Answer:

The main drugs for asthma and COPD can be divided into rescue medications (bronchodilators) and controllers (for maintenance).

Patients with infrequent asthma symptoms are placed solely on a short-acting ₂-agonist (SABA). Alternatively, anticholinergic inhalers such as ipratropium may be given, although their slower onset of action makes them less preferred.

Patients with increased risk for exacerbations (including smokers) and/or those with frequent symptoms should be placed on controller therapy with a low-dose inhaled corticosteroid (ICS). In patients with severe symptoms, a long-acting ₂-agonist or a high-dose ICS are added. Acute exacerbations are treated with a short course of oral corticosteroids.

Theophylline was a widely prescribed oral controller medication for asthma but has fallen out of favor secondary to its narrow therapeutic index, multiple drug interactions, and side effect profile. It may be prescribed in patients with COPD. Patients taking theophylline require routine level testing. They should continue theophylline in the perioperative period to avoid an asthma or COPD exacerbation secondary to withdrawal.

Other oral medications targeting the inflammatory component of asthma include the mast cell stabilizer cromolyn, the anti-IgE antibody omalizumab, and leukotriene receptor antagonists such as zafirlukast and montelukast. The phosphodiesterase-4 inhibitor roflumilast may be added to the treatment regimens of patients with severe COPD.