Asthma Drug Chart

Drug MOA Administration Side Effects Extra
Selective B-2 Agonist
Proventil (Albuterol)
Levalbuterol & Pirbuterol
Causes B-2 receptor activation- results in smooth muscle relaxation


Short acting Beta agonist

↑bronchodilation (main effect) ↑mast cell stability, ↑mucociliary transport due to B-2 receptor activation
Give nasally or inhalation

Albuterol (short acting drug) is only indicated and effective for acute symptom relief

Rescue therapy can be used but not ideal for prophylaxis due to short duration of action

Patients should have a short-acting inhaled B-2 agonist on hand regardless of whether primary therapy is with a long acting agent or another class of drugs

Regularly scheduled, daily, chronic use of SABA is not recommended.

Albuterol 90-180 mcg MDI q 4-6 hrs PRN
1.25-5 mg neb q 4-6 hr PRN
May involve both B-1 and B-2 stimulation: skeletal muscle tremors, CNS stimulation, HA, dizziness, insomnia

Metabolic side effects: hypokalemia & decrease glucose levels

Tolerance: desensitization with long term use caused by overprescribing & failure to use other adjunctive drugs such as steroids
XOPENEX (levalbuterol): has less side effects but cost more money

If given over a long duration, the drug loses Beta 2 selectivity and stimulates Beta 1 (↑heart rate, ↑force of contraction of heart, ↑impulse transmission, arrhythmias, ↑BP)

Beta stimulation can cause K+ to go into the cell (can give a hyperkalemia patient a breathing treatment to move potassium into the cell)

Albuterol is the preferred SABA for use in pregnancy
Serevent (Salmeterol)
Long acting Beta agonist

Inhaled bronchodilators that have a duration of bronchodilation of 12 hours after a single dose.

Used for prophylaxis only

Onset of action is too slow to be used for rescue therapy

LABAs are not to be used as monotherapy for long-term control of asthma

Daily use of LABA generally should not exceed 100 mcg salmeterol or 24 mpg formoterol

1 blister
q 12 hours

1 capsule q 12 hours

LABAs are used in combination with ICSs for long-term control and prevention of symptoms in moderate or severe persistent asthmaAsthma patient must have a short acting and long acting inhaler

COPD can only have a long acting inhaler!
Used to treat the underlying disease state

Prophylaxis only

The cornerstone of asthma treatment-
↓ inflammation

May boost actions of bronchodilators

Restores sympathomimetic efficacy that’s lost

Reduce airflow obstruction by reducing airway inflammation in bronchioles

Modify the body’s immune responses to various stimuli

Suppress cytokine production, airway eosinophil recruitment, and release of inflammatory mediators


Inhaled corticosteroids (ICS) provide local therapeutic action with minimal systemic effects

Educate patient to rinse mouth after each use
Inhaled steroids are not associated with a “rush” of relief when used. It takes about 2 weeks of use for noticeable improvement to be felt.

Hoarseness, cough (rinse mouth after each use to help prevent)

Use the minimum amount of steroid as possible. Way the risk and benefits with DM patients -may have to increase insulin

Used alone or with other drugs depending on asthma frequency & severity

Inhaled Corticosteriods (ICSs) are the most consistently effective long-term control medication at all steps of care for persistent asthma, and ICSs improve asthma control more effectively in both children and adults than leukotriene receptor antagonists (LTRAs) or any other single, long-term control medication do.
Systemic Steroids
anti-inflammatory medications that reduce airway hyperresponsiveness, inhibit inflammatory cell migration and activation, and block late phase reaction to allergen


Used for severe, persistent or poorly controlled asthma

Cause many side effects during therapy

Adults: Methylprednisolone
.5–60 mg daily in a single dose in a.m. or qod as needed for control
Short-course “burst”: to achieve control, 40–60 mg per day as single or 2 divided doses for 3–10 days
Fluid & electrolyte imbalances

