Asthma Treatment: When Your Inhaler Isnt Enough

May 1, 2013

By Barret Procyshyn, Pharmacist at the Dauphin Clinic Pharmacy


Spring is right around the corner. We just have to get through this last snow storm. This is very exciting news for most of us, as we cannot wait for warmer weather. However; for asthmatics the thought of the snow melting and pollen season beginning can be worrisome. There is a strong link between seasonal allergies and asthma outbreaks. If you have asthma and are finding yourself using your inhaler more often, you are not alone. Most often, we think of inhalers as the best method to help asthmatics breathe. However; there are pills available which can be very effective in reducing the asthma symptoms.


Over 300 hundred million people in the world suffer from asthma and it is one of the most common chronic diseases in children. Since the 1980s and 1990s the prevalence of asthma has almost doubled. This may be due to increasing exposure to allergens and air pollutants. Although asthma is often diagnosed, it is often not properly treated. It a major cause of hospitalization in children and over 300 deaths every year in Canada.


Inhalers are a very effective tool in preventing asthma symptoms and treating asthma attacks. They are very safe and have minimal side effects, even in children. For these reasons inhalers are considered a first line treatment. An issue with inhalers is they are not very convenient. Inhalers are fairly large and can be a nuisance to take to school or to work. They are not always the easiest to use, especially in young children or in the elderly. Most inhaler users do not use proper technique. Even if the inhaler is being used properly, they do not always prevent 100% of asthmatic symptoms.


Therefore, we should consider oral medications in the tablet form more often. The pills we use for asthma are leukotriene receptor antagonists or LTRA tablets. Leuktorienes, very simply, are involved in asthmatic and allergic reactions to sustain inflammation. Inflammation and mucus production in asthma is exactly what we do not want because it makes it harder to breathe. The LTRA pills work to prevent the inflammation, which is what is causing the shortness of breath.


Examining scientific studies concludes the pills are not better than inhalers. However, there seems to be more and more evidence emerging they may be just as good of a treatment option when measuring quality of life. Canadian asthma guidelines recommend the use of LTRAs when asthma is not controlled adequately by low doses of inhaled steroids. They are also recommended as an alternative in patients who cannot or will not use inhalers. In the United States LTRAs are recommended in first line use.



Two examples of LTRA pills available are montelukast and zafirlukast. Zafirlukast is taken twice daily and is recommended for use in adults and children over the age of 12. Montelukast is a once daily pill which is available for children and adults. These medications have shown to be quite safe with few side effects. Montelukast is much more popular due to convenient once a day dosing and it has recently gone generic, making it much more affordable. LTRA pills may be most effective for those who suffer from allergies and asthma. Almost 75% of asthmatic children also have documented allergies.


If you have asthma and your inhalers are not working it may be worth giving them a try. From my experience, they seem to work well in Asthmatics who have a hard time controlling their breathing in the spring and fall seasons. It is also a good treatment option if the dose of steroids being inhaled per day is too high. Within a month of two of trying the medication the asthmatic should know whether it is effective or not.


If you are waking up at night from shortness of breath, have frequent coughing episodes or are unable to exercise because of you cannot breath, your asthma is not controlled. Trevor Shewfelt and I are certified respiratory educators and we may be able to help eliminate your symptoms. Please feel free to ask for help.


As always if you have any questions or concerns about these products, ask your pharmacist.


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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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