Asthma Medication Side Effects

A man using his inhaler on a hike

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As with all drugs, there are a number of side effects associated with asthma medications. In most cases, the drugs will be well tolerated, and the benefits of treatment will far outweigh the consequences. There may be times, however, when a side effect may be more severe.

By and large, people who understand the side effects of a drug before they take it will be less likely to quit if one happens. At the same time, it allows them to spot serious symptoms and get them treated before it becomes a problem.

The types of medication used to treat asthma are as diverse as the symptoms and include inhaled corticosteroids, short- and long-acting relief medications, oral steroids, leukotriene modifiers, mast cell stabilizers, and immune modulators.

Inhaled Corticosteroids

Inhaled corticosteroids (commonly known as inhaled steroids) are prescribed to help prevent the symptoms of asthma. When used regularly, they help decrease the frequency and severity of asthma attacks. However, they will not relieve an attack once it has started.

Inhaled corticosteroids can cause both local side effects (limited to a part of the body) and systemic side effects (affecting the entire body). Systemic effects tend to be more severe and are typically associated with long-term use. Among the possible side effects:

  • Oral candidiasis (thrush), a common fungal infection of the mouth
  • Dysphonia (hoarseness), usually short-term
  • Sore mouth or throat
  • A reflex cough or spasms of the trachea (windpipe)
  • A slight reduction in growth in children
  • Decreased bone density in adults
  • Easy bruising
  • Clouding of the eye (cataract)
  • Increased pressure in the eye (glaucoma)

The use of a spacer can often relieve some of the local side effects. Rinsing and gargling following use of inhaled corticosteroids will help to prevent local adverse effects, such as hoarseness and oral thrush (yeast infection of the mouth).

Short and Long-Acting Beta Antagonists

Short-acting beta antagonists (SABAs) like albuterol are typically used as rescue medications to provide the quick relief of asthma symptoms. By contrast, long-acting beta-agonists (LABAs) continue to work for 12 hours or more. The side effects are much the same since the two drugs share similar mechanisms of action. Side effects include:

  • Increased heart rate
  • Headache
  • Dizziness
  • Anxiety
  • Nervousness or tremors
  • Rash

While the side effects resolve quickly with SABAs, they can often persist with LABAs. A similar effect occurs when beta antagonists are used excessively.

While the overuse of a rescue inhaler can increase your risk of a severe attack, that risk is multiplied if you overuse a LABA, leading the FDA to issue a black box warning about the risk of fatal asthma attacks when using the drug Advair (fluticasone/salmeterol).

Oral Steroids Side Effects

Oral steroids are typically used if you have had or are at risk of a serious attack. While steroids are delivered intravenously in a hospital setting, they are given in oral form if your symptoms are severe but do not require hospitalization. Side effects are similar to those for inhaled steroids, albeit more common and severe. They can include:

  • Weight gain
  • Fluid retention
  • High blood pressure
  • Elevated blood sugar
  • Growth suppression in children
  • Osteoporosis in adults
  • Muscle weakness
  • Cataracts and glaucoma
  • Diabetes

If you require an oral steroid like prednisone two or more times per year, your asthma is not being well controlled. See your doctor and explore if any changes need to be made to your medication doses or drug combination.

Leukotriene Modifiers

Singulair (montelukast) and other leukotriene modifiers work by blocking a substance, called leukotriene, which can trigger an asthma attack. Leukotriene modifiers are generally well tolerated but do have a number of common side effects, including:

  • Stomach upset
  • Headache
  • Flu-like symptoms
  • Nervousness
  • Nausea or vomiting
  • Nasal congestion
  • Rash

Mast Cell Stabilizers

Cromolyn sodium and nedocromil are mast cell stabilizers used for persons with mild persistent asthma. These drugs work by preventing mast cells, a type of white blood cell, from secreting inflammatory substances into the airways.

Cromolyn sodium and nedocromil are generally well tolerated with most side effects decreasing with use. Most include:

  • A bad taste in the mouth
  • Cough
  • Itchy or a sore throat
  • Headache
  • Nasal congestion
  • Anaphylaxis, rarely

Anaphylaxis is an all-body, hypersensitive reaction which can cause severe hives, respiratory distress, shock, and even death. If you've taken a mast cell stabilizer and are experiencing wheezing, shortness of breath, or swelling of the face or tongue, call 911 or go your nearest emergency room.

Immunomodulator Effects

Xolair is an immunomodulator delivered as an injection. The aim of the injection is to adjust the way that the immune system responds to an asthma trigger, essentially preventing it from over-responding. Common side effects include:

  • Swelling and pain at the injection site
  • Viral illness
  • Upper respiratory tract infections
  • Sinusitis
  • Headache
  • Sore throat
  • Anaphylaxis, rarely

As with cromolyn sodium and nedocromil, symptoms of anaphylaxis demand immediate emergency care.

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Article Sources
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Additional Reading
  • Agbetile, J. and Green, R. "New therapies and management strategies in the treatment of asthma: patient-focused developments." J Asthma Allergy. 2011; 4: 1-12.
  • National Heart, Lung, and Blood Institute. "Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma." Bethesda, Maryland; 2007.