Medicines Used in the Treatment of Asthma

Although asthma is a chronic disease, there are effective treatment options. A treatment plan will be designed especially for you to help control your asthma. This plan, designed by your doctor, may include how to adjust your medicines based on your symptoms and peak flow results.

Note: The following information is not complete for each asthma medicine. It is general information about each of the categories of medicines used to treat asthma. You may be prescribed only one or several of these medicines based on your individual asthma treatment plan. Get specific information about each medicine you are prescribed.

Two main types of medicine are used to treat asthma: long-term control medicines (controllers) and quick relief medicines (rescue medicines). Long-term control medicines (controllers) prevent symptoms and treat the disease process. These medicines are taken daily, even if you feel well. Quick relief (rescue) medicines work quickly to open up narrowed airways when shortness of breath or other acute asthma symptoms occur.

Quick Relief Medicines (Rescue Medicines)

Rescue medicines provide quick relief from shortness of breath and asthma symptoms. They start to work within several minutes. These medicines are called “short-acting bronchodilators” because they only last four to six hours. Some quick relief medicines available today include:

Generic Name  Brand Name
 Albuterol    Proventil, Ventolin
 Pirbuterol  Maxair
 Ipratropium  Atrovent
 Ipratropium w / albuterol  Duoneb
 Levalbuterol  Xopenex

 

Rescue medicine side effects: Side effects may include increased heart rate, headache, and skeletal muscle tremors.

Carry your quick relief inhaler with you at all times.

Take it as needed to relieve symptoms. Tell your doctor how often you need to use your quick relief medication.

Talk to your doctor about signs that your asthma may be getting out of control. With good control, you may not need quick relief medications very often. In general, your doctor might advise you to call when you notice:

  • Increased need or use of quick relief bronchodilators (Ask your doctor to explain exactly what this means. Your doctor might want to be called if you need to use your quick relief bronchodilator often.)
  • Waking up at night with asthma symptoms
  • Decreased activity tolerance
  • Peak flow reading in the yellow and red zone (See “Peak flow monitoring” information in this booklet.)

Anticholinergic medicines, like ipratropium (Atrovent) are sometimes used to decrease the effects of asthma. This medicine does not work directly on the airways, but on the nerve that causes the airways to narrow. Anticholinergics may prevent the airways from tightening. Anticholinergic side effects: Side effects of anticholinergics include dry mouth, cough, and headache.

Long-term Control Medicines (Controllers)

  • How do controllers work? Controllers are taken every day, even if you don’t have symptoms. Many medicines can be used to control asthma. These include anti-inflammatory agents, long-acting bronchodilators (BRON-ko-DY-lay-tors), theophylline (thee-OF-uh-leen), and leukotriene (LUK-oh-treen) modifiers.
  • Anti-inflammatory medicines prevent swelling and narrowing of the airways. To work effectively, these medicines need to be taken every day, even if you don’t have asthma symptoms.
  • Inhaled steroids are the strongest and most effective anti-inflammatory medicine available. Anti-inflammatory medicines prevent asthma attacks by making the airways less sensitive to triggers and decreasing inflammation or swelling. The inhaled form of steroids is used in the long-term control of asthma. When anti-inflammatory medicines are started, it takes several weeks for them to have an effect. After several weeks, you should not need your quick relief (rescue) medicine as often. Some of the inhaled steroids available today include:
Generic Name Brand Name
 Beclomethasone  Various (Qvar, Vanceril, Beclovent)
 Budesonide  Pulmicort
 Flunisolide  Aerobid
 Fluticasone  Flovent
 triamcinolone acetonide  Azmacort
 mometasone  Asmanex

 

Inhaled-steroid side effects: Side effects of inhaled steroids include hoarseness or a yeast infection in the mouth. If the inhaler can be attached to a spacer (a long tube that attaches to the inhaler), the chance of these side effects is reduced. Rinsing your mouth with mouthwash or water may also help reduce the chance of side effects. Many people confuse the effects of inhaled steroids with those of steroids taken by mouth (like prednisone). These medicines are not the same and it is unlikely that you will have any of the common side effects that come with steroids taken by mouth.

