Breathing difficulty can be a distressing situation to combat and a major diagnostic challenge for the physicians. One of the most prevalent and significant cause of breathing difficulty is asthma.
Asthma is an inflammatory condition of the airway, characterized by hyper-responsiveness of the airway to certain trigger factors. These trigger factors can be anything from dust, pollen, cold air, tobacco smoke to physical activity like exercising. Asthma is also marked by an excessive mucous production by cells of the airway. Swelling, increased bronchial responsiveness and excess mucous production, leads to narrowing of the airways, causing episodes of breathing discomfort.
It is a life-long condition with no particular cure. However, asthma can be effectively managed through medications.
Symptoms
Some classic symptoms of asthma are as follows:
- Tightness in the chest.
- Difficulty in breathing, medically known as dyspnea
- Wheezing (i.e. a typical whistling sound produced while breathing)
- Coughing, which aggravates at night or in the morning
When the symptoms of asthma worsen, the patient is said to suffer an “asthma attack” or an “asthma flare-up”. Medically, this condition is known as “Status Asthmaticus”. It is an acute severe condition which is considered a medical emergency. It is a fatal condition requiring immediate medical intervention.
Treatment
There is no cure for asthma. Prevention and symptomatic relief are the goals of treatment. Treatment depends on the patient’s age, type of asthma and severity of the condition. Recognizing the trigger factors and their avoidance is the first step in preventing asthma attacks.
However, drug therapy is required in almost all the patients. Most of these drugs are available on prescription and are dispensed in drug-delivery devices, i.e. inhalers or nebulizers.
Earlier, some over the counter medications were available for asthma. These included combination tablets of ephedrine and guaifenesin, racepinephrine inhaler and CFC containing epinephrine inhalers. However, later it was realized that these drugs may mask symptoms of some debilitating conditions like cardiovascular conditions. Also, FDA has revoked CFC containing inhalers from the market, considering the environmental hazard (i.e. ozone depletion) posed by it. Therefore, doctors strictly condemn the use of over the counter medications for relieving asthma.
Most advocated treatment of asthma include corticosteroids, beta-2 adrenergic agonist, anti-cholinergics, mast cell stabilizers, leukotriene modifiers, theophylline and anti-IgE antibody. Acute onset of asthma necessitates the use of quick-relief medications. Once patient is stabilized, long-term medications are prescribed to prevent onset of future episodes.
The drugs used in asthma are described below.
1. Long-term Control Medications
These are the mainstay in the treatment of asthma. These are taken on a daily basis to prevent the onset of asthma i.e. a patient is supposed to take these medications even after the symptoms have resolved. Various drugs advocated in long-term control therapy are listed below.
I. Oral and Inhalation Corticosteroids
Corticosteroids are steroid hormones which are produced by the adrenal glands in our body. This group of steroids is of two types namely mineralocorticoids and glucocorticoids. Both of these types have anti-inflammatory properties due to which these are used to treat various diseases. Mineralocorticoids have no therapeutic benefit in asthma whereas Glucocorticoids are potent anti-inflammatory drugs and are very useful in asthma. They suppress the hyper-responsiveness of the bronchi and reduce the inflammation of the airway, thus providing relief in asthma. For long-term control of chronic asthma, inhalation steroids are used as a first-line drug. Oral steroids are used when patient is not responding to inhaled steroids.
Available as: Aerosol preparation in metered dose inhalers (MDIs) and dry powder inhalers (DPIs) as well as oral preparations
Aerosol preparation in MDIs
A. Beclomethasone dipropionate
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: beclomethasone dipropionate
Brand name: Qvar inhaler
Common side-effects: Nausea, stomach upset, vomiting, sore throat, headache, cough, unpleasant taste in mouth, dryness in mouth/throat/nose after use, deepened voice, hoarseness.
