What Doctors Need You to Know About Asthma Medications
Here's the inside scoop on the medications that control asthma and help people with the condition lead normal, healthy lives.
Asthma treatment basics
Coughing, wheezing, shortness of breath—these are just some of the symptoms of asthma, a condition that affects the lungs and makes breathing difficult.
It’s one of the most common diseases in the United States, affecting more than 25 million Americans, according to the Asthma and Allergy Foundation of America (AAFA).
It’s also a chronic disease. This means that asthma requires ongoing medical attention and management to keep its potentially dangerous symptoms in check.
But there’s reassuring news: research in Scientific Reports shows that with proper care—including treatment with asthma medication as directed by a doctor—most people with asthma can lead normal lives.
Read on to find out about the available asthma medications so you’re better informed when you talk to your doctor
What is asthma?
People with asthma have hyperresponsive airways, which is another way of saying their airways react to irritants and environmental factors.
The triggers that provoke asthma symptoms vary among individuals but often include allergies, air irritants, exercise, and weather conditions.
When a person with asthma encounters one of their triggers, it causes their airways to swell, tighten, and inflame. This narrowing makes it difficult for air to move out of the lungs, leading to asthma symptoms like:
- shortness of breath and rapid breathing
- chest tightness
Why is asthma medication so important?
While there’s no cure for asthma, medications control the symptoms and keep them from becoming life-threatening. Asthma medications are essential even if you feel like your condition is under control.
See, part of the problem with asthma is that you can feel perfectly fine even if there’s underlying inflammation in your lungs, says Mitchell Grayson, MD, chair of AAFA’s Medical Scientific Council and director of the Division of Allergy and Immunology at The Ohio State University.
Asthma medication controls that inflammation and in doing so reduces the severity of symptoms if you encounter a trigger.
Poor asthma management doesn’t just make it hard to breathe in the moment. It poses a long-term risk.
According to the American Lung Association, uncontrolled asthma may damage and scar the lungs, something known as airway remodeling. When this happens, your asthma meds may not work as well, and less air can move through your airways.
Dr. Grayson explains that, in general, our lung function starts to decline after we reach age 25. But damage from airway remodeling can accelerate this process.
What are the main asthma medications?
“The easiest way to understand the types of medicines for asthma is by category,” says Payel Gupta, MD, an allergist and immunologist at Mount Sinai Medical Center in New York and co-founder and chief medical officer for the telehealth allergy platform Cleared. “Broadly, there are controller medications and rescue medications.”
While controller medications focus on long-term asthma management, rescue medicine offers immediate relief during an asthma attack.
Both controller and rescue asthma medications are available in devices that deliver the drug straight to the lungs, per the AAFA. Options include:
- Metered-dose inhalers: They spray a burst of liquid medicine as an aerosol.
- Dry-powder inhalers deliver medication in powder form.
- Nebulizers: Machines that turn liquid medicine into a mist and deliver it through a tube.
With any inhaler-based medication, the right technique can make or break its effectiveness. Studies have found that proper use improves how well the drug works, reducing both the dosage you need and the medication’s side effects.
Unfortunately, proper use may not be all that common.
Research in the Journal of Aerosol Medicine and Pulmonary Drug Delivery found that up to 88 percent of people with asthma misused their inhalers. And earlier research suggests that up to 94 percent of people don’t use their inhalers correctly.
So make sure to follow your doctor’s instructions on how to use an inhaler closely and report any difficulties you encounter.
Tablet medication is also available for several types of controller asthma medications, and studies show these pill-based forms are just as effective as inhalers for symptom management, per The New England Journal of Medicine.
Only your doctor can determine which asthma treatment is right for you based on factors like your symptoms and triggers.
Asthma rescue medications
Dr. Gupta explains that rescue medications work by relaxing and opening up the airways after an asthma trigger causes them to tighten. They typically provide symptom relief within 15 to 20 minutes.
“These are meant to be used as needed and can be used every four to six hours,” adds Jennifer Monroy, MD, an allergist and immunologist at Barnes-Jewish Hospital in St. Louis, Missouri.
The main ingredient in most rescue inhalers is albuterol, an airway muscle relaxant that falls into the short-acting beta-agonist (SABA) class of drugs.