  • Oral steroids, such as prednisone and medrol, are taken by mouth. They may be taken for a short time to help treat a severe asthma attack. Oral steroids are an effective treatment for asthma, but they have many side effects. Therefore, they are not usually recommended for long-term therapy.
    • Oral steroid side effects: The side effects of oral steroids may include increased appetite, fluid retention, weight gain, nausea, vomiting, ulcers, or upset stomach. When steroids are taken for a longer period of time, the side effects may include high blood pressure, thinning of bones, cataracts, muscle weakness, and slower growth in children.
  • Non-steroidal anti-inflammatory medicines, such as cromolyn sodium and nedocromil, are sometimes prescribed to prevent asthma symptoms and attacks. They will not provide immediate relief of symptoms during an asthma attack. Drinking water before or after use may help to avoid dry cough. Rinsing the mouth after use may help the unpleasant taste. Talk to your doctor about using cromolyn before exercise or exposure to an asthma trigger to prevent symptoms.
  • Leukotriene modifiers are another type of asthma medicine. They help to reduce inflammation, swelling, increased mucus, and tightening of the airways. These medicines are taken by mouth. The leukotriene modifiers currently available include montelucast (Singulair), zafirlucast (Accolate), and zileuton (Zyflo).
    • Leukotriene modifier side effects: Side effects of leukotriene modifiers may include fatigue, fever, upset stomach, dizziness, headache, and rash.
  • Long-acting bronchodilators are used along with anti-inflammatory medicines to prevent symptoms, especially night-time symptoms (nocturnal asthma). They also prevent exercise induced narrowing of the airways, or bronchoconstriction (BRON-ko-con-STRICT-shun). The long-acting bronchodilators available today are salmeterol (Serevent) and formoterol
    (Foradil). This medicine is used daily. It should not be used for quick relief. With episodes of shortness of breath, you should use a quick relief (rescue) medicine.
    • Long-acting bronchodilators side effects: Side effects may include headaches for the first few weeks, tremors, and the potential for increased blood pressure or increased heart rate.
  • Combined inhaled medicines: Advair combines 2 controllers: salmeterol (a bronchodilator) and fluticasone (a steroid). Advair offers the long-acting bronchodilator effects of salmeterol and the steroid’s ability to reduce swelling in 1 inhaler. It is usually prescribed 2 times a day, morning and evening, about 12 hours apart. Do not exceed this dosage. NOTE: Advair comes in 3 different strengths that are color-coded. The fluticasone (steroid) dosage is different in each.

    Advair does not replace the fast-acting inhalers (rescue medicines) to treat an attack of severe symptoms. Talk to your doctor about how to use your quick relief (rescue) medicine for severe symptoms.
  • Oral bronchodilators, like theophylline, are used to support the inhaled medicines when nighttime symptoms occur. Oral bronchodilators are not used as much now since the medicines taken with inhalers have fewer side effects and are more effective.
    • Oral bronchodilator side effects: Side effects of oral bronchodilators include upset stomach, hyperactivity in some children, increased heart rate, and insomnia. The body’s use of theophylline can be changed by certain medicines, illness, and smoking. Blood tests are sometimes needed to make sure you are receiving the right dose of theophylline. Make sure you tell all doctors that you are taking theophylline when new medicines are prescribed.

Anti-IgE Medicine

Omalizumab (Xolair) is given as a shot to people who have moderate to severe asthma that is triggered by year-round allergens. This drug is for people who have symptoms even though they are on inhaled steroids.

To receive Xolair shots, you must also have:

  • A high IgE level, measured by a blood test, and
  • A positive allergy skin testing or RAST tests

Not everyone who has asthma can qualify to get Xolair shots. These shots are usually given every 2 to 4 weeks in the doctor’s office. Xolair may help reduce the number of asthma attacks.

Reviewed November 2011

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