The following are asthma controller medicines past and present:
1. Beclomethasone: First marketed by Allen & Hanbury in 1960 and marketed as Becotide in 1972 overseas with a recommended frequency of two puffs four times daily. GlaxoSmithKline's version of beclomethasone was Vanceril, and Schering-Plough's version was Beclovent, and both were approved by the FDA for sale in the U.S. in 1982. Other oversease brand names are Becloforte, and Beconaise. The initial inhalers were made with the chlorofluorocarbons (CFC) propellant and these have all been since phased out in favor of the HFA verions called Qvar (see below)
2. Fenoterol: It was a non-selective long acting beta agonist that asthma patients were allowed to use at home. It was marketed as Barotek. It was introduced to the market in New Zealand in 1976. Shortly thereafter the asthma death rate soared in New Zealand to a rate significantly higher than other nations. Fenoterol overuse was blamed for the deaths, however, this was never proven. Some believe that poor education about asthma medicines encouraged some asthmatics to continue using the medicine instead of seeking help. The New Zealant asthma death rate declined slightly after warnings were incorporated into the package in 1981, yet the death rate in New Zealand continued to be higher than other nations. The death rate fell 50 percent in 1990. Despite the warnings, sales of the product remained consistent and actually increased slightly in 1989-90. (1) Despite consistent sales, the product was taken off the market in the 1995 due to the scare. The product was also available in Japan and Canada.
6. Flunisolide: It was approved by the FDA in 1982 introduced to the U.S market as Aerobid. This turned out to be perfect timing for entry into this market, because in 1989 the National Heart, Lung and Blood Instute's (NHLBI) Asthma Guidelines were created. The guidelines recommended inhaled steroids as a top line asthma treatment, and sales of inhaled steroids skyrocketed, with Aerobid leading the way. Aerobid was the best selling inhaled steroid during the 1990s mainly because it had a stronger formula than triamcinolome and beclomethasone requiring fewer puffs to achieve the desired dose.
8. Salmeterol: It was approved by the FDA in 1994, and became the latest long acting beta adrenergic (LABA) to enter the market. The medicine attached to beta 2 adrenergic receptor sites in the lungs and continued to release the medicine for up to 12 hours. All that was needed was two puffs twice a day. The Advair Diskus, a dry powdered inhaler, was approved by the FDA in 1997. The diskus was green to distinguish it from the brown Flovent Diskus and eventually the Advair purple Diskus). By 2008 some suspected the medicine was the cause of asthma related deaths and a black box warning was placed on the product. The NHLBI Asthma Guidelines ultimately recommended the medicine not be used by itself in the treatment of asthma. If asthma is bad enough that this medicine is needed, the guidelines recommended taking it with an inhaled steroid to control inflammation. The product is still available as a treatment for other lung diseases such as COPD.
The medicine was marketed as an asthma controller medicine to prevent bronchospasm and inflammation in asthmatic lungs to prevent asthma. Because it combined the two medicines and the frequency is one puff twice daily, it greatly improves compliance with asthma medicine (I can personally attest to this). Sales skyrocketed during the 2000s and it continues to be the top selling asthma controller medicine. Some fear salmeterol is related to asthma deaths and a black box warning was placed on the packaging in 2008. I wrote about this in more detail here.The patent for Advair expired in the U.S. in 2010 and will expire by 2012 in most European countries. It's expected that soon generic products will enter the market which would increase competition and lower the cost of the inhalers (currently priced at over $100).
11 Budesonide: The inhaled steroid solution of Pulmicort was introduced to the market in the early 1980s as the only inhaled steroid available as a solution for home use. Studies showed it was the safest and best corticosteroid solution. It was mainly prescribed for kids, however it's recommended for any asthmatics who requires inhaled steroids and has trouble coordinationg an inhaler. From what I can tell it has the same potency as Flovent. A Pulmicort Turbohaler hit the market in the late 1980s as the first corticosteroid as a dry powder inhaler. In 1997 the Pulmicort Turbohaler was approved by the FDA as the first DPI inhaled corticosteroid. The inhaler never caught on and was later discontinued. In 2000 Pulmicort Respules became the first corticosteroid nebulizer solution to be approved by the FDA. However, due better inhaled steroids and the Monteral Protocol, the Pulmicort Turbohaler was phased out by June 30, 2011. The Pulmicort Respules continue to be marketed as an inhaled corticosteroid option for children and adults with poor coordination skills with their corticosteroid MDIs.
It basically works the same as Advair except the LABA (formoterol) is faster acting and appears to have a stronger cardiac effect. The steroid in this inhaler is mometasone furoate (see below). It's availabe as either a metered dose inhaler or dry powder inhaler via the Turbohaler. Note: Some countries have adopted the Symbicort Smart program whereby you can use your Symbicort as a rescue inhaler. I wrote about this here.
13. Beclomethasone: I'm mentioning this again because the older CFC versions of this inhaler were taken off the market and replaced by an HFA inhaler which has been rebranded as QVAR. It was approved by the FDA in 2000. The medicine is the same, yet some studies show the smaller particle size allows the medicine to penetrate deeper into the lungs as compared with other inhaled corticosteroids presently on the market.
15. Dulera: It was approved by the FDA in June of 2010. It hit the market as an alternative to Advair and Symbicort. It containes Mometasone and Furosimide. Other than that it works similar to Advair and Symbicort. Whether one of these works better than the other is a matter of personal choice and physician preference. I trialed this medicine once and it make my heart beat like a jackhammer and I went back on Advair.
17: Zafirlucast: This was another leukotriene receptor agonist admitted to the market as Accolate to compete with Singulair. It was approved by the FDA in 1999.
18. Zileuton: This was another leukotriene receptor agonist marketed as Ziflo. It was introduced to the market in 2007 and was discontinued in 2008 (you can read the discontinuation letter here). It failed to take off becaue the other options only had to be taken once daily, while this one had to be taken four times daily.
hardluck asthma) non responsive to other asthma remedies. It was approved by the FDA in 2003.
- Beasley, Richard, Sankei Nishima, Neil Pearce, Julian Crane, "Fenoterol and Asthma Mortality," The Lancet, August 8, 1998, volume 352, Issue 9126, page 486