The Best Medicine for Asthma

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Asthma is a condition that can require immediate and ongoing management, and finding the right asthma medication is an important part of that.

Most medications for asthma are inhaled and go right to the lungs to open the airways or reduce chronic airway inflammation. There are also oral medications and injections available that may be added to a treatment plan if asthma isn't well controlled or if you have allergic asthma (which happens in response to allergen exposure).

However, there is no one "best" asthma medication. Rather, there are a variety of short-term and long-term treatments for asthma that may be preferred depending on the purpose they need to serve, your asthma severity, and your triggers.

Below, you'll find a guide to the asthma medications currently available. To determine the best asthma medication and protocol for you, discuss your asthma symptoms and their frequency with your health care 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. It may be the only medication needed for:

  • Mild cases of asthma. Typically known as intermittent asthma, these asthma episodes happen twice a week or less, and nighttime symptoms happen no more than twice a month.
  • Exercise-induced asthma. This type of asthma is triggered by physical activity.

Inhaled Short-Acting Beta-Agonists (SABAs) 

Inhaled short-acting beta-agonists (SABAs) are bronchodilators that help 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 yours with you at all times.

SABAs typically come in hydrofluoroalkane (HFA) aerosol sprays or dry 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 three 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 SABAs
Medication Aerosol Inhaler Powder Inhaler Nebulizer Solution
AccuNeb (albuterol)    
Proair (albuterol) √ (HFA) √ (Respiclick)  
Proventil HFA (albuterol)  

 

Ventolin HFA (albuterol)    
Xopenex (levalbuterol)  √ (HFA)  

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 healthcare provider. This is a sign that more long-term control medication may be needed.

Asthma Doctor Discussion Guide

Get our printable guide for your next healthcare provider'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, regardless of their symptoms or lack thereof. A controller medication is used to prevent asthma exacerbations, often by reducing chronic airway inflammation over time.

Long-acting inhalers are the most common type of control medication used for asthma. They usually take a few days to a few weeks to start working, but you should notice less and less of a need to reach for your rescue medication after that.

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, the anti-inflammatory properties in these inhalers 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
Medication Aerosol Inhaler Powder Inhaler Nebulizer Solution
Aerospan HFA (flunisolide)    
Alvesco (ciclesonide)    
Armonair Respiclick (fluticasone)    
Arnuity Ellipta (fluticasone furoate)      
Asmanex (mometasone) √ (HFA)    
Flovent (fluticasone) √ (HFA) √ (Diskus)  
Pulmicort (budesonide)   √ (Flexhaler) √ (Respules)
Qvar (beclomethasone)    

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

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 medication use.

Inhaled corticosteroids may slow children's growth slightly, particularly in the first several months of treatment, but overall adult height is not affected significantly by the use of inhaled steroids. In addition, poor asthma control can slow growth.

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

Inhaled Long-Acting Beta-Agonists (LABAs)

Long-acting beta-agonists (LABAs) are bronchodilators whose effects last for 12 hours or more. They are an add-on treatment for the prevention of symptoms and are not used to treat acute asthma or asthma exacerbations.

LABAs should only be used in conjunction with inhaled steroids and are only prescribed when a low dose of inhaled corticosteroids isn't enough to manage symptoms.

Available LABAs
Medication Powder Inhaler Nebulizer Solution
Brovana (arformoterol)  
Perforomist (formoterol)   
Serevent (salmeterol)

 

LABAs can have severe side effects, including severe asthma exacerbations that, while rare, increase the risk of asthma-related deaths. Tell your healthcare provider if you have a heart, central nervous system, or metabolic disorder, as this may further increase your risk of these events.

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 bronchospasm is not controlled with another asthma medication.

Combined Therapy Inhalers

Combination inhalers administer inhaled corticosteroids and LABAs simultaneously. These are commonly used once a LABA is added.

Common Combination Inhalers
Medication Aerosol Inhaler Powder Inhaler
Advair (fluticasone and salmeterol) √ (HFA) √ (Diskus)
Airduo Respiclick (fluticasone and salmeterol)  
Dulera (mometasone and formoterol)  
Symbicort (budesonide and formoterol)  

Inhaled Long-Acting Muscarinic Antagonists (LAMAs)

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 a combination therapy of inhaled corticosteroids and LABAs. The main brand of this medication used for asthma is Spiriva Respimat (tiotropium bromide), an inhalation spray.

