Controllers prevent asthma symptoms as they treat the inflammation inside the airway. Controller medication is taken every day as the effect of the medication increases over time which improves asthma control in the long term. Regular use treats the persistent inflammation of the airways. Even if you are not having asthma symptoms, you should not forget to take your controller medication. The reason you are not experiencing any symptoms is because the controller is doing its job. Review your controller dose at each visit with your Doctor.
Types of Controller medications:
Corticosteroids:
Inhaled corticosteroids (ICS) are considered the first line therapy for treating asthma and are used to treat the underlying airway inflammation that is always present in people with asthma. It is considered an anti-inflammatory medication. With daily, regular use, the inhaled corticosteroids reduce inflammation and mucus in the airways, which in turn makes the airways less sensitive to triggers. When your doctor prescribes you an inhaled corticosteroid, it can take days or weeks to reduce the airway inflammation, so be patient. Inhaled corticosteroids are not for the relief of sudden-onset asthma symptoms and you will not feel it work like your reliever does. The longer you use your controller medication, the less you will need to use your reliever medication as you have decreased your airway inflammation and therefore controlled your symptoms.
When you are feeling better, do not stop taking the inhaled corticosteroid. The anti-inflammatory medication is keeping your asthma under control. If you stop taking it, the inflammation may return. Instead, talk to your doctor about adjusting the dose, or follow your Asthma Action Plan.
In order to minimize possible side effects, your Doctor will prescribe the lowest dose of medication needed to control your symptoms. It may take some experimenting to find out what that dose is. You and your doctor might have to try a few different doses or a few different medications before you find what works best for you. Over time, your medication needs may change so reassessment is needed.
The common side effects of inhaled corticosteroids are a hoarse voice, sore throat and mild throat infection called thrush (yeast infection). Sore throat and thrush are commonly caused by poor inhaler technique. Show your Doctor, Asthma Educator or Pharmacist how you use your inhaler. You may need a “spacer” if you are using a puffer (metered dose inhaler). Rinsing out your mouth with water after using your inhaled corticosteroids will also help reduce these side effects. For more information about correct inhaler technique, please visit the "Correct Inhaler Techniques” section of this web site.
Examples of Inhaled corticosteroids:
- Flovent® (Fluticasone)
- Pulmicort® (Budesonide)
- QVAR® (Beclamethasone dipropionate)
- Alvesco® (Ciclesonide)
Oral corticosteroids
Oral corticosteroids may be prescribed for more severe or troublesome asthma symptoms. First line treatment with daily use of inhaled corticosteroids will; in most cases treat your asthma without the need for oral medications.
Oral corticosteroids can have serious side effects if used for a long time. However, when required, they have significant benefits that outweigh their side effects. Your doctor can explain the pros and cons of using oral corticosteroids.
Examples of oral corticosteroids are:
- Prednisolone (sold as Pediapred®)
- Prednisone (sold as Deltasone®)
Possible side effects of long-term oral corticosteroid use include: water retention, bruising, puffy face, increased appetite, weight gain, stomach irritation, mood changes, and fractures.
Leukotriene Receptor Antagonists (LTRAs) or Anti-Leukotrienes
Leukotriene Receptor Antagonists (LTRAs) are in a class of oral medication that is not a steroid and constitute a preventative therapy for asthma. They may also be referred to as anti-inflammatory preventers. LTRAs work by blocking a chemical reaction that can lead to inflammation in the airways.
LTRAs can be prescribed alone in cases of mild asthma. LTRAs may also be used when an inhaled steroid can not, or will not, be used. If you've been taking inhaled steroids and your asthma still isn't well-controlled, your doctor may prescribe LTRAs as an add-on treatment instead of increasing the dosage of your inhaled steroids.
The medication comes in different once-daily forms - tablet, chewable tablets or granules - and has few side effects. The side effects of LTRAs are minimal and may include nausea and headache. Please ask your doctor or pharmacist about a full list of side effects.
Examples of LTRAs include:
- Singulair® (Montelukast)
- Accolate® (Zafirlukast )
Frequently Asked Questions about LTRAs
Q: What are leukotrienes?
