The Best Medicine for Asthma

In This Article

There are a variety of short-term and long-term treatments for asthma and what is needed for asthma control will depend on a variety of factors, such as asthma severity and triggers.

Most medications for asthma are inhaled and go right to the lungs to open the airways or to reduce chronic airway inflammation, but there are also oral medications or injections that may be added if asthma isn't well controlled or if you have allergic asthma that happens in response to allergens.

To determine the best asthma protocol for you, discuss your asthma symptoms and their frequency with your healthcare provider.

The Best Medications for Asthma
Verywell / Laura Porter

Quick-Relief Inhalers

Also known as "rescue inhalers," quick-relief inhalers are short-term medications for acute asthma symptoms, such as wheezing, chest tightness, shortness of breath, and coughing. Everyone with asthma should have a quick-relief inhaler and it may be the only medication needed for mild cases of asthma or exercise-induced asthma that only happens during physical activity. Mild asthma is typically known as intermittent asthma in which asthma episodes happen twice a week or less and nighttime symptoms happen no more than twice a month.

Inhaled Short-Acting Beta-Agonists (SABAs) 

Inhaled short-acting beta-agonists (SABAs) are bronchodilators that help to quickly widen your airways, allowing for improved air flow. This type of prescription asthma medication is the drug of choice for acute relief of asthma symptoms and can prevent symptoms from getting worse, so it is important to always keep it with you.

SABAs typically comes in aerosol sprays (HFAs) or powder inhalers that are handheld and portable. These quick-relief inhalers can typically be used as needed for asthma symptoms with a max of about 3 treatments every 20 minutes for adults. There are also SABA solutions that can be used with a nebulizer, a machine with a face mask that helps you inhale a fine mist. Common types of inhaled SABAs include:

Ventolin HFA, Proair HFA, and Proventil HFA are albuterol aerosol inhalers. Proair Respiclick is a powder inhaler and AccuNeb is an albuterol solution for a nebulizer. Xopenex is available in an aerosol inhaler or in a solution for a nebulizer.

These short-acting inhalers can cause side effects that include jitteriness and heart palpitations.

If you start using SABAs more than twice a week for your asthma, contact your doctor since a more long-term control medication may be needed.

Asthma Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Long-Acting Inhalers

In addition to SABAs, the majority of people with asthma also require one or more long-term controller medications that are taken daily. A controller medication is used to prevent asthma symptoms, often by reducing chronic airway inflammation over time, and is taken regardless of how the person’s asthma is doing that day.

Long-acting inhalers are the most common type of control medication used for asthma. They usually take a few days to a few weeks in order to start working, but then a person with asthma notices that less and less rescue medicine is needed.

Inhaled Corticosteroids

Inhaled corticosteroids, also called inhaled steroids, are a first-line treatment for asthma and are the most effective medications for long-term control of persistent asthma, which happens several times a week to up to multiple times a day.  When used daily, these inhalers have anti-inflammatory properties to reduce airway inflammation and prevent asthma symptoms in adults and children. These medications are available as aerosol inhalers, powder inhalers, or as solutions for nebulizers.

Common inhaled corticosteroids in aerosol inhalers include:

Common inhaled corticosteroids in powder inhalers include:

  • Pulmicort Flexhaler (budesonide)
  • Asmanex Twisthaler (mometasone)
  • Arnuity Ellipta, Flovent Diskus, Armonair Respiclick (fluticasone)

Inhaled corticosteroids for a nebulizer include:

  • Pulmicort Respules (budesonide) for a jet nebulizer machine that is connected to an air compressor

Most inhaled corticosteroids are taken twice a day, although some are FDA-approved to be taken once a day, such as Arnuity Ellipta.

Common side effects include hoarseness, sore throat, and mouth irritation. Thrush (oral yeast infection) may happen at high doses of inhaled corticosteroids and can be avoided by rinsing your mouth and spitting after using the medication.

Inhaled corticosteroids may slow children's growth slightly, particularly in the first several months of treatment, but poor asthma control may do the same. 

If you don't have a reduction in frequency or severity of asthma symptoms within four to six weeks of starting a new control medication, the treatment likely needs to be adjusted.

Inhaled Long-Acting Beta-Agonists

Long-acting Beta-Agonists (LABAs) are bronchodilators whose effects last for 12 hours or more. They are an add-on for the prevention of symptoms and are not used to treat acute asthma or asthma exacerbations. They are typically used in combination with corticosteroids and only prescribed when a low- or medium-dose of inhaled corticosteroids isn't enough to manage symptoms. LABAs include:

  • Brovana (arformoterol)
  • Perforomist (formoterol)
  • Serevent (salmeterol)

Brovana and Perforomist are solutions for nebulizers and Serevent is a powder inhaler.

Safety Warning

LABAs can have severe side effects, including severe asthma exacerbations, that, while rare, increases the risk of asthma-related deaths. LABAs may also increase the risk of hospitalizations in children and adolescents. If breathing or wheezing gets worse when using LABAs, stop immediately and seek immediate medical help if the bronchospasm is not controlled with another asthma medication.