Studies suggest that when LAMAs are used in combination with inhaled corticosteroids and LABAs, they may further reduce the need for rescue oral steroids compared to using only LABAs and inhaled corticosteroids. However, 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.

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.

Tell your healthcare provider if you have kidney problems, glaucoma, enlarged prostate, problems passing urine, or blockage in your bladder, as this can increase your risk of negative effects when using a LAMA. Careful monitoring may be needed.

Mast Cell Stabilizers

Mast cells are immune cells in your connective tissue. 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 are another treatment option for allergic asthma, since they can help stop these immune system signals.

The main mast cell stabilizer used is cromolyn sodium, which is available as a generic medication. Like all drugs of this kind, it's a solution that gets inhaled using a nebulizer (in this case, about four times a day) to prevent symptoms.

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

Oral Medications

Oral medications may be prescribed as controller medications. Others may be used either as long-term treatment or to address acute symptoms.

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 daily. They target molecules called leukotrienes that contribute to airway constriction and inflammation in asthma.

Common leukotreine modifiers used for allergies and asthma include: 

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

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

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

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

Oral Corticosteroids

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

Common oral corticosteroids include:

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

Because oral corticosteroids are systemic treatments (i.e., they affect the whole body, not just the lungs), these drugs can have more serious side effects than inhaled corticosteroids. 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 may include bone loss, impaired hormone production, behavioral or mood disturbances (mood swings, personality changes, euphoria, psychosis), and an increased risk of heart problems.

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.

Children on oral corticosteroids will need to be monitored, since these drugs can suppress growth, particularly in the first several months of treatment. However, overall adult height is not affected significantly by the use of inhaled steroids.

Methylxanthines

Methylxanthines are mild stimulants. Theophylline, originally derived from plant compounds in tea and also found in cocoa, is typically used as an add-on treatment for asthma.

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 and capsules, as well as 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 healthcare provider 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 prompt or worsen other respiratory symptoms, such as coughing. Inform every healthcare provider that treats you about your asthma and pay attention to asthma symptoms if you take any of the following 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 drugs (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 biological therapies that can help address the underlying allergy to try to prevent breathing issues.

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 healthcare providers' offices in case of an allergic reaction to the drug, which can happen at any time during therapy (not just at the first dose). 

Injections that help reduce eosinophils are only used for people with severe eosinophilic asthma. These medications target cytokines and include the following.

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

Cinqair, Fasenra, and Nucala 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 healthcare provider 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).

Immunotherapy

Immunotherapy 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 or allergic asthma.

The type of immunotherapy used is based on the allergens you react to. Your healthcare provider will want to do skin-prick test or run bloodwork to confirm your allergies before starting immunotherapy.

Most people are aware of the subcutaneous (under the skin) injection form of immunotherapy, more commonly known as allergy shots. If your healthcare provider is administering these injections, you may be asked to wait about 30 minutes after administration so you can be monitored for an allergic reaction.

If an injection is not desirable or practical, immunotherapy can also be delivered via sublingual (under the tongue) dissolving tablets.

Prescription immunotherapy tablets include:

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

If you are prescribed tablets, your healthcare provider will want to monitor you during the first doses to make sure they don't trigger a serious allergic reaction. Thereafter, you can take the tablets at home; you will likely be prescribed an epinephrine auto-injector in case you develop a severe reaction.

Allergic Reactions From Asthma Medications

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

  • Wheezing
  • Cough
  • Shortness of breath
  • Chest tightness
  • Dizziness/fainting
  • Rapid or weak heartbeat
  • Facial flushing
  • Itching
  • Hives
  • Swelling of the throat or tongue; trouble swallowing

A Word From Verywell

Asthma can be frustrating, but there are a variety of treatments that can provide relief and prevent flare-ups. It's a matter of making sure you are on the best asthma medication for your case.

If you notice any changes in frequency or severity of symptoms, contact your healthcare provider. 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, stepping down your medications with careful monitoring.

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