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.