Expansion
Beta-2 agonists, antimuscarinics, corticosteroids and leukotriene antagonists
Expansion
Bronchodilators (relievers)
- Short acting beta-2 agonists (salbutamol): minutes. Side effects are predictable from beta stimulation: tremor, tachycardia, hypokalaemia, lactic acidosis at high dose
- Long acting beta-2 agonists (salmeterol, formoterol): must never be used alone in asthma, only combined with an inhaled corticosteroid
- Short and long acting antimuscarinics (ipratropium, tiotropium): dry mouth, urinary retention, glaucoma risk if nebulised into the eyes
Anti-inflammatory (preventers)
- Inhaled corticosteroids: the cornerstone of asthma management. Oral candidiasis and dysphonia, prevented by spacer use and mouth rinsing; growth effects in children at high dose
- Leukotriene receptor antagonists (montelukast): oral; useful in exercise and aspirin-sensitive asthma; neuropsychiatric effects
- Biologics: anti-IgE (omalizumab), anti-IL-5 (mepolizumab) for severe eosinophilic asthma
Key distinction: asthma is fundamentally an inflammatory disease requiring steroids, whereas COPD responds better to bronchodilators, with steroids reserved for those with exacerbations or eosinophilia.
Inhaler technique and spacer use determine effectiveness more than drug choice, and should be checked at every review.