Treatments and drugsBy Mayo Clinic staff
Avoiding the workplace irritant that causes your symptoms is critical. But that's easier said than done. Once you become sensitive to a substance, even tiny amounts of it may trigger asthma symptoms. As long as the substance is used in your workplace, it may still cause asthma symptoms even if you wear a mask or respirator. You may need medications to keep your symptoms under control and to prevent asthma attacks.
Treating asthma involves both preventing symptoms and treating an asthma attack in progress. Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief (rescue) medications quickly open swollen airways that are limiting breathing. In some cases, medications to treat allergies are needed.
The right medication for you depends on a number of things, including your age, symptoms, asthma triggers 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. These medications include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex), ciclesonide (Alvesco), 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. A fungal infection in your mouth or throat is the most common side effect from these medications. But, you can usually prevent that by rinsing your mouth after inhaling these drugs.
- Leukotriene modifiers. These oral medications include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo CR). They help prevent asthma symptoms for up to 24 hours. In rare cases, montelukast has 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). LABAs open the airways and reduce inflammation. However, they've been linked to severe asthma attacks. LABAs should only be taken only in combination with an inhaled corticosteroid.
- Combination inhalers such as fluticasone and salmeterol (Advair Diskus, Advair HFA) and budesonide and formoterol (Symbicort) and mometasone and formoterol (Dulera). These medications contain a LABA along with a corticosteroid. Like other LABA medications, these medications may increase your risk of a severe asthma attack.
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 (brong-koh-DIE-lay-tur) medications can rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA) and pirbuterol (Maxair Autohaler). These medications act within minutes, and effects last several hours.
- Ipratropium (Atrovent). Your doctor might prescribe this inhaled mediation 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, but it's sometimes used to treat asthma attacks.
- Oral and intravenous corticosteroids. These medications relieve airway inflammation caused by severe asthma. Examples include prednisone and methylprednisolone (Medrol). They can cause serious side effects, such as high blood pressure, weight gain and an increased risk of infection, when used long term, so they're only used to treat severe asthma symptoms on a short-term basis.
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:
- Allergy medications. These include oral and nasal spray antihistamines and decongestants as well as corticosteroid, cromolyn (NasalCrom) and ipratropium (Atrovent) nasal sprays.
- Allergy shots (immunotherapy). Immunotherapy injections 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.
- Omalizumab (Xolair). This medication, which is given by injection, is specifically for people who have difficult to control allergies and asthma. It reduces the immune system's reaction to allergy-causing substances, such as pollen, dust mites or pet dander.
Don't rely only on quick-relief medications
Long-term asthma control medications — such as inhaled corticosteroids — are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an asthma attack.
If you do have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your long-term control medications are working properly, you shouldn't need to use your quick-relief inhaler very often. Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more often than your doctor recommends, see your doctor. You probably need to adjust your long-term control medication.
- Occupational asthma. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/sec05/ch057/ch057h.html?qt=occupational%20asthma&alt=sh. Accessed Jan. 28, 2011.
- Malo J. Diagnosis and clinical assessment of asthma. http://www.uptodate.com/home/index.html. Accessed Jan. 28, 2011.
- Tarlo SM. Occupational exposures and adult asthma. Immunology and Allergy Clinics of North America. 2008;28:563.
- Dykewicz MS. Occupational asthma: Current concepts in pathogenesis, diagnosis, and management. Journal of Allergy and Clinical Immunology. 2009;123:519.
- Bardana EJ. Occupational asthma. Journal of Allergy and Clinical Immunology. 2008;121:S408.
- Maestrelli P, et al. Mechanisms of occupational asthma. Journal of Allergy and Clinical Immunology. 2009;123:531.
- Mapp CE, et al. Occupational asthma. American Journal of Respiratory and Critical Care Medicine. 2005;172:280.
- Smith AM, et al. Management of work-related asthma. Journal of Allergy and Clinical Immunology. 2009;123:551.
- Balkissoon R. Asthma overview. Primary Care: Clinics in Office Practice. 2008;35:41.
- Guidelines for the diagnosis and management of asthma. Bethesda, Md.: National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. Accessed Jan. 28, 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 Feb. 5, 2011.
- Kealoha MK. What's new in alternative therapies for asthma in children? Journal of Community Health Nursing. 2009;26:198.
- Engler RJ, et al. Complementary and alternative medicine for the allergist-immunologist:Where do I start? Journal of Allergy and Clinical Immunology. 2009;123:309.
- Li XM, et al. Efficacy and mechanisms of action of traditional Chinese medicines for treating asthma and allergy. Journal of Allergy and Clinical Immunology. 2009;123:297.
- Ernst E. Spinal manipulation for asthma: A systematic review of randomised clinical trials. Respiratory Medicine. 2009;103:1791.
- OSHA frequently asked questions. Occupational Safety & Health Administration. http://www.osha.gov/OSHA_FAQs.html. Accessed Feb. 5, 2011.