Asthma medications: Know your options

Various asthma medications, for short- and long-term treatment of asthma, can help you manage your asthma symptoms. Treatment options include bronchodilators, corticosteroids, immunotherapy and anti-IgE antibodies.

Along with avoiding your triggers and staying healthy, asthma medications play an important role in managing asthma. Long-term control medications keep your asthma under control on a day-to-day basis. Quick-relief (rescue) medications treat symptoms once they start. If your asthma is triggered by airborne allergies, you may need allergy medications along with asthma medications to help keep your asthma under control.

You'll need to work closely with your doctor to determine which asthma medication or combination of asthma medications works best for you. Your age, your symptoms and possible side effects all play a role in choosing the dose and type of asthma medications you need. Asthma medications are different in dose and type for children, women who are pregnant, and for people who have certain health problems or who take certain other medications. Asthma symptoms often change over time. This means you'll need to monitor your asthma carefully and work with your doctor to adjust your asthma medications as needed.

Types of asthma medication

Category	Purpose	Medication types
Long-term asthma control medication	Taken regularly to control chronic symptoms and prevent asthma attacks — the most important type of treatment for most people with asthma	Inhaled corticosteroids Long-acting beta-2 agonists (LABAs) Leukotriene modifiers Cromolyn, nedocromil Theophylline
Quick-relief medication (rescue medication)	Taken as needed for rapid, short-term relief of symptoms — used to prevent or treat an asthma attack	Short-acting beta-2 agonists such as albuterol Ipratropium (Atrovent) Oral and intravenous corticosteroids (for serious asthma attacks)
Medication for allergy-induced asthma	Taken regularly or as needed to reduce your body's sensitivity to a particular allergen	Antihistamines Decongestants Immunotherapy injections

Long-term-control medications

Long-term use of medications is critical to controlling persistent asthma. You'll probably need to take them every day on a long-term basis. There are several types of long-term control medications, which include:

Inhaled corticosteroids
These anti-inflammatory drugs are the most effective long-term control medications for asthma. They reduce inflammation in your airways, prevent blood vessels from leaking fluid into your airway tissues and block allergic responses. Examples include:

Fluticasone (Flovent)
Budesonide (Pulmicort)
Triamcinolone (Azmacort)
Flunisolide (Aerobid)
Beclomethasone (Qvar)
Mometasone (Asmanex)

If you're using a metered dose inhaler, use a spacer and rinse your mouth with water after each use. This reduces the amount of drug that can be swallowed and absorbed into your body. It also reduces side effects, such as mouth and throat irritation and oral yeast infections.

Long-acting beta-2 agonists (LABAs)
These asthma medications are part of a group of medications called bronchodilators, which open up constricted airways and reduce inflammation. Their effects last at least 12 hours and are used to control moderate to severe asthma and to prevent nighttime symptoms. LABAs are used on a regular schedule along with inhaled corticosteroids for moderate or severe persistent asthma. LABAs are often used to treat persistent asthma in combination with inhaled corticosteroids. They shouldn't be the only medication you take for asthma. Examples include:

Salmeterol (Serevent Diskus)
Formoterol (Foradil Aerolizer)

Leukotriene modifiers
These inhaled asthma medications reduce the production or block the action of leukotrienes — immune system chemicals that cause asthma symptoms. Leukotriene modifiers are sometimes used with other medications such as inhaled corticosteroids to help prevent asthma attacks in older children and adults with mild persistent asthma. Examples include:

Montelukast (Singulair)
Zafirlukast (Accolate)

Cromolyn and nedocromil
These inhaled asthma medications are sometimes prescribed to help prevent attacks in people with mild persistent asthma. They may also be used to help prevent asthma triggered by exercise or allergens by decreasing allergic cell reactions. These are generally taken three to four times a day and include:

Cromolyn (Intal)
Nedocromil (Tilade)

Theophylline
You take this bronchodilator in pill form every day to treat mild persistent asthma. Theophylline (Theo-24, Theochron, Uniphyl, others) is a bronchodilator — it relaxes the airways and decreases the lungs' response to irritants. It may be helpful for relieving your nighttime symptoms of asthma. If you're taking theophylline, you'll need regular blood tests to make sure you're getting the correct dose.

