Nonsteroidal Anti-Asthma Agents: An Overview (2025)

Nonsteroidal anti-asthma agents play a crucial role in managing asthma by targeting inflammation and reducing airway hyperresponsiveness. Unlike corticosteroids, these medications work through different mechanisms, offering alternative treatment options for asthma patients.

In this article, we’ll explore the types of nonsteroidal anti-asthma agents, how they work, and when they’re typically prescribed to help control asthma symptoms and prevent exacerbations.

What are Nonsteroidal Anti-Asthma Agents?

Nonsteroidal anti-asthma agents are medications used to manage asthma by targeting inflammation without relying on corticosteroids. They help reduce airway swelling, prevent asthma symptoms, and control allergic reactions.

Common types include leukotriene receptor antagonists (e.g., montelukast), mast cell stabilizers (e.g., cromolyn sodium), and monoclonal antibodies (e.g., omalizumab). These agents work by blocking inflammatory pathways, reducing mucus production, and preventing airway constriction.

They are often prescribed for long-term asthma control, especially in patients with allergic asthma or those sensitive to steroids. While effective, they are typically used as part of a broader asthma management plan alongside bronchodilators and inhaled corticosteroids.

Types of Nonsteroidal Anti-Asthma Agents

Nonsteroidal anti-asthma agents are essential in managing asthma by targeting specific pathways involved in airway inflammation and hyperresponsiveness. These agents are classified based on their mechanism of action and how they affect the airways.

The two primary categories include:

1. Antileukotrienes
2. Monoclonal antibodies

Antileukotrienes

Antileukotrienes work by inhibiting the action of leukotrienes, which are inflammatory chemicals that contribute to airway swelling, bronchoconstriction, and mucus production. By blocking leukotrienes, these medications help reduce asthma symptoms and prevent exacerbations.

The three main types of antileukotrienes include:

• Zafirlukast (Accolate): A leukotriene receptor antagonist that prevents leukotrienes from binding to receptors in the airways, reducing inflammation and airway narrowing.
• Montelukast (Singulair): Another leukotriene receptor antagonist that helps decrease asthma symptoms and is often prescribed for long-term asthma control and allergy management.
• Zileuton (Zyflo): A leukotriene synthesis inhibitor that blocks the enzyme 5-lipoxygenase, responsible for producing leukotrienes. It is particularly effective for severe asthma management.

Note: By targeting leukotrienes, these medications reduce airway inflammation, improve breathing, and help maintain better asthma control.

Monoclonal Antibodies

Monoclonal antibodies are biologic drugs designed to target specific immune system components that trigger asthma symptoms. They work by blocking key proteins or receptors involved in allergic and eosinophilic asthma, reducing inflammation and minimizing asthma attacks.

Common monoclonal antibodies used to manage asthma include:

• Omalizumab (Xolair): Binds to immunoglobulin E (IgE), preventing it from triggering allergic reactions that can cause asthma symptoms.
• Mepolizumab (Nucala): Targets interleukin-5 (IL-5), reducing eosinophil levels, a type of white blood cell involved in asthma-related inflammation.
• Benralizumab (Fasenra): Directly targets eosinophils by binding to their IL-5 receptors, prompting their destruction and reducing inflammation.
• Reslizumab (Cinqair): Also targets IL-5, reducing eosinophil-related inflammation, particularly in severe asthma cases.

While monoclonal antibodies are highly effective for managing asthma, they are used primarily for patients with moderate to severe asthma who do not respond well to standard treatments.

It is important to note that these medications are not intended for treating acute asthma attacks but serve as long-term management solutions to reduce the frequency and severity of asthma symptoms.

Nonsteroidal Anti-Asthma Agent Practice Questions

1. What is the general indication for the clinical use of nonsteroidal antiasthma agents?  
They are used for the prophylactic management of mild persistent asthma.

2. Are nonsteroidal antiasthma drugs considered controllers or relievers?  
Controllers

3. A patient experiencing an acute exacerbation of asthma will find relief from what type of medication?  
A bronchodilator (e.g., albuterol).

4. What are mast cells?  
Connective tissue cells containing heparin and histamine involved in allergic reactions and inflammation.

