Add-On Medications

You know that controller medications manage or control your asthma. You use add-on medications with a controller medication. Unlike controller medicines, you do not use add-on medicines daily. However, you take them to get relief from your symptoms. These are some add-on asthma medications. 

Beta (β2) -Adrenoceptor Agonists (β2)-Agonists)

Beta-agonists (“β2-agonists”) ¹ are the most common add-on medication. They treat airway obstruction. However, they do not just treat airway obstruction in asthma. These medications treat airway obstruction in respiratory conditions, such as chronic obstructive pulmonary disease (COPD).

During an asthma attack, your airway muscles become tightened and constructed. β2-agonists reverse this. They open and relax your airways.

Types of β2-agonists

There are two types of β2-agonists. We refer to them by their features, such as the onset, and duration of their effects. The two types of β2-agonists are:

• Long-acting β2-agonists
• Short-acting β2-agonists

Are β2-agonists Good?

Healthcare providers use β2-agonists more than other add-on medications. β2-agonists help manage your asthma symptoms. However, healthcare providers do not recommend mono use. When used as a monotherapy, β2-agonists can cause health issues and complications.

Complications

• Headaches and tremors
• Heart problems, such as fast heart rate and unique heartbeat
• Death in severe cases

Long-Acting Beta (β2)—Adrenoceptor Agonists (LABAs)

Long-acting (β2)-adrenoceptor agonists (LABAs) help with uncontrolled moderate-to-severe asthma. LABAs widen and protect your airways from narrowing. LABAs work shortly after you inhale them. The results can last twelve or more hours.

Are LABAs Good?

The current recommendation is a short course. Short-course is achieved once you get control of your asthma symptoms. To discontinue LABAs, take a step-down approach where you gradually decrease your use.

Complications

• LABAs can cause inflammation
• LABAs cause allergic reactions in some 
• Worsen asthma symptoms or cause asthma attacks requiring hospitalization in children
• LABAs can trigger severe asthma in people
• Use can cause hospitalization, intubation, or death.

Short-Acting Beta (β2)—Adrenoceptor Agonists (SABAs)

Next are short-acting beta (β2)-adrenoceptor agonists (SABAs). SABAs are a medication that provides immediate relief of your asthma symptoms. Healthcare providers never prescribe them alone. SABAs are used as a combination therapy with inhaled steroids or LABAs.

How SABAs Work

SABAs work quickly and provide almost instant relief. The downside is that the effects do not last long. On average, you experience relief for 3-6 hours – roughly half the time for LABAS. You can inhale LABAs or take them by mouth. However, oral SABAs can cause side effects.

Are SABAs Good?

The verdict is out. On the one hand, SABAs provide immediate relief from your asthma symptoms. However, the relief is temporary, and they are associated with side effects.

Complications

• Greater risk of side effects
• Airway reactivity
• Airway narrowing
• Death, in some cases

Anticholinergics

Anticholinergics ² is another type of add-on medication that offers quick relief from your asthma symptoms. The biggest difference between anticholinergics and β2-agonists is that anticholinergics are a last resort. What that means is healthcare providers use them when SABAs either do not work or are not well-tolerated.

How they Work

Anticholinergics block chemicals that cause your airway muscles to contract. As a result, your airways widen, allowing you to breathe again.

Complications

• They’re uncommon
• Their relief is temporary
• They may not work as well

Leukotriene Modifiers (LT Modifiers)

Leukotriene modifiers (LT modifiers) ³ are another kind of add-on medication. LT Modifiers work by limiting inflammatory cells and open your airways. They’re similar to SABAs because they decrease your asthma symptoms, flareups, and your need for other medications. Healthcare providers tend to use them as a last resort when medications are ineffective or for mild asthma that does not respond to controller medications.

Complications

• LT modifiers aren’t as effective as other asthma medications.
• Don’t use it if you’re on antidepressants! They interact with these medications. Thus, reducing their efficacy.
• People with mental health conditions are at risk for suicidal ideation. The risk is greater for people who’ve previously attempted suicide, as well as people on medications that have a side effect of suicide
• LT modifiers induce hepatitis and pancreatitis. However, both conditions improve once you stop the medication.
• They cause stomach issues in children, such as pain, nausea, and increased appetite. 
• Increase your risk for Churg-Strauss syndrome  ⁴
• Children are likely to have headaches, ear infections, and rashes.
• Mood disorders like agitation, aggression, hallucinations, sleep disorders, depression, and concentration problems can occur in children. 

Theophyllines

Healthcare providers rarely prescribe theophyllines ⁵. They’re a third-line medication. What this means is healthcare providers use them as a last resort; after everything else is tried. Theophyllines may help treat poorly controlled asthma.

How they Work

Theophyllines block cells that cause airway inflammation. Thus, allowing your airways to open. Theophyllines also block late responses to allergens. However, they cannot do this alone. In essence, theophyllines work when used with long-term oral medication.

Complications

• Theophyllines have more side effects than other add-on medications. For instance, nausea, vomiting, and stomach pain are common side effects.
• Their effects are weak
• Cause irregular heartbeat and death in severe cases