“[Albuterol] can also be used prior to exercise to prevent symptoms if patients know that exercise is a trigger,” says Ekta Perera, MD, an allergist and immunologist and assistant professor of medicine at Columbia University Irving Medical Center.
But the AAFA recommends talking to your doctor if you use a rescue inhaler more than two days a week, as you may benefit from adding a controller medication to your treatment plan.
Oral steroids for asthma, such as prednisone or hydrocortisone, help relieve serious asthma flare-ups that don’t respond to other medications.
“These steroids work to decrease allergy inflammation to help you feel better,” explains Dr. Monroy.
But she says that while the medication works great, it’s not typically something patients should take for a long period of time. That’s because long-term use of oral steroids can lead to side effects like weight gain, diabetes, and bone loss.
These medications, while not quite effective as SABAs, can help open your airways quickly and reduce mucus production. Like SABA medications, this type of medication is taken via an inhaler.
Asthma control medications
Controller medications help people with moderate to severe asthma improve control over their condition and prevent symptoms, says Dr. Perera. There are both daily-use inhalers as well as oral tablets, including:
These maintenance inhalers deliver a small amount of steroid to the lungs, which reduces inflammation in the airways. They’re the most effective long-term control medication available.
Dr. Monroy says that this helps to prevent asthma attacks and can enable patients to decrease their use of rescue inhalers.
“There are different preparations that can be used once or twice daily,” she says. “These inhalers can be used in the long term.”
Common corticosteroid inhaler medications include, according to the AAFA:
- beclomethasone dipropionate (QVAR RediHaler)
- budesonide (Pulmicort Flexhaler)
- ciclesonide (Alvesco)
- fluticasone propionate (Flovent HFA)
- mometasone furoate (Asmanex Twisthaler)
- fluicasone propionate/salmeterol (Advair Diskus)
“Long-acting inhalers open the airways similar to albuterol,” Dr. Monroy explains.
But while albuterol’s effect wears off within a few hours, long-acting beta-agonists, like salmeterol xinafoate (Serevent Diskus) relax the airways for 12 hours or more.
Leukotriene modifiers are daily oral medications. “These work differently from inhaled steroids and albuterol,” explains Dr. Monroy.
They open the airways by blocking leukotrienes, chemicals the body releases when we come into contact with something we’re allergic to. These chemicals cause inflammation in our airways, triggering asthma symptoms.
That’s why they’re usually a prescription for patients with allergic asthma—asthma triggered by allergies. Dr. Perera says that it’s also a common treatment for exercise-induced asthma (bronchoconstriction).
The main types of leukotriene modifiers include:
- montelukast sodium (Singulair)
- zafirlukast (Accolate)
- zileuton (Zyflo CR)
Combination asthma therapy
In late 2020, the National Institutes of Health released new asthma-management guidelines that included single maintenance and reliever therapy (SMART), per JAMA.
Dr. Grayson explains that with this SMART protocol, patients use an inhaled corticosteroid in combination with a drug called formoterol, which has both short-acting and long-acting bronchodilator properties.
This combination provides comprehensive relief for symptoms as they arise while promoting long-term control—all in a single formula.
“This is a shift in terms of the way we practice,” he says.
Most patients only need to use the SMART therapy when they have symptoms, which helps to improve people’s compliance to their treatment plan.
The SMART approach comes with another advantage as well. Dr. Grayson says that we use fewer inhaled steroids with the combination therapy, reducing the risk of steroid-related side effects.
But despite this lower dose, research in Therapeutics and Clinical Risk Management found that patients using SMART therapy experienced improved airway function and a lower risk of severe asthma symptoms.
Dr. Monroy says that for some people with asthma, symptoms may still not be well controlled with standard asthma medications.
A person who continues to have asthma attacks that require doctor or emergency room visits is a good candidate for biologic therapy, she says.
“[Biologics] are specialized drugs that target a specific pathway in the allergy immune response to help decrease inflammation,” says Dr. Monroy. “There are currently five biologic therapies approved for asthma, with more on the way.”
Dr. Perera says the available biologic treatments for asthma include:
- Omalizumab to treat moderate to severe persistent asthma in people with year-round allergies.
- Mepolizumab, benralizumab, or reslizumab for moderate to severe eosinophilic asthma, a rare but serious form of the disease; eosinophil are pro-inflammatory white blood cells.
