FACTBOX: Asthma drugs attack from several angles

(Reuters) - New federal guidelines on asthma recommend inhaled drugs called corticosteroids as the first line of treatment.

They are among several classes of drugs marketed to treat asthma, which affects 300 million people worldwide.

Corticosteroids reduce inflammation in the bronchial tubes, which carry air to the lungs. They can also help reduce the production of mucus.

Inhaled corticosteroids include GlaxoSmithKline's fluticasone, sold alone under the brand name Flovent and also as part of its Advair product, which combines the two drugs fluticasone and salmeterol.

Budesonide is sold by AstraZeneca under the brand name Pulmicort and triamcinolone is marketed by Abbott under the brand name Azmacort.

Other inhaled corticosteroids include beclomethasone, made by Teva Pharmaceuticals under the brand name Qvar, and Schering-Plough's inhaled corticosteroid Asmanex, known generically as mometasone.

Xolair, made by Genentech and Novartis, is a monoclonal antibody, an engineered protein that blocks the immune system compound immunoglobulin E, overproduced during an allergic asthma attack.

Known generically as omalizumab, it is injected and approved only for people over the age of 12.

Among the other classes of drugs are long-acting beta-2 agonists -- bronchodilators that open constricted airways.

LABAs include Glaxo's salmeterol, sold as Serevent and also part of its Advair product, and formoterol, sold by Novartis under the brand name Foradil.

The panel recommends care in using these drugs and they should not be used to treat acute symptoms but instead in combination with inhaled corticosteroids if patients 5 or older need the extra medication.

Leukotriene modifiers interfere with the production and action of leukotrienes, which are produced by lung cells during an asthma attack. They do not help open the airways.

Leukotriene modifiers include montelukast, sold by Merck and Co. under the brand name Singulair and zafirlukast, sold by AstraZeneca under the brand name Accolate.

Short-acting beta-2 agonists open the airways and are sometimes called rescue medications because they work quickly.

The generic drug albuterol is the most commonly used drug in this class, which also include ipratropium, sold by privately held Boehringer Ingelheim Pharmaceuticals under the brand name Atrovent.

The anticholinergic drug ipratropium bromide, available generically, may also be used for quick relief.