Indicated in Pregnancy: Yes
Alcohol Content: Present (As Ethanol in propellant)
B. Mometasone
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: mometasone inhalation
Brand name: Asmanex HFA
Common side-effects: cough, body aches, congestion, cold or flu-like symptoms, dryness or soreness of the throat
Indicated in Pregnancy: Yes
Alcohol Content: Present (As Ethanol in propellant)
Dry Powder Inhalation in DPIs
A. Budesonide
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: budesonide inhalation powder
Brand name: Pulmicort Turbuhaler
Common side-effects: Ear ache, fever, diarrhea, pain while urinating, lower abdominal pain, nausea, redness or discharge from the eye, eyelid or lining of eye, trouble swallowing, sore throat, shortness of breath, vomiting, vaginal itching and discharge
Indicated in Pregnancy: Yes
Alcohol Content: Absent
Oral steroids
A. Prednisolone
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: prednisolone
Brand name: Prelone
Side-effects: Heartburn infections, insomnia, dizziness, headache, nausea
Indicated in Pregnancy: Yes
Alcohol Content: Absent
B. Hydrocortisone
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: hydrocortisone
Brand name: Cortef
Side-effects: Blurred vision, anxiety, aggression, dry mouth, dizziness, decrease amount of urine, irritability, pounding irregular heartbeat, headache, mood changes, mental depression, trembling, restlessness, weight gain, trouble sleeping
Indicated in Pregnancy: Yes
Alcohol Content: Absent
C. Dexamethasone
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: dexamethasone
Brand name: Baycadron
Side-effects: Agitation, aggression, blurred vision, anxiety, irritability, headache, mood changes, shortness of breath, weight gain, trouble thinking, walking, sleeping
Indicated in Pregnancy: Indicated only for short-term use
Alcohol Content: Absent
Oral Corticosteroids are also used in treatment of other diseases, such as allergic diseases, arthritis, etc.
II. Long-acting β-2 Adrenergic Agonist
This group of drugs stimulates the β-2 adrenergic receptors which are present in the bronchi of the respiratory system. These receptors when stimulated, relax the muscles of the bronchi and cause bronchodilation i.e. dilation or expansion of the airways. These drugs are most effective when inhaled. However, research has shown that regular use of these drugs may worsen asthma. Therefore, it is recommended that patients requiring long-term use of this drug should combine it with inhaled steroids.
Available as: Aerosol preparation in metered dose inhalers (MDIs) and dry powder inhalers (DPIs)
Aerosol preparation in MDIs
A. Salmeterol
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: salmeterol xinafoate
Brand name: Serevent
Side-effects: Headache, cough with mucous, throat irritation, difficulty with breathing, runny nose, stuffy nose, sneezing, wheezing, chest tightness
Indicated in Pregnancy: Yes
Alcohol Content: Absent
Dry Powder Inhalation in DPIs
A. Formoterol
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: formoterol inhalation powder
Brand name: Foradil Aerolizer
Side-effects: Cold or flu-like symptoms, chills, body aches, headache, ear congestion, fever, cough, hoarseness, difficulty in breathing, nasal congestion, sore throat, loss of voice, runny nose, sneezing
Indicated in Pregnancy: Yes
Alcohol Content: Absent
Long-acting β-2 Adrenergic Agonist are also used in the treatment of other respiratory disorders, such as COPD.
III. Leukotriene Modifiers
Cysteinyl Leukotrienes (CysLT) are inflammatory mediators which are released by inflammatory cells of the body, such as mast cells, macrophages, eosinophils in response to a trigger factor. These mediators are produced in asthma and are responsible for several biological consequences such as constriction of bronchi, increased secretion of mucous and hyper-responsiveness of bronchi.
Leukotriene modifiers stop the action of CysLT and thus help in dilation of bronchi, reduce mucous secretion and decrease the responsiveness of bronchi, thereby relieving inflammation of airway.
