Many different inhalers and pills are used to treat asthma. Inhalers work faster and usually have fewer side effects. Inhalers are medicines that you breathe into your lungs as you spray them through your mouth.

The most important asthma medicines are the "anti-inflammatories"-- cromolyn, nedocromil and corticosteroids. These medicines, called preventers, help decrease the inflammation and mucus in your airways. People who have asthma can prevent asthma attacks by using these inhalers several times every day.

Other medicines called "bronchodilators"-- albuterol and salmeterol -- relax the muscles around the airways during an asthma attack. When the muscles are relaxed, the airways become larger and allow more space for the air to move in and out. These medicines, called relievers, can help relieve the symptoms of an asthma attack. If you can keep your asthma under control with the anti-inflammatory drugs, the relievers might only be needed in emergencies.

You can take some preventers and relievers in pill form. To keep your asthma under control you might need to use a combination of pills and inhalers.

An expert panel for the National Asthma Education and Prevention Program (NAEPP) recently issued new guidelines that recommend the use of a revised classification system for asthma. Based on these guidelines, asthma is classified as mild intermittent, mild persistent, moderate persistent and severe persistent. It is important to note that patients at any level of severity may have severe, life threatening exacerbations.

Low grade (not obviously noticeable) progressive inflammation occurs in the bronchial tubes of asthmatics not optimally treated. This means that when asthma symptoms occur there is much less room for safety because the bronchial airways are already narrowed.

Asthma Severity	Treatment Recommendations
MILD INTERMITTENT ASTHMA	STEP 1
Symptoms < 2 times per week No symptoms between flares Flares brief Normal peak flow between flares Night symptom< 2 times per month Lung tests > 80% predicted* Lung test variability < 20% * Peak flow or FEV1	Short acting beta-agonist as needed (daily medication not needed)
MILD-PERSISTENT ASTHMA	STEP 2
Symptoms > twice a week but < 1 time a day flares affect activity Night symptoms > twice per month Lung tests ³ 80% predicted* Lung test variability 20 - 30 %	Daily anti-inflammatory medication (low- dose inhaled corticosteroids, mast cell stabilizers, leukotriene modifiers, or sustained release Theophylline) Short acting ß-agonist as needed
MODERATE-PERSISTENT ASTHMA	STEP 3
Daily symptoms Daily use of inhaled ß-agonist Flares affect activity > 2 times per week and may last days Night symptoms > 1 time per week FEV1 or peak flow > 60% but < 80% of predicted (when not having flare) Peak flow variability > 30%	Daily anti-inflammatory medication (low or medium-dose inhaled corticosteroids) PLUS Long acting bronchodilator IF NEEDED medium to high dose corticosteroids AND Long acting bronchodilator
SEVERE-PERSISTENT ASTHMA	STEP 4
Continual symptoms Limited physical activity Frequent flares FEV 1 < 60% predicted Peak flow variability > 30%	Daily anti-inflammatory medication High dose inhaled corticosteroids PLUS Long-acting bronchodilator AND Corticosteroid tablets or syrup
1997 NAEP guidelines