Receiving a diagnosis of asthma may be frightening, but learning what the treatment options are can help alleviate the anxiety that comes with diagnosis.
Asthma strikes nearly eight percent of Americans, according to the U.S. Centers for Disease Control and Prevention, so if you have asthma, you are not alone. A chronic condition, asthma occurs when the airways become inflamed and narrow, which hinders airflow.
"The prevention of asthma as a condition is quite difficult. What you can prevent is the frequency and severity of attacks by the use of regular treatment," Dr. John Costello, a pulmonologist at Mayo Clinic Healthcare in London, said in a recent article.
Depending on the severity, certain asthma medications may help you manage your symptoms. Here, experts break down the most common long-term and quick-acting medications for asthma, how they work and potential side effects.
You May Also Like
Non-medication treatments for asthma
Your physician will work with you to develop an individualized treatment plan. It is important to follow this plan diligently and check in with your physician regularly.
Avoid triggers
Because asthma is triggered by many things in the environment, one of the most important treatments for asthma does not involve medication, but rather awareness of what those triggers are. It is important for you to keep a journal in which you record when you have an attack and what triggered it. By noticing what your individual triggers are, you are more prepared to avoid them in the future. According to the Allergy & Asthma Network, some common triggers are:
- Hot or cold air
- Pet dander, dust, pollen, perfumes, smoke
- Laughing or crying
- Stress
- Exercise
- Colds or viruses
Lifestyle changes
Asthma treatment may also include lifestyle changes. If you smoke, it will be essential for you to quit, according to the American Lung Association. Medications to help with quitting may be part of your treatment plan. In addition, obese patients are more likely to experience asthma symptoms than the general public, the CDC says. Losing weight can be an essential part of controlling asthma.
RELATED: Checking Your Peak Flow? Here’s How to Correctly do it
Keep a journal
In addition to recording triggers and attacks, keep a record of each time you use your quick-relief (rescue) inhaler. One sign of well-controlled asthma is using the rescue inhaler two times a week or less, according to Mount Sinai. If you find your attacks increasing and you are using your quick-relief inhaler more often, you should make an appointment with your doctor to review your treatment plan.
You May Also Like
A peak-flow meter, an instrument that gauges how well you breathe, can also be a valuable tool in controlling asthma. If you use this regularly and report the results to your physician, it helps the doctor evaluate how well the treatments are working, the Asthma and Allergy Foundation of American says.
Asthma medications
There are two main categories of medications in the asthma treatment arsenal; long-term (control medications), and quick-acting (rescue medications).
Long-term
Long-term medications are ones that are taken every day as a way to control asthma, the Mayo Clinic says. The goal of these medications is to prevent asthma attacks. These reduce airway inflammation and prevent the airways from narrowing.
It should be noted that while these daily long-term medications help control and ward off asthma attacks, quick-acting medications should be used during an acute asthma attack if one occurs.
Bronchodilators
Long-acting beta-2 agonists (LABA) relax the muscle bands around your airway (bronchi), making it easier to get air in and mucus out. These medications for asthma are taken twice a day through an inhaler and last up to 12 hours, according to the Cleveland Clinic. LABA medications should be given with a corticosteroid. (See combination medications below.)
The main side effects of LABA medications are nervous or shaky feelings, hyperactivity, overexcitement, increased heart rate, upset stomach and trouble sleeping.
- Salmeterol (Serevent)
- Formoterol (Foradil)
Long-acting muscarinic antagonists (LAMA) also relax the muscle bands around your airway, the National Heart, Lung, and Blood Institute (NHLBI) says. This asthma medication is used if the steroid/LABA combination doesn't give enough relief. Do not use this medication if you have glaucoma or are at risk of urinary retention.
- Tiotropium bromide (Respimat)
Theophylline. While not used often, theophylline can be useful in relaxing the airways and preventing reactions to irritants. It is taken as a pill and used for mild asthma symptoms. You may need to have blood tests drawn on a regular basis to make sure the level of medication is correct, the Mayo Clinic says.
Side effects are the same as the other bronchodilators, but may also include chest pain or discomfort, dizziness, fainting, increase in urine volume or seizures.