A: Leukotrienes are chemical compounds that are released during the inflammatory process. They are chemical messengers that help protect the body against attacks by invaders. However, when they are a part of an allergic response, leukotrienes cause airway obstruction, mucous production, and swelling of the airways. Leukotriene modifiers block the action or production of leukotrienes, and subsequently inhibit the inflammatory process. Two types of leukotriene-based medications have been developed: leukotriene inhibitors that interfere with the actual synthesis of leukotrienes, and leukotriene antagonists that block the action of leukotrienes by interfering with receptor sites.
Q: Who should take LTRAs?
A: In the 1999 Asthma Consensus Guidelines and 2003 Updates, LTRAs are classified as medication that may be useful as add-on therapy to inhaled corticosteroids or as single agents in the management of asthma for patients who cannot or will not use inhaled corticosteroids.
Q: Are LTRAs safe for children?
A: Montelukast is the only LTRA that has been studied in children. It is indicated for pediatric patients two years of age and older with few side effects. For more detailed information on pediatric side effects, please talk to your doctor.
| Anti Immunoglobulin E (Anti-IgE) Therapy |
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| Anti-IgE Treatment Demonstration |  |
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Anti-IgE treatment might be recommended if you have allergic asthma and you keep experiencing persistent symptoms despite taking your controller medications.
If you have allergic asthma (about 60% of asthma is caused by allergy), your symptoms are triggered when you inhale certain allergens in the air. These allergens cause a chain reaction that leads to inflammation in the lungs.
While inhaled steroids work by treating and reducing the inflammation, anti-IgE therapy works by keeping inflammation from developing in the first place. It does so by blocking immunoglobulin E, a substance in the body that is one of the underlying causes of inflammation in allergic asthma.
Anti-IgE therapy is only available by prescription. Unlike other asthma medications, it is not administered by pill or by inhaler. It needs to be injected once every two or four weeks by a doctor or other trained healthcare professional.
The only anti-IgE therapy available in Canada is omalizumab (Xolair®).
The most common side effects of anti-IgE therapy are: skin irritation or reaction at the site of the injection, and respiratory tract infections (e.g., common cold).
Frequently Asked Questions on Anti-IgE therapy
Q: Who is Anti-IgE therapy for?
A. Anti-IgE therapy with omalizumab is for adults and adolescents (12 years of age and above) with moderate-to-severe, persistent allergic asthma who continue to have asthma symptoms even though they are taking inhaled steroids.
Q: How quickly does anti-IgE therapy work?
A. It does take time for the IgE blocking to start working. It is normal not to feel a difference right away. It is important to keep getting your injections until your doctor tells you otherwise. In scientific studies testing omalizumab, the benefits of IgE therapy were shown in most patients by three months.
Q: Does omalizumab (Xolair®) have any serious side effects?
A. In scientific studies, cancer was seen in a small number of patients receiving omalizumab, as well as in those receiving placebo injections. The rate was higher in patients treated with omalizumab than placebo (0.5% vs. 0.2%). This difference has not been conclusively linked to the omalizumab.
Some patients in the studies had a serious allergic reaction called anaphylaxis. This was rare, occurring in less than 0.1% of patients. Doctors have been advised to observe patients for a period after omalizumab injection to make sure that no anaphylaxis develops. If it does, it can be treated.
Q: Will I still need to keep taking my inhalers?
A. Yes. Anti-IgE therapy is meant to complement, not replace, your existing medications. Although many patients taking IgE therapy have been able to have the dose of their inhaled steroid decreased over time, you will still need to keep taking your other asthma medications as directed by your doctor.
Q: How often is omalizumab given?
A. Depending on your body's IgE level and your body weight, omalizumab will be given once every two or four weeks.
Q: Who will administer the injection?
A. Omalizumab needs to be injected by a trained healthcare professional. You may be able to have it done at your usual doctor's office. In some cases, your doctor will refer you to another location to have the injection given. There are specialty clinics in many Canadian cities that have been especially set up to give injections of omalizumab.
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