Tell your doctor if you have heart, central nervous system, or metabolic disorders since they may increase your risk of serious side effects.

Combined Therapy Inhalers

There are also combination inhalers that administer inhaled corticosteroids and LABAs simultaneously.

Combination inhalers include:

  • Advair HFA, Advair Diskus, Airduo Respiclick (fluticasone and salmeterol)
  • Symbicort (budesonide, formoterol)
  • Dulera (mometasone, formoterol)

Inhaled Long-Acting Muscarinic Antagonists

Inhaled long-acting muscarinic antagonists (LAMAs) are anticholergenic drugs that are typically prescribed for chronic obstructive pulmonary disease (COPD). They are another type of bronchodilator and they target muscarinic receptors that can become dysfunctional in allergic asthma. LAMAs are sometimes prescribed as an add-on treatment if asthma isn't well controlled with combination therapy of inhaled corticosteroids and LABAs. The main brand of this medication used for asthma is Spiriva Respimat (tiotropium), an inhalation spray.

Research suggests that when LAMAs are used in combination with inhaled corticosteroids and LABAs, it may reduce the need for rescue oral steroids compared to those on just LABAs and inhaled corticosteroids, but more research is needed.

Common side effects of LAMAs include sore throat, cough, dry mouth, and sinus infections. Serious side effects include a risk of glaucoma (increased pressure in the eye) or new or worsening urinary retention. Tell your doctor if you have kidney problems, glaucoma, enlarged prostate, problems passing urine, or blockage in your bladder.

If you combine Spiriva with other anticholinergic medicines, side effects may increase. Research has also found a link between long-term use of strong anticholergenics—tricyclic antidepressants, first-generation antihistamines, bladder antimuscarinics—and an increased risk of dementia and Alzheimer's disease. Inhaled anticholergenics were not part of the research, so whether or not these medications also increase risk is unclear.

Signs of Allergic Reaction

Most medications for asthma carry a risk of severe allergic reactions to the medication. Seek emergency medical attention if any of the following symptoms develop or worsen after taking an asthma medication:

  • wheezing
  • shortness of breath
  • cough
  • chest tightness
  • trouble breathing
  • dizziness
  • fainting
  • rapid or weak heartbeat
  • flushing
  • itching
  • hives
  • swelling of the throat or tongue
  • trouble swallowing

Mast-Cell Stabilizers

Another option for allergic asthma is a mast cell stabilizer that is inhaled through a nebulizer. Mast cells are immune cells in your connective tissue and when you're exposed to an allergen, they play a major role in triggering the release of immune system mediators, such as histamine, and signaling proteins, such as cytokines, that cause inflammatory responses and can trigger asthma. Mast cell stabilizers can help to stop these signals. The main mast-cell stabilizer used is cromolyn sodium that's available as a generic medication. It's a solution inhaled using a nebulizer about four times a day to prevent symptoms.

Common side effects of cromolyn sodium includes drowsiness, hoarseness, or upset stomach and may resolve after you adjust to the medication.

Oral Medications

Leukotriene Modifiers

Leukotriene modifiers are asthma controller medications that are sometimes used in combination with inhaled steroids or as an alternative option for adults or children who are unable to take inhaled corticosteroids, don't want to take them, or tend to forget doses. Leukotriene modifiers often come in oral tablets that are taken once a daily. They target molecules called leukotrienes that contribute to airway constriction and inflammation in asthma.

Common leukotreine modifiers used for allergies and asthma include: 

  • Singulair (montelukast)
  • Accolate (zafirlukast)
  • Zyflo (zileuton)

Singulair for children is also available in chewable tables or oral granules.

Mental Health Warning

Singulair may cause behavior or mood changes, including suicidal thoughts, in some people. Contact your doctor immediately if you notice any mental health changes while taking montelukast.

Zyflo can increase certain liver enzymes and your doctor may want to do periodic tests to monitor your liver function. It should not be used by those with liver impairment.

Oral Corticosteroids

Oral corticosteroids may be taken as a short course during an asthma attack to quickly manage symptoms and reduce inflammation or may be prescribed as a long-term treatment.

Common oral corticosteroids include:

  • Prednisone Intensol, Sterapred (prednisone)
  • Flo-Pred, Orapred, Pediapred (prednisolone)
  • Medrol (methylprednisolone)
  • Decadron (dexamethasone)

Oral corticosteroids can have more serious side effects than inhaled corticosteroids, because the medicine is a systemic treatment that goes outside the lungs. Due to this increased risk of side effects, they are typically used only if the asthma is moderate to severe and other medications haven't been effective.

Common side effects include agitation, headache, fluid retention, increased appetite, and weight gain.

Serious side effects, include bone loss, impaired hormone production, behavioral or mood disturbances (mood swings, personality changes, euphoria, psychosis), and an increased risk of heart problems.

