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This can be done programmatically using the CreateTable command in SQL. We would rarely download the database and make changes and then upload it, but would do this at a scripting level. Granted this is mostly done on a staging (testing) server as opposed to the production (online) server.
There is a asp based tool that I think is great for what you would like to do. It is called TableEditor and you can download it for free (open source) from [2enetworx.com...]
2enetworx is a open source website that has lots of great projects, including TableEditor, a Survey, and even the entire website.
I hope this helps.
Patrick