Renal: Na & H20 retention

Metabolic: altered glucose, fat, & protein metabolism. Hyperglycemia (a problem for diabetics), ↓ lineal growth in children


Various CNS & mood changes
Easy to start treatment but harder to stop safely

Even brief use of systemic steroids can cause long-term suppression of endogenous steroid production, put patient at risk of withdrawal
LT Receptor
Antagonists (LTRAs)
Singular (Montelukast)
Blocks cysteinyl LT receptors, “ interrupt” various inflammatory processes including bronchoconstriction, eosinophil migration & local edema

For control treatment only- not rescue

Modestly effective

Inhalation: once a day dosing

For use in patients .≥ 5 years old

Monitor Liver function

Black letter warning box for suicidal ideation

10 mg ohs

40 mg daily (20 mg tablet bid)
Black letter warning box for suicidal ideationIs quite $$$

For use in mild-persistent symptoms

Can be an alternative to inhaled steroid, but using a steroid is preferred
Methylxanthines consists of caffeine & tea

aminophylline are bronchodilators

Inhibition of phosphodiesterase causes vasodilation

Blockade of bronchoconstriction by adenosine receptors

Oral agents used for 24 hr control & nocturnal symptoms

Not used for acute symptom control

Parenteral (aminophylline, IV) for acute symptoms- only used In hospitals

No inhaled formulations

3rd or 4th line drugs because of potential complications

Used with neonates to stimulate the breathing center in preemies

Used for sleep apnea

Monitoring of serum theophylline concentration is essential.

Starting dose
10 mg/kg/day up to 300 mg maximum; usual maximum:
800 mg/day
Extensive hepatic metabolism: important in context of interactions with drugs that↑ or↓ hepatic metabolism

Low therapeutic index

Think about toxicity because these drugs are metabolized by the liver

CNS stimulation: (intensity parallels blood level of drug)-this is the earliest sign of toxicity

Seizures are a major consequence of toxicity- apnea during seizure is the major cause of death

Cardiac stimulation (rate, contractility)

GI irritation: ulcerogenicity
Dosing adjustments: ↑((mg/kg) for children (age,weight-dependent), smokers, & use of drugs that stimulate metabolism

Reduced (mg/kg) doses for: ↓ liver function, history of CV disease, seizures, & use of drug that ↓ hepatic metabolism

Use of other cardiac stimulants (caffeine & tea) belong to the same family of methy-xanthines

Does not play a major role in the treatment of asthma
Atrovent (Ipratropium)
Methylxanthines= consists of caffeine & tea,

aminophylline are bronchodilators

Inhibition of phosphodiesterase causes vasodilation

Blockade of bronchoconstriction by adenosine receptors

Inhibits muscarinic cholinergic receptors and reduces intrinsic vagal tone of the air- way

Ipratropium bromide may be used as an alternative bronchodilator for patients who do not tolerate SABA

Ipratropium HFA
17 mcg/puff,
200 puffs/canister 2–3 puffs q 6 hours

Nebulizer solution
0.25 mg/mL (0.025%) 0.25 mg q 6 hours

Drying of mouth and respiratory secretions, increased wheezing in some individuals, blurred vision if sprayed in eyes.
If used in the ED, produces less cardiac stimulation than SABAs.
Treatment of choice for bronchospasm due to beta-blocker medication.
Mast Cell
Intal and Tilade
Used for treatment of COPD & exercise induced asthma

↓↓ mediator release from mast cells & prevents inflammatory response

Acts locally to inhibit release of mediators of type 1 allergic reactions, including histamine and leukotrienes, from sensitized mast cells after exposure to an antigen

Antiasthmatic and antiallergenic
Orally inhaled powderNegligible toxicity

Few serious side effects (coughing)
Xolair (Omalizumab)Used for severe asthma

Monoclonal antibody against IgE

Given SC injection every 2-4 weeks
Control medication-not for rescue (no bronchodilator activity)

↓frequency and severity of symptoms

↓ steroid dosage requirements

Very $$$$!