Eliminating exposure to allergic and environmental irritants has proven to be the most successful way to treat people with allergy-induced asthma. Studies have shown that exposure to allergens (e.g. house dust, mites, animal dander, cockroaches, etc.) can cause increased inflammation in the lungs, worsening asthma symptoms, decreased lung function, and an increased need for asthma medications.

Avoiding these allergens reduces asthma symptoms significantly and decreases lung inflammation. Measures such as removing animals from the home, minimizing exposure to allergy-causing dust mites, eliminating cigarette smoking in the home, exterminating cockroaches, etc. can be highly beneficial.

If doubt exists about which substances are triggering allergic reactions, allergy testing can be performed.

Studies have shown that children with asthma who are exposed to cigarette smoke have more asthma symptoms, and require more frequent emergency room visits for their asthma.

Avoiding substances that trigger asthma (for some people this might include animals/pets, cigarette smoke, chemical exposures, pollen, etc.) is very important for asthma control. Asthma triggers cause the airways to constrict or close-down so that air cannot get through. They also cause irritation and swelling in the airways which makes the airways more sensitive and irritable for the next few hours to days and more likely to constrict.

Inhaled beta 2 drugs provide quick relief (within 2-3 minutes) and are approximately four times more powerful than other types of asthma drugs. They are the drug of choice for asthma flares and for those with infrequent symptoms who need occasional, quick-acting treatment. They are also the drug of choice for emergency asthma attacks.

Unlike older beta drugs (epinephrine, isoproterenol, and isoetharine), the newer beta 2 drugs have few effects on the heart except at high doses. Beta 2 drugs should be administered at the lowest possible dose at which symptoms are controlled.

The effects of beta 2-drugs last from 4 to 6 hours; considerably longer than comparable medications.

Beta 2 drugs work by opening up the airways allowing air to flow more readily.

Common side effects can include heart pounding, jitteriness, and shakiness.

Inhaled steroids are powerful drugs that are highly effective in reducing lung inflammation and in preventing asthma attacks. They are often used for people whose symptoms are not adequately controlled with quick-acting beta 2 drugs alone.

Inhaled steroids cause few side effects except when taken at higher doses.

It is important to note that inhaled steroids take up to a week or more to work and, therefore, should not be relied upon alone to treat acute flairs of asthma symptoms.

Most common side effects include dry, irritated throat and yeast infection in the mouth or throat.

Mast cell stabilizers are occasionally used instead of inhaled steroids especially for children although they are not as effective and do not prevent severe attacks as well as inhaled steroids. They must be taken 4 times a day. Their main appeal is that they cause almost no side effects.

They are also sometimes used as an alternative to beta 2 drugs to prevent exercise-induced asthma (taken 15-20 minutes before beginning exercise). They are not quick-acting and, therefore, not effective once symptoms flare.

Salmeterol and Foradil are long-acting forms of the beta 2 drugs. These medications may be used to treat people whose symptoms are not entirely relieved with the combinations of a short-acting beta 2 drug and inhaled steroids. They are also used to treat people who have exercise-induced asthma.

Because they are long-acting, these drugs are useful for people with night-time flares who would otherwise have to awaken to treat symptoms.

Although long-acting, they are not fast-acting (takes 20-30 minutes) and, therefore, not useful for the acute flare.

Usually taken twice daily but some people do well with once daily.

Important to note that the long-acting beta drugs do not have any effect on lung inflammation and are not recommended as the sole asthma treatment. They should be used along with inhaled steroids or other anti-inflammatory asthma drugs.

Side effects may include jitteriness, tremors, racing heart, and muscle cramps.

Advair Discus combines the inhaled steroid - fluticasone (Flovent) with the long-acting beta drug - Salmeterol (Serevent) which can be convenient for some individuals who take both drugs.

Leukotriene drugs are unpredictable and work in less than 50% of people with asthma. It takes about a month to determine whether these medications will work for a particular person.

Zafirlukast and montelukast are longer-acting than zileuton and can be taken once or twice a day.

Leukotriene drugs are used for symptom prevention rather than for relief during acute attacks.

They can cause liver inflammation and liver blood tests should be monitored when taking the drugs.

Theophylline is moderately effective in decreasing lung inflammation and in preventing asthma flares. It is not as effective as long-acting beta 2 drugs. Before beta 2 drugs, theophylline used to be the standard asthma treatment but has largely been replaced by long-acting beta drugs. It is an alternative for people who cannot take long-acting beta 2 drugs.

Theophylline pills are usually taken once or twice a day.

When taking theophylline, it is important to have blood tests to periodically monitor theophylline blood levels since high blood level cause a risk of seizures and serious abnormalities of the heart rhythm. Theophylline overdose can even cause fatalities.

A number of other drugs can increase theophylline blood levels including cimetadine (Tagamet), propranalol (Inderal), phenytoin (Dilantin), certain antibiotics and several other less common medications. Cigarettes and marijuana will also cause theophylline levels to rise. In addition, certain conditions such as liver disease, heart failure, particular lung conditions, and advanced age tend to increase theophylline levels.