Available as: Oral preparations
A. Montelukast
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: montelukast sodium
Brand name: Singulair
Side-effects: Headache, flu-like symptoms, bloody nose, stomach pain, breathing discomfort, sweating, joint pain, tenderness or pain around cheekbones and eyes, chest tightness, trouble with swallowing
Indicated in Pregnancy: Yes
Alcohol Content: Absent
B. Zafirlukast
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: zafirlukast
Brand name: Accolate
Side-effects: Fever, chils, hoarseness of voice, cough, lower back or side pain, painful urination
Indicated in Pregnancy: Yes
Alcohol Content: Absent
C. Zileuton
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: zileuton
Brand name: Zyflo
Side-effects: Nausea, fever, headache, cough, runny or stuffy nose, upset stomach, pain around cheekbones and eyes, wheezing, chest tightness, troubled breathing
Indicated in Pregnancy: Use only when absolutely indicated
Alcohol Content: Absent
IV. Methylxanthines
When the body of an asthma patient is exposed to an allergen or a trigger factor, inflammatory cells such as mast cells activate. These cells release a chemical called histamine which acts as an inflammatory mediator and produces symptoms of asthma. Theophylline and its compounds belong to methylxanthines class of drugs. They reduce the release of histamine from inflammatory cells, thus are beneficial in asthma. They also promote the clearance of excess mucous and causes bronchodilation.
Available as: Oral preparations
A. Theophylline
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: theophylline oral
Brand name: Theo-24
Side-effects: Fainting, chest pain, slow, paving or irregular heartbeat, persistent vomiting, increase in urine volume, seizures, light-headedness, trembling, rapid pulse
Indicated in Pregnancy: Safe during second and third trimester. However, risk during first trimester has not been completely ruled out
Alcohol Content: Absent
Theophylline is also used in the treatment of bronchitis, emphysema and other breathing disorders. Injectable preparations of theophylline have been discontinued, as per FDA instructions.
V. Mast Cell Stabilizers
This group of drugs stabilizes the mast cells and prevents their degranulation i.e. it prevents the release of inflammatory mediators from mast cells, thus preventing the onset of asthma.
Available as: Oral preparations and aerosol preparations.
Oral Preparation
A. Ketotifen Oral
US-FDA Status: Not Approved for Asthma
Generic name: ketotifen
Brand name: Asthafen
Side-effects: Dizziness, blurred vision, severe drowsiness
Indicated in Pregnancy: No
Alcohol Content: Absent
However, oral ketotifen is being used for asthma in Canada, Europe and Mexico. Also, FDA approved the use of ocular administration of ketotifen ophthalmic in US for conjunctivitis and it is available as an over the counter formulation, such as eye drop.
Aerosol preparation (inhaler or nebulizer)
A. Sodium Cromoglycate
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: cromolyn Inhalation Solution (nebulizer)
Brand name: Intal Nebulizer solution
Side-effects: Diarrhea, headache, muscle pain, irritability, nausea. Abdominal pain.
Indicated in Pregnancy: Yes
Alcohol Content: Absent
B. Nedocromil Sodium
US-FDA Status: Not approved
Generic name: nedocromil sodium
Brand name: Tilade inhaler
Side-effects: Body ache, cough, abdominal pain
Indicated in Pregnancy: Yes
Alcohol Content: Absent
Sodium cromolycate and nedocromil inhalers contain a CFC containing propellant, which is an environmental hazard. Hence, FDA has phased out these inhalers. However, in line with the Montreal Protocol (an international agreement to ban CFC), new inhalers containing HFA propellant were developed. But, these are available in UK and Australia only, and are not sold in US.
Hence, nedocromil formulations are completely discontinued and nebulized solutions of cromolyn are the only remaining formulations, which can be used.
VI. Anti-IgE Antibody
When the body is exposed to an allergen, immunoglobulin E (IgE) binds to the surface of mast cells and facilitates the release of inflammatory mediators which aggravate asthma. Anti-IgE antibodies are monoclonal antibodies, which do not act on any inflammatory cell, instead neutralize the free circulating IgE, thus preventing the onset of asthma.
Available as: Subcutaneous injection
A. Omalizumab
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: omalizumab
Brand name: Xolair injection
Side-effects: Chills, blistering, body aches, fever, bleeding, congestion, leg pain, hoarseness, itching, lumps, muscle or joint pain, numbness, sore throat, runny nose, redness, tenderness in cheekbones and eyes
Indicated in Pregnancy: Yes
Alcohol Content: Absent
Omalizumab is being tried in other allergic diseases as well.
