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Treatments and drugs
By Mayo Clinic staffTreatment for asthma generally involves avoiding the things that trigger your asthma attacks and taking one or more asthma medications. Treatment varies from person to person.
- Most people with persistent asthma use a combination of long-term control medications and quick-relief medications, taken with a hand-held inhaler.
- If your asthma symptoms are triggered by airborne allergens, such as pollen or pet dander, you may also need allergy treatment.
- You may need to try a few different medications before you find what works best.
- Because asthma changes over time, you will need to work with your doctor to monitor your symptoms and learn how to make needed adjustments.
Medications used to treat asthma include long-term control medications, quick-relief (rescue) medications and medications to treat allergies. The right medication for you depends on your age and symptoms, and what seems to work best to keep your asthma under control.
Long-term control medications
In most cases, these medications need to be taken every day. Types of long-term control medications include:
- Inhaled corticosteroids such as fluticasone (Flovent Diskus), budesonide (Pulmicort), triamcinolone (Azmacort), flunisolide (Aerobid), beclomethasone (Qvar) and others. These medications reduce airway inflammation and are the most commonly used long-term asthma medication. Unlike oral corticosteroids, these medications are considered relatively low risk for long-term corticosteroid side effects. You may need to use these medications for several days to weeks before they reach their maximum benefit.
- Long-acting beta-2 agonists (LABAs) such as salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer). These inhaled medications, called long-acting bronchodilators, open the airways and reduce inflammation. They are often used to treat persistent asthma in combination with inhaled corticosteroids. Long-acting bronchodilators should not be used for quick relief of asthma symptoms.
- Leukotriene modifiers such as montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo CR). These inhaled medications work by opening airways, reducing inflammation and decreasing mucus production.
- Cromolyn and nedocromil (Tilade). These inhaled medications reduce asthma signs and symptoms by decreasing allergic reactions. They're considered a second choice to inhaled corticosteroids, and need to be taken three or four times a day.
- Theophylline, a daily pill that opens your airways (bronchodilator). It relaxes the muscles around the airways.
Quick-relief medications
Also called rescue medications, you use quick-relief medications as needed for rapid, short-term relief of symptoms during an asthma attack, or before exercise, if your doctor recommends it. Only use these medications as often as your doctor tells you to. If you need to use these medications too often, you probably need to adjust your long-term control medication. Keep a record of how many puffs you use each day. Types of quick-relief medications include:
- Short-acting beta-2 agonists, such as albuterol. These inhaled medications, called bronchodilators, ease breathing by temporarily relaxing airway muscles. They act within minutes, and effects last four to six hours.
- Ipratropium (Atrovent). Your doctor might prescribe this inhaled anticholinergic for the immediate relief of your symptoms. Like other bronchodilators, ipratropium relaxes the airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis.
- Oral and intravenous corticosteroids to treat acute asthma attacks or very severe asthma. Examples include prednisone and methylprednisolone. These medications relieve airway inflammation. They may cause serious side effects when used long term, so they're only used to treat severe asthma symptoms.
Medications for allergy-induced asthma. These decrease your body's sensitivity to a particular allergen or prevent your immune system from reacting to allergens. Allergy treatments for asthma include:
- Immunotherapy. Allergy-desensitization shots (immunotherapy) are generally given once a week for a few months, then once a month for a period of three to five years. Over time, they gradually reduce your immune system reaction to specific allergens.
- Anti-IgE monoclonal antibodies, such as omalizumab (Xolair). This medication reduces your immune system's reaction to allergens. Xolair is delivered by injection every two to four weeks.
Albuterol inhaler changes: Know what to expect
The Food and Drug Administration (FDA) has required that metered-dose albuterol inhalers that use chlorofluorocarbon (CFC) propellent be replaced with hydrofluoroalkane (HFA) inhalers by the end of 2008. HFA inhalers work as well as CFC inhalers and are as safe, but they don't harm the ozone layer. If you're used to using a CFC inhaler, talk to your doctor about making the switch to an HFA inhaler. There are a few differences you should know about:
- Your HFA inhaler may have a different taste and feel from your older CFC inhaler.
- HFA inhalers have a less forceful spray than the older CFC inhalers. Make sure you know how to use your inhaler correctly - otherwise, you may not get the full dose of medication with each spray.
- HFA inhalers are more costly than the older, generic albuterol CFC inhalers.
- HFA inhalers should be cleaned with water every week.
Treatment by severity for better control: A stepwise approach
Treatment based on asthma control can help you manage your asthma. Asthma treatment should be flexible and based on changes in symptoms, which should be assessed thoroughly each time you see your doctor. Then, treatment can be adjusted accordingly.
For example, if your asthma is well controlled, your doctor may prescribe less medicine. If your asthma is not well controlled or getting worse, your doctor may increase your medication and recommend more frequent visits.
