteroids through a metered dose inhaler or a nebulizer, work very well for children. Nebulizer corticosteroids like Pulmicort (budesonide) and inhaler corticosteroids like Flovent (fluticasone propionate) work the same way, by reducing lung inflammation so that when asthmatics do encounter a flare, they don�t react as severely as they would if their lungs were irritated. The word steroid can sound scary when medicating a child, but corticosteroids are different from the ones that are notoriously abused with major side effects. Those are anabolic steroids, a synthetic version of androgen (the male sex hormone). Corticosteroids mimic the action of the naturally occurring cortisone and hydrocortisone produced by the adrenal gland. Although corticosteroids can cause side effects like inhibiting growth, increased susceptibility to infection, or cataracts or glaucoma when older after heavy use, using the inhaled dosage means very little of the medicine enters the bloodstream, reducing the risk.

Doctors generally prescribe the lowest possible dose of corticosteroids for children in order to avoid any side effects and can tailor the frequency of use for each patient. My daughter, for example, uses the lowest-dosage Flovent inhaler�44 mcg--twice a day from September through May because illness is her major trigger. During the summer, when cold and flu viruses aren�t around, the danger of her having a flare is so much lower that I can keep her off the Flovent and maintain her with only an emergency inhaler.

Another class of meds used for asthma maintenance is the oral leukotriene inhibitors like Singulair (montelukast), Accolate (zafirlukast), and Zyflo (zileuton). Singulair is the most common. These meds block leukotrienes, which are chemicals that produce inflammation associated with allergies. The FDA approved Singulair as an asthma preventative in 1998 and, two years later it approved low dosages for infants under age two. For some, leukotriene-antagonists are a godsend because they can control asthma so well, especially in young children, that they sometimes eliminate the need for a corticosteroid. Some patients report mild side effects like headaches and stomachaches, but anecdotal evidence from parents suggests a small number of children experience more severe gastrointestinal problems, nightmares, and hyperactive behavior. As with any medication, reactions can vary for each individual.

A third class, the inhaled long-acting beta agonists like Foradil (formoterol) or Serevent (salmeterol) work by long-term bronchodilation. These meds relax the muscles surrounding the bronchial tubes, allowing air to flow more freely. They are similar to the short-acting beta agonists, the main emergency treatment for asthmatics, but they work a lot longer. Doctors usually prescribe them in addition to inhaled corticosteroids for more severe, persistent asthma. As with all beta agonists, Foradil and Serevent can cause rapid hearbeat, shakiness, and dizziness.

New to the list of asthma controller meds is Xolair (omalizumab), an injected monoclonal antibody that works primarily for allergen-induced asthma. It works by blocking IgE (immunoglobulin E), the substance that causes the allergic response. Patients age 12 and older with persistent allergen-induced asthma can take these injections in addition to inhaled corticosteroids, but since the FDA approved Xolair in 2003, no data exists for long-term side effects. Short term side effects include swelling and irritation at the injection site, increased viral and respiratory infections and sinusitis, sore throats, and headaches. The FDA reports that 0.1% of patients experienced anaphylactic shock up to 24 hours after a dose of Xolair. Anaphylaxis is a severe and often fatal allergic reaction and the FDA notes this severe reaction can occur after any dose of Xolair, not just the first one.

As always, contact your doctor first with any questions about your preventative medicine options.