Any patient who has a diagnosis of asthma is a candidate for an asthma medication. Patients with mild, infrequent asthma symptoms may only need a short-acting rescue medication, such as albuterol. Patients with more frequent and persistent asthma symptoms are candidates for daily medications.
The choice of medication will depend on the severity of the condition.
What are controller medications for asthma (long-term control)?
A controller medication is a daily medication that is used to prevent or improve asthma symptoms in patients who experience frequent symptoms.
The decision to use a controller medication for a patient with asthma is based on the frequency and type of daytime or nighttime symptoms, frequency of medical visits for asthma, frequency of requiring asthma rescue medications, frequency of oral steroid use, impact of asthma symptoms on daily life, and breathing tests for asthma, which are performed in the medical office.
In patients requiring controller medications, inhaled corticosteroids are generally considered as the first-line therapy for asthma.
What are rescue medications for asthma (short-term control)?
A rescue medication for asthma is a medication that works within minutes to open the airways (bronchodilate) and provides quick relief from asthma symptoms, such as chest tightness, shortness of breath, cough, or wheezing.
The rescue medications for asthma include albuterol, levalbuterol, and ipratropium.
Of these, albuterol is by far the most commonly prescribed rescue medication for asthma. Levalbuterol is the chemical “mirror image” of albuterol and may have less potential to make patients restless or jittery.
Ipratropium has shown to be helpful when used along with albuterol in patients requiring emergency treatment for asthma. It also may be used in patients who are unable to tolerate albuterol or levalbuterol.
Medication use guidelines
- Refer to the asthma action plan when deciding how or when to use medications. This plan will be designed for
- the best asthma control. Make sure you understand and can follow the plan.
- Wash your hands prior to preparing or taking medications.
- Take your time. Double-check the name and dosage of all medications before using them.
- Keep medications stored according to the instructions given with the prescription.
- Check liquid medications often. If they have changed color or formed crystals, throw them away and get new ones.
- Never run out of medications. Call the pharmacy or doctor’s office at least 48 hours before running out. Know your pharmacy phone number, prescription and clinic numbers, medication name and dose so you can easily call for refills.
- Inform the doctor about any other medications being taken. Medications can work differently when taken together.
- Asthma medications are very safe. However, side effects can occur and vary depending on the medication and dose.
Ask the doctor to describe medication side effects. Report any unusual or severe side effects.
Types of asthma medications
Medications are used to treat, prevent and control asthma symptoms, to reduce the number and severity of asthma episodes and to improve airflow. There are two main types of asthma medications:
These are the most important medicines for most people with asthma. Anti-inflammatory medications reduce swelling and mucus production in the airways.
As a result, airways are less sensitive and less likely to react to triggers. These medications need to be taken daily and may need to be taken for several weeks before they will begin to control asthma.
Anti-inflammatories lead to fewer asthma symptoms, better airflow, less-sensitive airways, less airway damage and fewer asthma episodes. If taken every day, they control or prevent asthma symptoms.
These medications relax the muscle bands that tighten around the airways. This action rapidly opens the airways, letting more air in and out of the lungs and improving breathing.
Bronchodilators also help clear mucus from the lungs. As the airways open, the mucus moves more freely and can be coughed out more easily.
In short-acting forms, bronchodilators relieve or stop asthma symptoms and are very helpful during an asthma episode.
In long-acting forms, bronchodilators provide control of asthma symptoms and prevent asthma episodes.
Anti-inflammatory medications are some of the most important treatment options for people with asthma. They prevent asthma attacks and work by reducing swelling and mucus production in the airways.
As a result, airways are less sensitive and less likely to react to asthma triggers.
Direct anti-inflammatory medications include corticosteroids (inhaled and oral). Other controller medications that will be discussed here are mast cell stabilizers and leukotriene modifier medications.
Although not true “anti-inflammatory” medications, they work with corticosteroids to augment the anti-inflammatory action.
Inhaled corticosteroids are the most effective medications to reduce airway inflammation and mucus production.
The use of these medicines leads to better asthma control with fewer symptoms and flare-ups and less of a need for hospitalization.
Inhaled steroids prevent symptoms; they do not relieve symptoms. Dosages vary and inhaled steroids need to be taken every day for best results. Some results are seen in 1 to 3 weeks, with the best results seen after 3 months of daily use.
Drug names: Generic name (Brand name)
- Beclomethasone (Qvar®)
- Budesonide (Pulmicort®; Symbicort® – combination budesonide and formoterol- a long-acting beta2-agonist)
- Flunisolide (Aerobid®)
- Fluticasone (Flovent® HFA; Advair® – combination fluticasone and salmeterol -a long acting beta2-agonist)
- Mometasone (Asmanex®)
- Triamcinolone (Azmacort®)
Inhaled corticosteroids in metered dose inhaler (MDI) form work best when used with a spacer device. Dry powder inhalers (DPI) are the newest delivery devices and do not use a spacer.
Budesonide (Pulmicort® Turbuhaler), fluticasone (Flovent® Diskus), and mometasone (Asmanex® Twisthaler) are inhaled steroids available in DPI form.
Budesonide is the only corticosteroid available in nebulizer form (Pulmicort® Respules).