- Dupilumab for moderate to severe persistent eosinophilic or oral steroid-dependent asthma.
Most drugs are home injections, but there are also intravenous (IV) preparations.
“Depending on your history, your provider can help choose a biologic that works best for you,” she says. “[For example,] there are some that would work better if you have a higher eosinophil count in your blood or if you have a history of nasal polyps or eczema.”
Other long-acting medications
Depending on your asthma triggers and how you respond to first-line treatments, your doctor may prescribe one of these long-acting asthma medications:
- Cromolyn is a mast cell stabilizer that can prevent airway inflammation and swelling when you come into contact with a trigger.
- Theophylline opens airways by relaxing muscles. It’s available as a tablet, capsule, syrup, or solution.
- Immunotherapy can help reduce your body’s reaction to allergens and may be helpful if you have allergic asthma. They’re delivered as an allergy shot or in liquid or tablet form.
Are there OTC asthma medications?
The only FDA-approved over-the-counter (OTC) medication for asthma treatment is Primatene Mist.
But research in the Annals of the American Thoracic Society shows its misuse can lead to dangerous side effects—and prescription treatments like albuterol are far more effective.
That’s why the experts say you should never use an OTC medication to treat asthma without talking to your doctor first. Along with this increased risk of side effects, relying on OTC medicines can delay proper care or interfere with other medications you take.
However, if allergies trigger your asthma, Dr. Perera says that OTC antihistamines or nasal steroid sprays may help improve symptoms. Again, it’s important to get your doctor’s sign-off before taking any medication.
How long do I need to take asthma medication?
Asthma is a lifelong condition that requires ongoing treatment and management to keep symptoms at bay. But according to the AAFA, people may be able to reduce the amount of medicine they take once their condition is well managed.
Still, don’t stop taking your prescription without your doctor’s order. This puts you at risk for serious flare-ups and potentially worsened asthma down the line.
Will medicine alone control my asthma?
While a crucial part of effective asthma treatment, medication is just one part of an asthma action plan. Your doctor will help you develop this personalized approach to managing your asthma.
An asthma action plan might include:
- day-to-day care, like medication routines and instructions
- trigger identification and avoidance
- having a plan in place for emergencies
- lifestyle changes that may reduce flare-ups
Research in Breathe also found that diet and exercise promote healthy lung function and can help you manage asthma and maintain long-term control.
Next, check out the best foods to prevent asthma attacks.
- Mitchell Grayson, MD, chair of the Asthma and Allergy Foundation of America's Medical Scientific Council and director of the division of allergy and immunology at The Ohio State University
- Ekta Perera, MD, allergist/immunologist and assistant professor of medicine at Columbia University Irving Medical Center
- Payel Gupta, MD, allergist/immunologist at Mount Sinai Medical Center in New York and cofounder and chief medical officer for the telehealth allergy platform Cleared
- Jennifer Monroy, MD, board-certified allergist and immunologist at Barnes-Jewish Hospital and Washington University in Saint Louis, Missouri
- American Lung Association: "How Asthma Affects Your Body"
- Asthma and Allergy Foundation of America: "Asthma Facts and Figures"
- Asthma and Allergy Foundation of America: "Asthma Medicines"
- Asthma and Allergy Foundation of America: "Asthma Treatment"
- National Heart, Lung, and Blood Institute: "Asthma"
- Annals of the American Thoracic Society: "The Surprising Reintroduction of Primatene Mist in the United States"
- Breathe: "Evidence for lifestyle interventions in asthma"
- JAMA: "Managing Asthma in Adolescents and Adults: 2020 Asthma Guideline Update From the National Asthma Education and Prevention Program"
- Journal of Aerosol Medicine and Pulmonary Drug Delivery: "Inhaler Technique in Asthma: How Does It Relate to Patients' Preferences and Attitudes Toward Their Inhalers?"
- Scientific Reports: "Effect of asthma control on general health-related quality of life in patients diagnosed with adult-onset asthma"
- The New England Journal of Medicine: "Leukotriene Antagonists as First-Line or Add-on Asthma-Controller Therapy"
- Therapeutics and Clinical Risk Management: "A smarter way to manage asthma with a combination of a long-acting β2-agonist and inhaled corticosteroid"