5. What are three antileukotriene agents?  
Zafirlukast, Zileuton, and Montelukast.

6. Is cromolyn sodium available as an MDI?  
No, it is not.

7. What is the brand name for Zafirlukast?  
Accolate

8. What is extrinsic asthma associated with?  
Allergic reactions triggered by environmental allergens.

9. What is the product of an immune response in asthma?  
Allergic inflammation of the airway.

10. What plays a central role in attracting mast cells and eosinophils?  
T lymphocytes, which release mediators that attract other cells and damage epithelial cells.

11. What medical conditions are associated with elevated FENO (fractional exhaled nitric oxide)?
Asthma, chronic bronchitis, chronic cough, sarcoidosis, pneumonia, alveolitis, bronchiolitis obliterans syndrome (BOS), and bronchiectasis.

12. Who typically has a decreased FENO level?  
Smokers

13. What is cromolyn sodium considered to be?  
A mast cell stabilizer.

14. Where and how is cromolyn sodium effective?  
It prevents bronchospasm by inhibiting mast cell degranulation.

15. What is the most commonly reported side effect of cromolyn sodium?  
Nasal congestion

16. What are anti-sickle cell effects of cromolyn sodium?  
It may reduce sickling by blocking calcium-activated potassium channels, which cause erythrocyte dehydration.

17. How long does it take for the clinical application of cromolyn sodium to improve symptoms?  
It may take 2-4 weeks for noticeable improvement in symptoms.

18. What is the usual dose of nebulized cromolyn sodium?  
20 mg four times per day.

19. What do leukotrienes exhibit in the airway?  
Increased mucus secretion, inhibition of ciliary action, airway edema, bronchoconstriction, and recruitment of inflammatory cells.

20. How is Zileuton administered?  
By tablet

21. What are the hazards and side effects of Zileuton?  
It interacts with theophylline and warfarin, requiring close monitoring.

22. What is Zafirlukast’s mechanism of action?  
Zafirlukast is a leukotriene receptor antagonist.

23. What is another name for Montelukast?  
Singulair

24. What is Montelukast’s (Singulair) mechanism of action?  
Montelukast is a leukotriene receptor antagonist that blocks leukotriene receptors to reduce inflammation and bronchoconstriction.

25. What patients can Singulair be administered to?  
Adults, adolescents, and pediatric patients from 6 months and older based on age-specific dosing guidelines.

26. What is the dosage of Singulair for adults and adolescents >15 years?  
One 10 mg tablet taken daily.

27. What is the dosage of Singulair for pediatric patients 6 to 14 years?  
One 5 mg chewable tablet taken daily.

28. What is the dosage of Singulair for pediatric patients 2 to 5 years?  
One 4 mg chewable tablet or one 4 mg packet of oral granules taken daily.

29. What is the dosage of Singulair for pediatric patients 12 to 23 months?  
One 4 mg packet of oral granules taken every evening.

30. What is the dosage of Singulair for pediatric patients 6 to 23 months?  
One 4 mg packet of oral granules taken daily for allergic rhinitis.

31. What is the clinical indication for the use of anti-leukotriene drug therapy, such as montelukast, in asthma?  
As an alternative to inhaled corticosteroids for mild persistent asthma.

32. What percentage of patients benefit from antileukotriene agents?  
About 50% to 70%.

33. What are the advantages of antileukotriene agents?  
Effective in aspirin sensitivity and often in exercise-induced asthma.

34. What is another name for Omalizumab?  
Xolair

35. What is the administration method of Xolair?  
Xolair is administered as a subcutaneous injection.

36. What is Omalizumab used to treat?  
Moderate to severe asthma as a monoclonal antibody targeting IgE.

37. Antileukotrienes can be tried as an alternative to what?  
Inhaled corticosteroids or cromolyn-like agents in mild persistent asthma requiring more than as-needed β2 agonists.

38. What is another name for Zileuton?  
Zyflo (Zyflo CR)

39. What is another name for Cromolyn Sodium?  
Intal

40. What is another name for Nedocromil?  
Tilade

41. What is another name for Zafirlukast?  
Accolate

42. What medication is recommended for an adult patient with severe asthma who is also receiving corticosteroid therapy?  
Omalizumab (Xolair)

43. After reviewing prescriptions for a patient prescribed sustained-release theophylline (Theo-Dur) for asthma control, what additional medication prompts dose adjustment?  
Zafirlukast (Accolate)

44. What medication should be discontinued if a patient’s liver enzymes are elevated three times the normal range during asthma treatment?  
Zileuton (Zyflo)

45. What medications help prevent bronchoconstriction, vascular permeability, and mucus secretion?  
Zileuton (Zyflo), Zafirlukast (Accolate), and Montelukast (Singulair).