Side effects: Side effects will depend on the dose. There are few side effects with lower doses. At higher doses, thrush (yeast infection in the mouth) and hoarseness may occur, but are not common.
Rinsing the mouth after each use and using a spacer device with MDIs will help prevent these side effects.
Oral (and intravenous) corticosteroids (systemic corticosteroids)
Purpose: Relief and control
Drug names: Generic name (Brand name)
- Prednisone (Deltasone®)
- Prednisolone (Prelone®, Pediapred®, Orapred®)
Forms: Oral forms of corticosteroids are used to relieve severe asthma episodes. These drugs are always used with other medications to either control sudden and severe asthma episodes or to treat long-term, hard-to-control asthma.
Oral corticosteroids take 3 hours to begin working and work best after 6 to 12 hours. Sometimes corticosteroids are taken in high doses for a few days (steroid burst), in a lower dose daily, or every other day for long-term control.
Side effects: Long-term use can cause acne, weight gain, mood or behavior changes, upset stomach, bone loss, eye changes and slowing of growth. These side effects can rarely occur with high doses of inhaled steroids or short-term steroid bursts.
What are the different forms of asthma medications (pills, inhalers, nebulizers)?
Many first-line controller and rescue medications are administered through asthma inhalers. Some of these inhalers are called “metered-dose inhalers” in which the inhaler itself propels the medication into the lungs.
Other inhalers are activated by patients taking a breath, and these are called dry powder inhalers or breath-actuated inhalers.
Different types of inhalers may work better for different individuals, but both types of inhalers are effective for asthma symptom control if used correctly.
Nebulizers are machines that allow asthma medications to be delivered in an aerosolized form, and the medications are then inhaled through a mouthpiece or mask.
Nebulizers are often used for children who are unable to perform the proper technique required for inhalers. Some asthma medications are also available as pills.
There is only one available injectable medication for asthma (omalizumab — see below), and this is administered in a health care setting only.
What kinds of asthma medications are used in children and toddlers?
Short-acting beta-agonists (albuterol and levalbuterol) are used as rescue medications in children and toddlers.
These may be used via an inhaler with a spacer and face mask in younger children, and via inhaler in older children. These medications are also available in nebulized form, which may be easier to use in infants and toddlers.
Inhaled corticosteroids are the mainstay for daily controller medications in children and toddlers. The choice of which inhaled corticosteroid often comes down to which medication delivery device is preferred by caretakers.
Young children can use metered dose inhalers with a spacer and face mask, as long as caregivers are trained and feel comfortable with the proper technique.
Budesonide is available via nebulizer, and this may be easier for infants and younger toddlers. Some children may also feel comfortable with a dry powder inhaler.
If used properly, all medication delivery devices are effective, so choice is usually individualized based on caregiver and child preference.
Combination inhalers are also used in children, and health care professionals caring for children with asthma may choose these for children with moderate-to-severe asthma.
The leukotriene modifier medications are also used in children. Montelukast is available in granules that can be sprinkled on food, and is approved for infants as young as 6 months.
It is also available in chewable form. Zafirlukast is available for children ages 5 and up. Zileuton is recommended for children ages 12 and up.
Omalizumab may be used in children ages 12 and up with poorly-controlled asthma and evidence of allergic sensitization.
What kinds of asthma medications are safe to use in pregnancy?
About one-third of pregnant women with asthma experience improvement of the condition during pregnancy, one-third have worsening of asthma symptoms during pregnancy, and one-third stay the same, so asthma control and resulting asthma medication use during pregnancy should be closely monitored.
It is generally accepted that the risk of uncontrolled asthma in pregnancy carries more of a risk to the mother and fetus than the use of any of the asthma medications.
Therefore, any of the asthma medications can be used in pregnancy if thought to be appropriate by the health care professional.
Of all the asthma medications, montelukast, zafirlukast, budesonide, cromolyn, and omalizumab have been best studied to be the safest in pregnancy. ‘
Why do I have more than one kind of asthma medicine?
There are basically two different types of asthma medication: controller and reliever medicines. Remember, asthma is inflammation of the airways in the lungs.
Unless you have very mild asthma, you probably use both types of medicine.
Long-term preventive medicines are those that are taken on a daily basis, to keep the airways stable and control asthma symptoms.
Reliever or rescue medicines are taken during an asthma episode (to stop the symptoms of coughing, wheezing and shortness of breath) or prior to exercise to prevent symptoms.
Is it safe to use an inhaled steroid every day?
Inhaled steroids are the medication of choice to treat chronic, persistent asthma. They provide long-term control to prevent asthma symptoms.
Unlike oral forms, inhaled steroids are considered safe to use on a regular basis.
When taken correctly, the medication does not enter the bloodstream and, therefore, side effects are eliminated.
Local side effects such as hoarseness, yeast infection in the mouth and coughing can be avoided by rinsing the mouth and gargling with water or mouthwash after each use, and by using a spacer device with metered dose inhalers.
Discuss any concerns you have with your doctor.
Will I always have to take asthma medicine?
How often you need to take your asthma medication depends on how severe your asthma is and how frequently you have symptoms.
For example, if your asthma symptoms occur only during a certain time of the year when your allergens are present, then you may only have to take medications to control your symptoms during that time.
However, this is somewhat unusual and most people with asthma need to take daily control medications. Discuss your care plan with your doctor.