VII. Anticholinergics
Bronchial smooth muscles consist of a particular receptor, called as muscarinic receptors, which cause constriction of bronchi. Anti-cholinergic used in asthma inhibits these receptors, thus cause dilation of bronchi.
Available as: Aerosol preparation in metered dose inhalers and in inhalation sprays
A. Ipratropium bromide
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: ipratropium bromide
Brand name: Atrovent HFA
Side-effects: Bloody or cloudy urine, cough with mucous, bladder pain, increased urge to urinate, painful urination, shortness of breath, chest tightness.
Indicated in Pregnancy: Yes
Alcohol Content: Present (In propellant)
B. Tiotropium bromide
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: tiotropium inhalation spray
Brand name: spiriva respimat
Side-effects: chest heaviness, sweating, nausea, irregular or fast heartbeat, breathing discomfort, pain in arm, jaw or back.
Indicated in Pregnancy: Yes
Alcohol Content: Absent
Anticholinergics are chief bronchodilators used in the treatment of COPD.
2. Quick Relief Medications
These are also known as rescue medications. These are used in an acute episode of asthma, medically known as Status Asthmaticus. Various drugs which effectively relieve bronchospasm in an acute asthma attack are listed below.
I. Short-acting β-2 Adrenergic Agonist
The mechanism of action is similar to long-acting β-2 Adrenergic Agonist. These act for a shorter period of time and are taken through inhalation route in acute attacks of asthma.
Available as: Oral preparations and Aerosol preparations in metered device (inhaler or nebulizer)
Oral preparations
A. Terbutaline
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: terbutaline oral
Brand name: Brethine
Side-effects: Trembling in hands, feet, arms and leg, headache, sweating, light headedness
Indicated in Pregnancy: No
Alcohol Content: Absent
B. Albuterol
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: albuterol sulfate
Brand name: Vospire ER
Side-effects: Trembling in hands, arms, feet, legs and pounding heartbeat and pulse
Indicated in Pregnancy: No
Alcohol Content: Absent
Aerosol preparations
A. Albuterol
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: albuterol
Brand name: Proventil-HFA
Side-effects: Trembling in hands, arms, feet, legs and pounding heartbeat and pulse
Indicated in Pregnancy: Yes
Alcohol Content: Present (As ethanol in propellant)
B. Terbutaline
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: terbutaline nebulizer
Brand name: Bricanyl
Side-effects: Trembling in hands, feet, arms and leg, headache, sweating, light headedness.
Indicated in Pregnancy: Yes
Alcohol Content: Absent
Earlier, terbutaline was available over the counter and was used by many pregnant women to prevent recurrent preterm labor. It was found that terbutaline lead to major cardiovascular events and maternal deaths. Hence, FDA has disapproved the off-label use of terbutaline for acute obstetric cases, including treatment of uterine hyperstimulation and preterm labor.
II. Intravenous Corticosteroids
The mechanism of action of steroids in asthma has already been mentioned in the previous section. However, in an acute attack, injections in the veins are administered as it relieves the bronchoconstriction in lesser time. Once the patient is stabilized, oral steroid therapy is started.
Available as: Injectable preparations
A. Hydrocortisone
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: hydrocortisone sodium succinate
Brand name: Solu-Cortef
Side-effects: Blurred vision, anxiety, aggression, dry mouth, dizziness, headache, irritability, depression, mood changes, dizziness, decreased amount of urine
Indicated in Pregnancy: Yes
Alcohol Content: Absent
B. Triamcinolone
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: triamcinolone hexacetonide
Brand name: Aristospan
Side-effects: Anxiety, blurred vision, aggression, noisy rattling breathing, irritability, shortness of breath, headache, mental depression, dizziness
Indicated in Pregnancy: Yes
Alcohol Content: Absent
III. Combination of Anti-cholinergic and β-2 Adrenergic Agonist
The acting mechanism of anti-cholinergic and β-2 Adrenergic Agonist has already been stated previously. In an acute attack of asthma, both these group of drugs are combined to produce effective results.
