Free
E-newsletter
Subscribe to Housecall
Our weekly general interest
e-newsletter keeps you up to date
on a wide variety of health topics.
Mayo Clinic Housecall
Stay up to date on the latest health information.
What you get
- Free weekly e-newsletter
- Mayo Clinic expertise
- Recipes, tools and other helpful information
- We do not share your e-mail address
Treatments and drugs
By Mayo Clinic staffFor many people, a few puffs from a quick-relief inhaler right before exercise is enough to control asthma symptoms. These bronchodilator (brong-koh-DIE-lay-tur) medications — albuterol, for example — quickly open the airways and can help control symptoms for several hours.
Quick-relief medications
Also called rescue medications, quick-relief medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your doctor recommends it. Types of quick-relief medications include:
- Short-acting beta agonists. These inhaled bronchodilator medications include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA) and pirbuterol (Maxair Autohaler). For most people, one to two puffs of albuterol or another inhaled short-acting beta agonist 10 to 15 minutes before exercise is enough to prevent symptoms for up to four hours. These inhaled bronchodilator medications can rapidly ease symptoms during an asthma attack. However, it is possible to develop a tolerance to these medications if they're used frequently.
- Ipratropium (Atrovent). Your doctor might prescribe this inhaled medication for 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, but it's sometimes used to treat asthma attacks.
However, some people also need to take additional medications to control asthma symptoms. You may need daily long-term control medications if you have frequent asthma symptoms when you're not exercising, or if using a medication before exercise doesn't keep your symptoms 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. These medications include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex Twisthaler), triamcinolone (Azmacort), flunisolide (Aerobid), beclomethasone (Qvar) and others. They are the most commonly prescribed type of long-term asthma medication. You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a relatively low risk of side effects and are generally safe for long-term use.
- Leukotriene modifiers. These oral medications include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo, Zyflo CR). They help prevent asthma symptoms for up to 24 hours. In rare cases, these medications have been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any unusual reaction.
- Theophylline. This is a daily pill that helps keep the airways open (bronchodilator). Theophylline (Theo-24, Elixophyllin, others) relaxes the muscles around the airways to make breathing easier. It's not used as often now as in past years because more-effective medications are available.
- Long-acting beta agonists (LABAs). These inhaled medications include salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer). Taken 30 minutes before exercise, long-acting beta agonists can prevent symptoms of exercise-induced asthma for up to 12 hours. However, they've been linked to severe asthma attacks. LABAs should always be taken only in combination with an inhaled corticosteroid.
- Combination inhalers. Fluticasone and salmeterol (Advair Diskus), budesonide and formoterol (Symbicort), and mometasone and formoterol (Dulera) are examples of combination inhalers. These medications contain a LABA along with a corticosteroid. Like other LABA medications, these medications may increase your risk of a severe asthma attack and need to be used with caution.
Treatment for allergy-induced asthma
If your asthma is triggered or worsened by allergies, you may benefit from allergy treatment as well. Allergy treatments include:
- Omalizumab (Xolair). This medication is specifically for people who have allergies and asthma. It reduces the immune system's reaction to allergy-causing substances, such as pollen, dust mites or pet dander. Xolair is delivered by injection.
- Allergy medications. These include oral and nasal spray antihistamines and decongestants as well as corticosteroid, cromolyn and ipratropium nasal sprays.
- Allergy shots (immunotherapy). Over time, immunotherapy injections gradually reduce your immune system reaction to specific allergens. This may help relieve your symptoms if certain allergens, such as pollen, trigger your asthma.
Don't rely only on quick-relief medications
If you've been prescribed long-term asthma control medications — such as inhaled corticosteroids — you shouldn't need to use your quick-relief inhaler more often than your doctor recommends. Keep a record of how many puffs you use each week. If you frequently need to use your quick-relief inhaler, see your doctor. You probably need to adjust your long-term control medication.
- Krafczyk MA, et al. Exercise-induced bronchospasm: Diagnosis and management. American Family Physician. 2011;84:427.
- Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: A practice parameter. Palatine, Ill.: The American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology. http://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/Exercise-induced-bronchoconstriction-2011.pdf. Accessed Sept. 26, 2011.
- Rakel D. Pulmonary problems. In: Rakel D. Integrative Medicine. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/208746819-2/0/1494/0.html. Accessed Sept. 26, 2011.
- Asthma and exercise: Tips to remember. American Academy of Allergy, Asthma and Immunology. http://www.aaaai.org/conditions-and-treatments/library/asthma-library/asthma-and-exercise.aspx. Accessed Sept. 26, 2011.
- Exercise-induced asthma. Asthma and Allergy Foundation of America. http://www.aafa.org/display.cfm?id=8&sub=17&cont=168. Accessed Sept. 26, 2011.
- Parker MJ. Asthma. Otolaryngology Clinics of North America. 2011;44:667.
- Covar RA, et al. Allergic disorders. In: Hay WW, et al. Current Diagnosis & Treatment: Pediatrics. 20th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/content.aspx?aID=6589316. Accessed September 26, 2011.
- Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma. Bethesda, Md.: National Institutes of Health. http://www.nhlbi.nih.gov/guidelines/asthma/07_sec3_comp4.pdf. Accessed Sept. 26, 2011.
- Updated information on leukotriene inhibitors: Montelukast (marketed as Singulair), zafirlukast (marketed as Accolate), and zileuton (marketed as Zyflo and Zyflo CR). U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm165489.htm. Accessed Sept. 26, 2011.
- FDA drug safety communication: New safety requirements for long-acting inhaled asthma medications called long-acting beta-agonists (LABAs). U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm200776.htm. Accessed Sept. 26, 2011.
- Asthma action plan. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.pdf. Accessed Sept. 27, 2011.
Find Mayo Clinic on