Noisy medications or bronchodilators treat the noisy, obvious, uncomfortable part of asthma: coughing, wheezing, choking, shortness of breath, and chest tightness caused by muscle spasms in the bronchial tubes.
You really notice when noisy medications are working. Your symptoms improve dramatically; you notice you are breathing more easily, more deeply. Most noisy medications such as albuterol and Xopenex (levalbuterol) begin relieving symptoms within a very short time, usually minutes. However, Serevent®, a twice-daily bronchodilator, usually takes between 20 and 30 minutes to begin working and should not be used to treat a sudden or severe asthma attack. Foradil®, also a 12-hour bronchodilator, has a rapid onset of action, usually within a few minutes.
Some bronchodilators are rapid acting while others have a slower onset. Some should be used every day while others should only be used to stop symptoms, but not more than twice a week without contacting your physician. And still others utilize unique technologies to deliver the medications deeply into the airways where inflammation and congestion exist.
Quiet medications treat the underlying components of asthma, i.e., inflammation and immune system reactions leading to airway inflammation. While there are several different types of quiet medications, the Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma, produced by the National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program states that inhaled corticosteroid medications are the most effective means of reducing and preventing airway inflammation available today.
You won’t feel anything happen immediately after using a quiet medication. You may think it’s not working, but with use as prescribed by your physician, you should begin to notice fewer noisy symptoms and less need for noisy medications.
Like salt and pepper, Batman and Robin, noisy and quiet medications work well together and even alone. But never expect an inhaled corticosteroid to relieve a sudden attack of wheezing and coughing. And don’t count on a bronchodilator to relieve or prevent airway inflammation. It’s not going to happen.
Another class of quiet medications known as leukotriene (luke-oh-try-een) modifiers interrupts one of the many complex immune processes that precede airway inflammation. These oral medications are not related to inhaled corticosteroids.
Oral corticosteroids are generally reserved for more severe asthma flares and their use is limited because of unwanted side effects. They should never be used without your physician’s knowledge.
Because allergies, gastroesophageal reflux, sinus congestion, and viral infections may play an important role in triggering asthma symptoms, your physician may prescribe additional medications to relieve these conditions.
Important: If you are treating or having noisy symptoms of cough, wheeze, choking, shortness of breath, or chest tightness two or more times a week, make certain your asthma management plan includes a strategy for dealing with both the quiet and noisy parts of asthma.
Reprinted from Allergy & Asthma Health Consumer Guide 2002. Medical editors for this article: Martha Hogan, MD, Neil MacIntyre, MD, Michael Mellon, MD, Dennis Williams, PharmD.