Available as: Aerosol preparations
Albuterol sulfate/Ipratropium bromide
US-FDA Status: Approved for Asthma
Availability: Prescription only
Generic name: ipratropium bromide and albuterol sulfate
Brand name: Combivent respimat inhalation spray
Side-effects: Cough with mucous, body aches, chills, headache, fever, loss of voice, sore throat, runny or stuffy nose, sneezing, chest tightness, breathing difficulty.
Indicated in Pregnancy: Yes
Alcohol Content: Absent
Other Drugs Used
The above-mentioned drugs are the chief drugs used in the treatment of asthma. However, there are certain other drugs, which may be added to the conventional treatment. These are described below.
1. Ephedrine
It is a pressor agent, belonging to a class of drugs, known as adrenergic drugs. It is an alkaloid, derived from Ephedra vulgaris. It acts on certain receptors, called as alpha and beta-adrenergic receptors, present in various organs of our body, including bronchi. By stimulating these receptors, ephedrine causes bronchodilation, thus preventing the onset of asthma attacks and providing symptomatic relief.
However, stimulation of receptors of blood vessels, heart, etc. can produce side-effects. Ephedrine also bears the potential to enter brain and act as a CNS stimulant.
Available as: Oral preparations, Injectable preparations and Topical preparations.
A. Oral preparation
US-FDA Status: Unapproved for Asthma
Generic name: ephedrine
Brand name: Ephedrine hydrochloride
Side-effects: Nervousness, headache, dizziness, restlessness, stomach irritation.
Indicated in Pregnancy: Only when absolutely indicated
Alcohol Content: Absent
B. Injectable preparation
US-FDA Status: Unapproved for Asthma
Generic name: ephedrine (intravenous route)
Brand name: Akovaz
Side-effects: Dizziness, blurred vision, headache, fast pounding irregular heartbeat, pounding in the ears.
Indicated in Pregnancy: No
Alcohol Content: Absent
C. Topical preparation
US-FDA Status: Unapproved for Asthma
Generic name: ephedrine in sodium chloride
Brand name: Pretz-D nose spray
Side-effects: Headache, nasal irritation such as burning, dryness or itching.
Indicated in Pregnancy: No
Alcohol Content: Absent
Although ephedrine is unapproved by the US-FDA, it is available as a nasal preparation in several other countries, like Argentina, Austria, Germany, etc.
2. Mucolytic
It belongs to a class of drug, known as “Expectorants”. It facilitates expectoration by thinning the tenacious mucous in asthmatic patients, thus relieving the symptoms.
Available as: Oral preparations (Tablets and syrups)
A. Ambroxol
US-FDA Status: Unapproved for Asthma
Generic name: ambroxol hydrochloride
Brand name: Ambrodil
Side-effects: Nausea, gastric irritation, lacrimation
Indicated in Pregnancy: Not indicated in first trimester
Alcohol Content: Absent
B. Bromhexine
US-FDA Status: Unpproved for Asthma
Generic name: bromhexine hydrochloride
Brand name: A-cold syrup
Side-effects: Gastric irritation, nausea, lacrimation, rhinorrhea
Indicated in Pregnancy: Not indicated in first trimester
Alcohol Content: Absent
OTC Drugs for Asthma
Based on the conflicting opinions of pharmaceutical regulatory bodies of various countries, the availability of anti-asthmatic drugs varies from country to country. Some of the US-FDA disapproved drugs are approved by other regulatory bodies and are being sold in various countries.