46. What medication is most likely recommended for a 4-month-old infant with asthma?  
Montelukast (Singulair)

47. A patient with allergic rhinitis on montelukast (Singulair) is also receiving rifampin (Rifadin) for tuberculosis. What intervention is beneficial?  
Closely monitor the patient’s clinical condition.

48. What is the mode of action of Zileuton (Zyflo)?  
It inhibits the enzyme 5-lipoxygenase (5-LO), reducing leukotriene synthesis.

49. What medication has a mean half-life of 26 days?  
Omalizumab (Xolair)

50. What medications require dose modification when used with oral Zileuton (Zyflo)?  
Warfarin, theophylline, and corticosteroids.

51. What treatment modification is required for an asthmatic patient using Montelukast and phenobarbital?  
Maintain the same dosage of Montelukast.

52. What clinical signs in an asthmatic patient on Zileuton therapy compel discontinuation of Zileuton treatment?  
Fatigue, pruritus, and lethargy.

53. A patient taking Zileuton (Zyflo) for bronchitis is also prescribed propranolol (Inderal). What should be done?  
Avoid concomitant administration due to potential interactions.

54. Coadministration of what anti-leukotriene agent with aspirin may cause complications?  
Zafirlukast (Accolate)

55. What medication is the drug of choice for treating aspirin-induced asthma?  
Montelukast (Singulair)

56. What effects during theophylline therapy may prompt switching to cromolyn sodium?  
Nausea and nervousness.

57. What is an alternative treatment plan for an infant with mild persistent asthma receiving corticosteroids?  
Stop corticosteroid therapy and switch to cromolyn sodium.

58. What is the usual dose of cromolyn sodium for asthma management?  
80 mg/day in divided doses

59. What medications require dose modification when co-administered with oral Zileuton (Zyflo)?
Warfarin, theophylline, and corticosteroids.

60. What modification is needed for an asthmatic patient using cromolyn sodium who regularly skis in the winter?  
Add beta-agonists to the treatment plan.

61. What is the category of asthma if a patient experiences an asthma attack as a result of exposure to cats?  
Extrinsic (allergic asthma)

62. What is the result of an airway obstruction that occurs with asthma?  
Bronchoconstriction, increased mucus production, and mucosal swelling.

63. What happens when cytokines are released during an allergic response?  
Endothelial adhesion molecules are upregulated, promoting inflammation and cell recruitment.

64. What are mast cell stabilizers?  
Cromolyn sodium, montelukast, and zafirlukast.

65. What does Cromolyn sodium prevent?  
Mast cell degranulation and excessive accumulation of eosinophils.

66. What is the mechanism of action for Accolate?  
Leukotriene receptor antagonist.

67. What disease can Cromolyn be used to treat?  
Seasonal allergic rhinitis.

68. What percent solution does an ampoule or vial of cromolyn sodium contain (20 mg/mL of aqueous solution)?  
4%

69. What suggestion should be given if extubation is delayed due to glottis swelling?  
Administer racemic epinephrine or MDI albuterol.

70. What age can Omalizumab (Xolair) be prescribed for children?  
12 years of age or older.

71. How many weeks does it take for Cromolyn Sodium to take effect?  
One to three weeks for noticeable improvement in symptoms.

72. What anti-leukotriene modifier is approved for children younger than 5 years of age?  
Montelukast (Singulair)

73. What should be monitored monthly when taking Zyflo?  
Liver enzyme levels (ALT, AST).

74. What drugs interact with Zyflo and may require a dosing adjustment?  
Theophylline, warfarin, and propranolol.

75. What combination treatment improves chronic asthma outcomes better than using drugs separately?  
A combination of β2 agonists and anti-leukotrienes.

76. Regarding exercise-induced asthma, what promotes leukotriene generation that results in bronchoconstriction?  
Increased airflow through irritated goblet cells.

77. Antileukotrienes are particularly useful in controlling asthma triggered by what factors?  
Exercise-induced asthma and aspirin sensitivity.