Common side effects include nervousness, nausea, vomiting, loss of appetite, diarrhea and headache.

Steroid pills are the most powerful asthma medication available. Short courses of steroid pills are often used to treat severe asthma attacks. A small percentage of people require long-term steroid pills for severe asthma that does not improve with other medications.

Chronic use of steroid pills can cause a number of serious side effects, such as bone loss, fluid retention, etc. Long-term use is less often necessary now because of the availability of inhaled steroids which are nearly as effective and which cause far fewer complications.

It is important to note that, for those who have taken steroid pills for approximately three weeks or more, steroids should not be stopped abruptly since this often results in an asthma attack or other serious problem.

Steroids in the pill (and intravenous) form take up to six hours to work and, therefore, should not be relied upon alone to treat the acute asthma attack.

Beta 2 drugs are available in liquid and pill form but are not as effective as inhalers. They also take longer to work (20-30 minutes) and cause more jitteriness than the inhaled form of the drug.

The liquid form or pill form might be used occasionally for very young children and others who are unable to inhale medication.

Use of over-the-counter inhalers for asthma flares can result in serious problems. These medications are not effective in decreasing the lung inflammation and swelling that can occur with asthma. If inflammation becomes severe and is left untreated, serious and even life-threatening breathing problems may occur.

Catecholamines belong to the same group of drugs as the beta 2 drugs. Catecholamines, however, place considerable stress on the heart, and are effective for only a short period of time - only 30 to 90 min. The beta 2 drugs have effectively replaced catecholamines since they are as effective, longer-acting and have virtually no impact on the heart.

Isoprotetenol is the most potent of the catecholamines.

Isoetharine has the least impact on the heart of the catecholamines but is not very effective in treating asthma.

The long-acting beta drugs in the pill form are not as effective as the inhaled form of the drugs. Also, the pills may cause more intense side effects of jitteriness, heart pounding, and tremors than the inhaled long-acting beta drugs.

The pills are inconvenient - they must be taken three time a day.

Expectorants are drugs that help break up mucus by causing fluids to be secreted into the airways. One expectorant called acetylcysteine may actually worsen asthma symptoms in certain individuals. This problem can be prevented by using acetylcysteine in combination with inhaled beta - drugs.

Sedatives and tranquilizers should never be taken during the acute asthma attack, even in the face of great anxiety. They decrease the ability to breath and can cause a life-threatening situation. These drugs have been known to cause a complete cessation of breathing during asthma attacks.

Theories have been proposed to suggest that methotrexate and gold treatments might be helpful for people whose asthma is severe enough to require long-term oral steroid pills. However, methotrexate and gold seem to be minimally effective for asthma and cause numerous and serious side effects. Treatment with these substances is considered experimental.

There is controversy about the effectiveness of IV magnesium for acute asthma attacks and its use is not currently recommended.

New inhaled, short-acting beta 2 drug that causes slightly less jitteriness and heart racing than the standard beta 2 drugs. May be recommended for older people with heart disease or young children who become very jittery from other inhaled beta 2 drugs. Side effects are only slightly better than with other beta 2 drugs and the slight improvement is probably not worth the much higher cost for most people.

Anticholinergics are not recommended as a first choice for asthma since they are not as effective as the beta 2 drugs and they are slower acting (10-15 verses 1-2 minutes). (Some sources report that anticholinergics take up to 60 to 90 minutes to work).

Anticholinergics may be prescribed for people with asthma in two situations; for those with serious heart disease who cannot risk the heart stimulation caused by beta 2 drugs; and for those who are taking a type of antidepressent called an MAO inhibitor (Nardil, Parnate) or an anti-Parkinson drug called Eldepryl (selegiline). Some physicians will also prescribe anticholinergics when asthma symptoms persist despite the use of beta 2 drugs.

Asmanex is available in other countries and is available in the United States as a nasal steroid spray called Nasonex. It is effective when taken once daily.

Another new inhaled steroid under development, called ciclesonide, is activated in the lungs only alter it is inhaled. This drug may cause fewer side effects than other inhaled steroids. It is also taken once daily.

May act immediately and last up to 24 hours - twice as long as existing long-acting beta drugs.

Combines the inhaled steroid budesonide (Pulmicort) with the long-acting beta drug formoterol (Foradil).

Decreases a substance called IgE, which is a molecule that is involved in the allergic response. Studies show that people with the most severe forms of allergic asthma may experience great improvement with this drug and may be able to decrease their dependence on the use of steroid pills and therefore, avoid the serious side effects that steroid pills can cause when used chronically.

Anti-IgE drugs are administered by injection.

Several drugs of this type are under investigation. The hope is to create a drug that acts like theophylline but causes fewer side effects such as nausea and heart pounding, and interacts with fewer drugs than theophylline. None of these drugs have reached the market yet. Ariflo is still pending FDA approval.

Allergy shots are commonly used to treat people with allergy-related asthma. Few sound scientific studies have evaluated the effectiveness of allergy shots, but those that have been attempted have failed to find any significant asthma improvement.