Children on oral corticosteroids will need to be monitored since these drugs can suppress growth.

Oral corticosteroids also suppress the immune system, which can make you more susceptible to infections. If you have an active bacterial, fungal, viral, or parasitic infection, you may need to delay treatment with oral corticosteroids.

Methylxanthines

Methylxanthines are mild stimulants and the drug theophylline, which was originally derived from plant compounds in tea and is also found in cocoa, is typically used as an add-on treatment. Theophylline helps relax the branches of the airways and can reverse corticosteroid resistance, which is when lung function doesn't improve despite high doses of corticosteroids. Theophylline comes in slow-release tablets or capsules or in a solution that you drink. It can also be injected during severe asthma attacks.

Common brands of theophylline include:

  • Elixophyllin
  • Quibron-T
  • Theo-24
  • Theolair
  • Uniphyl

Theophylline is most effective at certain blood concentrations that can be influenced by your liver metabolism, so your doctor may do blood tests to make sure you are taking an optimal dose.

Common side effects, which often resolve as your body adjusts to the medication, include headaches, irritability, and trouble sleeping.

Medications that May Worsen Asthma

Some medicines can trigger asthma flare-ups or other respiratory symptoms, such as coughing, or worsen symptoms. Inform every doctor that treats you about your asthma and pay attention to asthma symptoms if you take any of these medications:

  • Beta-blockers: While cardio-specific beta-blockers are only supposed to act on the heart, older beta-blockers are known to worsen asthma symptoms.
  • Aspirin
  • Nonsteroidal Anti-inflammatory Medications (NSAIDs) in those with an allergy to NSAIDs
  • Angiotensin Converting Enzyme (ACE inhibitors)

Injections

For those with year-round allergies and moderate to severe allergic asthma, there are injections that can help address the underlying allergy to try to prevent asthma.

Immunomodulators

Immunomodulators are biologic medications for severe asthma that target specific parts of the immune response to allergens, such as immunoglobulin E (IgE) antibodies and white blood cells called eosinophils that can increase lung inflammation. They are typically used as an adjunct therapy for asthma. 

Injections that target IgE antibodies include:

  • Xolair (omalizumab): This is an injection given under the skin ever two to four weeks. It binds to IgE antibodies, blocking their activity. Xolair is given in doctors' offices in case of allergic reaction to the drug, which can happen at any time during therapy and not just the first dose. 

Injections that help reduce eosinophils are only used for people with severe eosinophilic asthma. These medications target signaling proteins called cytokines and include:

  • Nucala (mepolizumab): An injection under the skin can be done at home or in a doctor's office and is used every four weeks
  • Cinqair (reslizumab): An infusion treatment into a vein in a healthcare setting every four weeks, and each infusion takes about 20 to 50 minutes
  • Fasenra (benralizumab): An injection under the skin that is given every four weeks for the first three months and then every eight weeks. It can be done at home or in a doctor's office.
  • Dupixent (dupilumab): A pen-like device is used at home to inject the medication under the skin every other week.

Nucala, Cinqair, and Fasenra interfere with interleuken-5 (IL-5), a cytokine that controls blood levels of eosinophils. Dupixent interferes with interleuken-4 (IL-4), which plays a role in the movement of eosinophils and the activation of IgE antibodies.

To help determine if you have severe eosinophilic asthma, your physician can give you a blood test that measures eosinophil levels.

Common side effects of immunomodulators include pain, fatigue, pruritus (itchy skin), and dermatitis (irritated or inflamed skin).

Allergy Immunotherapy

Immunotherapy (also referred to as "allergy shots") is an subcutaneous (under the skin) injection or a sublingual (under the tongue) dissolving tablet that exposes you to small amounts of an allergen over time in order to decrease your body’s reactivity it. This is a long-term treatment and it may take more than a year to see any improvement in allergy symptoms and allergic asthma. The type of immunotherapy used will be based on the allergens that you react to and your doctor will want to do skin-prick or blood tests to confirm your allergies before starting immunotherapy.

Prescription immunotherapy tablets include:

  • Grastek (Timothy grass pollen allergy extract)
  • Ragwitek (short ragweed pollen allergy extract)
  • Oralair (sweet vernal, orchard, perennial rye, Timothy, and Kentucky blue grass mixed pollens allergen extract)
  • Odactra (house dust mite extract)
  • Palforzia (peanut allergen powder-dnfp)

If you are prescribed tablets, your doctor will want to monitor you during the first doses to make sure it doesn't trigger a serious allergic reaction.

A Word From Verywell

Asthma can be frustrating, but there are a variety of medications that can provide relief and prevent flare-ups. If you notice any changes in frequency or severity of symptoms, contact your physician since treatment plans often need to be adjusted over time. This may mean increasing doses or adding medications, or if your asthma is well controlled for more than three months, you may also be able to step down your medications with careful monitoring.

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Article Sources
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