Combination medications: Corticosteroid and bronchodilator
A few inhaled asthma medications contain both a corticosteroid and a bronchodilator. They include:

Fluticasone and salmeterol (Advair Diskus)
Budesonide and formoterol (Symbicort)

Quick-relief medications

Short-acting bronchodilators — often called "rescue" or "quick-relief" medications — help reduce asthma symptoms or stop the symptoms of an asthma attack in progress. You take these medications when you begin to have symptoms, such as coughing, wheezing, chest tightness or shortness of breath. You may also use short-acting bronchodilators to prevent an asthma attack when your peak flow meter shows that your readings are lower than normal.

Short-acting beta-2 agonists (SABAs)
These bronchodilators open the lungs by relaxing airway muscles. They begin working within minutes and last four to six hours. If your symptoms are minor and infrequent, you may be able to manage your symptoms with these medications alone. However, most people with persistent asthma also need to use a long-term control medication as well. SABAs are the most common medication used to treat asthma flare-ups and exercise-induced asthma, but you shouldn't use them on a regular, daily basis. Your asthma may not be under control if you need to use a short-acting beta agonist more than two days a week to relieve your symptoms. These medications are usually delivered with an inhaler, but some are available in tablet form. They include:

Albuterol (AccuNeb, Proventil, Ventolin, others)
Levalbuterol (Xopenex)
Pirbuterol (Maxair)

The Food and Drug Administration (FDA) has required that metered dose albuterol inhalers that use chlorofluorocarbon (CFC) propellant be replaced with hydrofluoroalkane (HFA) inhalers by the end of 2008. HFA inhalers work as well as CFC inhalers and are as safe, but they don't harm the ozone layer. If you're used to using a CFC inhaler, talk to your doctor about making the switch to HFA inhalers. There are a few differences you should know about:

Your HFA inhaler may have a different taste and feel than your older CFC inhaler.
HFA inhalers have a less forceful spray than the older CFC inhalers. Make sure you know how to use your inhaler correctly — otherwise, you may not get the full dose of medication with each spray.
HFA inhalers are more costly than the older generic CFC albuterol inhalers.

Ipratropium (Atrovent)
This short-acting bronchodilator is usually prescribed for emphysema or chronic bronchitis. Your doctor might prescribe this medication for the immediate relief of your asthma symptoms. It may be used along with — or as an alternative to — short-acting beta-2 agonists.

Oral corticosteroids for serious asthma attacks
These medications may be taken to treat acute asthma attacks or severe asthma. They can cause bothersome short-term side effects, and more-serious side effects if they're taken for a long period of time. Examples include:

Prednisone
Methylprednisolone
Hydrocortisone

Medications for asthma triggered by allergies

Other medications focus on treating allergy triggers for asthma and include:

Anti-IgE monoclonal antibodies. The medication omalizumab (Xolair) is sometimes used to treat severe persistent asthma triggered by airborne allergens. If you have allergies, your immune system produces allergy-causing IgE antibodies to attack substances that generally cause no harm, such as pollen, dust mites and pet dander. Xolair blocks the action of these antibodies, reducing your immune reaction — and asthma symptoms. Xolair is delivered by injection every two to four weeks. It isn't generally recommended for children under 12.
Immunotherapy. Allergy-desensitization shots (immunotherapy) may help if you have allergic asthma that can't be easily controlled by avoiding triggers. You'll begin with skin tests to determine which allergens trigger your asthma symptoms, followed by a series of therapeutic injections containing small doses of those allergens. You generally receive injections once a week for a few months, then once a month for a period of three to five years. Over time, you should lose your sensitivity to the allergens.

Medications depend on asthma control: A stepwise approach

Treatment based on asthma severity can help you control your asthma. Then, treatment can be adjusted accordingly. For example, if your asthma is well controlled, you may be able to take less medicine, and your doctor may "step down" the amount of medication you need. On the other hand, if your asthma is uncontrolled or worsening your doctor may "step up" your treatment with an increase in medication.

Asthma medications: Safety issues and side effects

Many asthma medications cause minor side effects, which vary from medication to medication and from person to person. Be sure to keep track of medicine side effects and report them to your doctor. Often, bothersome side effects can be reduced or eliminated by a change in dose or medication. Be sure to talk to your doctor about any physical or mental health problems you have, as some conditions can increase your risk of serious side effects. Also tell your doctor about every medication you take, including herbal remedies or supplements. Most medications for asthma generally don't cause serious side effects, but some may. These include:

Oral corticosteroids. These medications are only used for severe asthma, and are generally only used for a period of days right after a severe asthma attack. Some people with the most severe asthma need to take oral corticosteroids every day in order to control the asthma. Long-term use of these medications can cause serious side effects, including cataracts, loss of bone mineral (osteoporosis), muscle weakness, decreased resistance to infection, high blood pressure, and thinning of the skin and impaired growth in children.
Inhaled corticosteroids. Unlike oral corticosteroids, long-term use of inhaled corticosteroids is generally considered free of serious side effects. In children, long-term use of inhaled corticosteroids may slow growth slightly, but the benefits of using inhaled corticosteroids to maintain good asthma control generally outweigh the risks. Regular use of inhaled corticosteroids may help prevent damage to the lungs, asthma attacks and other problems linked to poorly controlled asthma.
Long-acting beta-2 agonists (LABAs). One study of salmeterol (Serevent) showed that people taking the medication were at a higher risk of life-threatening asthma attacks than were people taking a placebo. It isn't clear if this is directly caused by use of LABAs, or due to the fact that some study participants didn't also use inhaled corticosteroids to maintain long-term asthma control. The FDA issued a warning that people who take these medications should get their asthma under control with inhaled corticosteroids first, and then add LABAs if needed, or make sure that they really need LABAs in order to control asthma. LABAs should not be used without using an inhaled corticosteroid at the same time.
Anti-IgE monoclonal antibodies, such as omalizumab (Xolair). About 1 percent of injections of this medication for allergy-induced asthma can trigger a life-threatening allergic reaction (anaphylaxis). The FDA issued a warning that anyone who takes omalizumab should be monitored closely by trained health professionals after getting an omalizumab injection in case of a severe reaction.

Preventing asthma attacks

The best way to prevent asthma attacks is to identify and avoid your triggers and closely watch your symptoms. Good asthma control also takes ongoing communication and teamwork with your doctor. But by working together, you and your doctor can design a step-by-step plan for living with your condition. The following steps will help you manage your asthma:

Use a written plan. With your doctor and health care team, write a detailed plan for taking maintenance medications and managing an acute attack. Then be sure to follow your plan. Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life in general.
Monitor your breathing. Like many people, you may recognize your own signs of an impending attack, such as slight coughing, wheezing or shortness of breath. But because your lung function may decrease before you notice any signs or symptoms, regularly measure your peak airflow with a home peak flow meter.
Treat attacks early. If you act quickly, you're less likely to have a severe attack. You also won't need as much medication to control your symptoms. When your peak flow measurements decrease and alert you to an impending attack, take your medication as instructed and immediately stop any activity that may have triggered the attack. If your symptoms don't improve, get medical help as directed in your action plan.
Get an annual flu vaccination. If your doctor recommends it, get a yearly flu shot or nasal flu spray (FluMist). The flu can worsen asthma symptoms, and people with asthma are at higher risk of other health problems caused by the flu.