78. What food can montelukast granules be mixed with for children?  
Breast milk, applesauce, or formula.

79. What is Cromolyn referred to as due to its role in preventing mediator release from mast cells?  
Mast cell stabilizer

80. What is a potent vasodilator that can cause epithelial damage in asthma?  
Neuropeptide

81. What are the clinical indications of nonsteroidal anti-asthma agents?  
Prophylactic management of mild persistent asthma as alternatives to or in combination with inhaled steroids.

82. What are the categories of nonsteroidal antiasthma agents?  
Mast cell stabilizers, leukotriene inhibitors, IgE inhibitors, and antihistamines.

83. What are mast cell stabilizers?  
Drugs that inhibit mast cell degranulation, preventing histamine release. Side effects are minimal.

84. What are two examples of mast cell stabilizers?  
Cromolyn Sodium (Intal) and Nedocromil Sodium (Tilade).

85. What is the recommended dose of Cromolyn Sodium (Intal)?  
SVN: 20 mg QID

86. What is the recommended dose of Nedocromil Sodium (Tilade)?  
MDI: 1.75 mg/puff, two puffs QID

87. What are IgE inhibitors?  
Monoclonal antibodies targeting IgE, administered as monthly injections (e.g., Xolair).

88. What is Xolair?  
An IgG monoclonal antibody that binds to and blocks IgE. It is administered as a monthly injection after reconstitution.

89. What are the side effects of Xolair?  
Anaphylaxis, viral infections, upper respiratory tract infections (URTI), and pharyngitis.

90. What are examples of antihistamines?  
Diphenhydramine (Benadryl), Brompheniramine maleate (Dimetapp), Loratadine (Claritin), Fexofenadine (Allegra), and Cetirizine (Zyrtec).

91. What is the mode of action for antihistamines?  
Blocks H1 receptor sites, thereby inhibiting the action of histamine.

92. What are the side effects of antihistamines?  
Sedation, dry mouth, and nasal dryness.

93. What is associated with an allergic reaction?  
Extrinsic asthma

94. What is an example of a mast cell stabilizer?  
Cromolyn sodium

95. How is Cromolyn sodium effective in preventing bronchospasm?  
By inhibiting mast cell degranulation, reducing histamine and other mediator release.

96. What is the most commonly reported side effect of cromolyn sodium?  
Nasal congestion

97. What effect involves reducing sickling by blocking calcium-activated potassium channels that cause erythrocyte dehydration?  
Anti-sickle cell effects.

98. How long does the clinical application of cromolyn sodium take to show improvement?  
It may take 2-4 weeks for noticeable symptom improvement.

99. What is the usual dose of nebulized cromolyn sodium?  
20 mg four times per day.

100. What are antileukotriene agents effective in?  
About 50% to 70% of patients with asthma.

101. What can be tried as an alternative to inhaled corticosteroids or cromolyn-like agents in mild persistent asthma requiring more than as-needed β2 agonists?  
Antileukotrienes

102. What is the clinical indication for the use of anti-leukotriene drug therapy, such as montelukast, in asthma?  
An alternative to inhaled corticosteroids for asthma management.

103. What is a monoclonal antibody used to treat moderate to severe asthma?  
Omalizumab

104. What is a leukotriene receptor antagonist?  
Montelukast (Singulair)

105. What is administered by tablet?  
Zileuton

106. What is another leukotriene receptor antagonist?  
Zafirlukast (Accolate)

107. What is a nonsteroidal antiasthma agent formulated as a subcutaneous injection?  
Omalizumab (Xolair)

108. What are nonsteroidal antiasthma drugs considered to be?  
Controllers, not relievers.

109. Where will a patient experiencing an acute exacerbation of asthma find relief from?  
A bronchodilator such as albuterol.

110. What is the general indication for the clinical use of nonsteroidal antiasthma agents?  
Prophylactic management of mild persistent asthma.

Final Thoughts

Nonsteroidal anti-asthma agents are valuable tools in asthma management, especially for patients who cannot tolerate corticosteroids or require additional control of their symptoms.

By understanding the pharmacological mechanisms, proper indications, and potential side effects of these medications, respiratory therapists can enhance treatment strategies and patient education.

Staying informed about these agents ensures that respiratory care professionals provide effective, individualized care that improves patient outcomes.