- Theophylline (Theo-24, Theo-Dur, Slo-Bid, and others)
RELATED: Inhaler Mistakes you Didn’t Know you Were Making
Corticosteroids
Corticosteroids are steroids that reduce inflammation in the airways, according to the NHLBI. They may be taken as a pill, although very few patients are on the pill for long term. It is frequently used in an inhaler, often combined with a LABA.
Side effects from the inhaled form are thrush (a mouth infection) and a hoarse voice.
Inhaled corticosteroids include:
- Fluticasone (Flovent HFA, Arnuity Ellipta, others)
- Budesonide (Pulmicort Flexhaler)
- Mometasone (Asmanex Twisthaler)
- Beclomethasone (Qvar RediHaler)
- Ciclesonide (Alvesco)
Combination asthma medications (Corticosteroid and LABA):
- Fluticasone and salmeterol (Advair)
- Budesonide and formoterol (Symbicort)
- Fluticasone and Vilanterol (Breo)
Leukotriene modifiers reduce swelling and help keep your airways open for up to 24 hours. According to Mayo Clinic, these medications block the effects of leukotrienes, immune system chemicals that cause asthma symptoms.
Side effects are uncommon, but may include nausea, headache, tiredness or diarrhea.
- Montelukast (Singulair)
- Zafirlukast (Accolate)
- Zileuton (Zyflo)
Quick-acting
These quick-acting medications are used in the event of an attack, or when you feel an attack coming on. These include an inhaler that you should carry with you at all times, and can include other medications that may help in the event of an attack.
While inhalation therapy is the treatment of choice, people with severe asthma may need corticosteroids, which can be given either by IV or orally, Costello says.
According to Costello, "if the patient's not responding, then admission to the hospital [is needed] to make sure that these medicines are administered efficiently."
It is very important not to change how you take your medications without checking with your physician first.
Inhaled short-acting beta2-agonists (SABAs) open the airways so air can flow through them during an asthma attack. They start working within 15 to 20 minutes and continue to work for 4 to 6 hours, according to the Cleveland Clinic.
Side effects can include tremors, rapid heartbeat, allergic reactions, muscle pain, worsening breathing, dry mouth, headache, sore throat or trouble sleeping.
Inhaled forms of SABA medications include:
- Albuterol (Ventolin)
- Levalbuterol (Xopenex)
- Albuterol and ipratropium bromide combination (DuoNeb)
Corticosteroids. Oral corticosteroids are usually prescribed for short-term use to help a patient overcome a flare-up. This type of medication quickly reduces swelling and inflammation in the airways.
Side effects include: Cataracts, osteoporosis, weight gain, high blood sugar, increased risk of infections, thinning bones and fractures, thin skin, bruising and slower wound healing, mood swings, depression and aggressive behavior.
- Prednisone (Deltasone, Prednicot, and others)
- Methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol)
Short-acting anticholinergic bronchodilators help open the airways quickly. This medicine may be less effective than SABAs, but it is an option for people who experience side effects with other medications, the Cleveland Clinic says.
Side effects you may experience with these inhalers are dry throat, eyes and nose; unusual taste; nausea and vomiting; or temporary blurred vision if the medicine gets in your eyes.
- Ipratropium bromide (Atrovent)
- Tiotropium bromide (Spiriva Respimat)
Corticosteroid reliever. In January 2023, the FDA approved Airsupra, which can be used as needed to prevent bronchoconstriction and asthma attacks.
In a study conducted before the approval, the risk of severe asthma exacerbation was significantly lower with a fixed-dose combination of albuterol and budesonide than with as-needed use of albuterol alone.
Most common side effects are headache, oral yeast infection, cough, and difficulty speaking.
- Airsupra (albuterol-budesonide)
Surgical treatment for asthma
In the case of severe asthma, surgery may be an option.
For many with severe asthma, medications don't work, with research published recently in the journal Science Translational Medicine suggesting that two natural substances that stimulate cell proliferation activate in the airways of severe asthma patients when they inhale corticosteroids and block the medications from working.
According to the Mayo Clinic, bronchial thermoplasty, usually done over three sessions, is used in patients with severe asthma who have failed medical treatments. It is not for everyone and is not available everywhere. The physician heats the inside of the lung to destroy the smooth muscles which limits the ability of the lung tissue to tighten. This may make it easier to breathe and decreases the incidence of asthma attacks.
While asthma is a chronic illness, you and your physician can create an individualized treatment plan that can give you the best possible control over your asthma.