The various OTC drugs available in several countries have been summarized below:
| Name of the Country | OTC Drug(s) Available |
| Argentina | Ephedrine (nasal) Bromhexine (oral) Ambroxol (oral) |
| Australia | Beclomethasone dipropionate (nasal) Fluticasone (nasal preparations) Mometasone (nasal) Theophylline (oral) Ketotifen (oral and nasal preparation) Ipratropium bromide (nasal) Salbutamol Bromhexine (oral) |
| Austria | Cromoglycic acid (nasal) Ephedrine (nasal) Ambroxol (oral) |
| Canada | Fluticasone (nasal preparations) Mometasone (nasal) Cromoglycic acid (nasal) Ephedrine (nasal) |
| China | Beclomethasone dipropionate (nasal) Fluticasone (nasal preparations) Prednisolone (oral) Cromoglycic acid (nasal) Ephedrine (nasal) Bromhexine (oral) Ambroxol (oral) |
| Croatia | Bromhexine (oral) Ambroxol (oral) |
| Czech Republic | Beclomethasone dipropionate (nasal) Fluticasone (nasal preparations) Ipratropium bromide (nasal) Bromhexine (oral) Ambroxol (oral) |
| Denmark | Beclomethasone dipropionate (nasal) Fluticasone (nasal preparations) Ketotifen (oral and nasal preparation) Bromhexine (oral) |
| France | Beclomethasone dipropionate (nasal) Cromoglycic acid (nasal) Ephedrine (nasal) Bromhexine (oral) Ambroxol (oral) |
| Germany | Beclomethasone dipropionate (nasal) Cromoglycic acid (nasal) Ephedrine (nasal) Bromhexine (oral) Ambroxol (oral) |
| Greece | Prednisolone (oral) Bromhexine (oral) Ambroxol (oral) |
| Hungary | Cromoglycic acid (nasal) Ipratropium bromide (nasal) Ephedrine (nasal) Bromhexine (oral) Ambroxol (oral) |
| India | Beclomethasone dipropionate (nasal) Fluticasone (nasal preparations) Mometasone (nasal) Prednisolone (oral) Cromoglycic acid (nasal) Ipratropium bromide (nasal) Salbutamol Ephedrine (nasal) Bromhexine (oral) Ambroxol (oral) |
| Ireland | Beclomethasone dipropionate (nasal) Fluticasone (nasal preparations) Ipratropium bromide (nasal) Ephedrine (nasal) Ambroxol (oral) |
| Italy | Beclomethasone dipropionate (nasal) Ketotifen (oral and nasal preparation) Ipratropium bromide (nasal) Ephedrine (nasal) Bromhexine (oral) Ambroxol (oral) |
| Japan | Beclomethasone dipropionate (nasal) Prednisolone (oral) Theophylline (oral) Ketotifen (oral and nasal preparation) Cromoglycic acid (nasal) Ephedrine (nasal) Bromhexine (oral) Ambroxol (oral) |
| Mexico | Cromoglycic acid (nasal) Salbutamol Bromhexine (oral) Ambroxol (oral) Philippines Bromhexine (oral) Ambroxol (oral) |
| Russia | Beclomethasone dipropionate (nasal) Fluticasone (nasal preparations) Mometasone (nasal) |
| Singapore | Beclomethasone dipropionate (nasal) Fluticasone (nasal preparations) Cromoglycic acid (nasal) Salbutamol Ephedrine (nasal) Bromhexine (oral) Ambroxol (oral) |
| South Africa | Beclomethasone dipropionate (nasal) Fluticasone (nasal preparations) Mometasone (nasal) Prednisolone (oral) Theophylline (oral) |
| South Korea | Beclomethasone dipropionate (nasal) Prednisolone (oral) Cromoglycic acid (nasal) Salbutamol Ephedrine (nasal) Bromhexine (oral) Ambroxol (oral) |
| Spain | Beclomethasone dipropionate (nasal) Fluticasone (nasal preparations) Prednisolone (oral) Cromoglycic acid (nasal) Ipratropium bromide (nasal) Ephedrine (nasal) Bromhexine (oral) Ambroxol (oral) |
| Switzerland | Cromoglycic acid (nasal) Ephedrine (nasal) Bromhexine (oral) Ambroxol (oral) |
| The Netherlands | Cromoglycic acid (nasal) Ipratropium bromide (nasal) Bromhexine (oral) Ambroxol (oral) |
| UK | Beclomethasone dipropionate (nasal) Fluticasone (nasal preparations) Mometasone (nasal) Theophylline (oral) Cromoglycic acid (nasal) Ipratropium bromide (nasal) Ephedrine (nasal) |
| USA | Fluticasone (nasal preparations) Cromoglycic acid (nasal) |
However, it is imperative to bear in mind that a doctor’s consultation is of utmost importance and self-medication is not advisable.
Other than the conventional medications, natural ways including lifestyle and dietary changes, can also play a vital role in managing asthma.
