What Is the Best Inhaled Steroid for Asthma?

Woman using an inhaler.
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Asthma is one of the most common chronic diseases and affects more than 25 million Americans. Asthma usually involves inflammation and swelling of the lining of the airways of the lungs, which irritates the smooth muscle around the lungs. When irritated, this smooth muscle contracts around the airways of the lungs, causing coughing, wheezing, shortness of breath, and chest tightness.

What Are Inhaled Steroids?

There are two different types of medications that are used to treat asthma: rescue inhalers and controller therapies. Rescue inhalers treat the immediate symptoms of asthma by relaxing the smooth muscles around the airways and can be used during an asthma attack. If you have been diagnosed with asthma, you most likely will have been given a prescription for a rescue inhaler, such as albuterol and Xopenex (levalbuterol). A generic for Xopenex HFA, levalbuterol, is also available and is a good alternative for those sensitive to albuterol sulfate.

Most people with asthma, however, also need a daily controller therapy to treat the underlying inflammation of the airways. The preferred controller therapy for most people with asthma, according to the National Heart, Lung, and Blood Institute, is an inhaled steroid.

Options for Treating Asthma

There are a number of inhaled steroids on the market available for the long-term control of asthma symptoms.

These include Flonase, Flovent HFA (fluticasone); QVAR, Qnasl (beclomethasone); Pulmicort, Flexhaler, Rhinocort (budesonide); Alvesco, Omnaris, Zetonna (ciclesonide); Aerospan HFA (flunisolide); and Arnuity Ellipta (fluticasone furoate).

These are all brand name medications; there are no generic versions available.

While these inhaled steroids tend to all work in the same way and have about the same efficacy as one another, there are some subtle differences between these medications that set them apart:

  • Flovent is available in two forms: a metered dose inhaler version and a discus version.
  • QVAR has a smaller particle size that is able to get deeper into the lung, which may make this inhaled steroid more efficient at treating asthma. In addition, QVAR is usually one of the lowest-cost inhaled steroids on the market.
  • Pulmicort is the preferred inhaled steroid for use during pregnancy, given its pregnancy category "B" rating.
  • Alvesco has been touted as having less steroid side effects since it is metabolized to its active steroid form inside the lung.
  • Asmanex is indicated for once-daily use, which makes this inhaled steroid convenient to use. 

Choosing the Best Option for You

In order to be effective, these medications must be taken regularly and require several days to weeks to reach their maximum effectiveness. Unlike oral steroids, inhaled corticosteroids like the aforementioned are typically safe for long-term use and have a low risk of side effects.

Check with your doctor to see if an inhaled steroid is needed to control your asthma, and which inhaled steroid is best for you.

If you are shopping around to find the cheapest inhaler, speak to your insurance to see which inhalers they cover and then ask your physician if that medication would work for you. You can also ask your physician and the drug company if they have any coupons or discounted payment plans.

View Article Sources
  • Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma.