Asthma Treatment & Medication

 

Asthma is a chronic lung disease. There are 25 million people with asthma living in the United States. This includes 20 million adults and 5 million children. Asthma causes episodes of coughing, wheezing, chest tightness and shortness of breath. Symptoms can be mild or severe, and sometimes life-threatening. Asthma cannot be cured. But asthma management can be achieved through effective asthma treatment.

Treatment for asthma focuses on managing symptoms and preventing and treating asthma attacks. Different asthma treatments have different roles. So, it is important to understand treatments and their roles in helping with asthma control.

How is asthma treated?

Asthma medicines play a central role in the asthma management. Some medications prevent or reduce airway inflammation. Others interrupt the allergic reaction that triggers symptoms. Some relieve coughing and wheezing, making it easier to breathe.

Your doctor will work with you to find the right combination of medicines for optimal asthma control. They will adjust the type and amount based on your symptoms and the type of asthma that you have. The goal of asthma treatment is to have you feel your best with the least amount of medicine needed to control asthma.

Get to know your medications.

Understand how and why they treat and soothe your lungs and airways. If you’re prescribed an inhaler, ask for one with a dose counter. Learn when and how you’re supposed to use your inhaler and follow your plan to better breathing.

Photo of young woman with an asthma inhaler

What are common types of asthma medications?

There are four basic types of asthma medicines. They each treat a different part of your asthma:

  • bronchodilators relax and open the airways to treat symptoms such as coughing, wheezing, chest tightness and shortness of breath.

  • anti-inflammatory medications reduce and prevent lung inflammation.

  • combination medications combine a bronchodilator and anti-inflammatory in one device.

  • leukotriene modifiers block the action of leukotrienes, chemicals involved in immune system responses.

  • biologics are medications that target the specific cells and pathways that cause inflammation related to severe asthma.

Bronchodilator inhalers

Bronchodilators relax and open the airways to relieve asthma symptoms. This helps with symptoms such as coughing, wheezing, chest tightness and shortness of breath. Bronchodilators can both be short acting and long acting.

Quick-relief (short-acting) bronchodilators

Quick-relief bronchodilators are beta2-agonist medications. You may sometimes hear these referred to as short-acting beta agonists or SABA. These include albuterol and levalbuterol. With these quick-relief medicines, symptom relief starts almost immediately and may last 3-6 hours. That is why this is typically the type of medicine you will be told to use if you are experiencing an asthma attack. Many people call quick-relief inhalers their “rescue inhaler” because it helps “rescue” from the symptoms of an asthma attack.

Doctors also prescribe quick-relief medications to prevent exercise-induced bronchospasm (EIB). You may also hear this called exercise-induced asthma. The quick-relief inhaler can be used 15-20 minutes before exercise to help prevent asthma symptoms.

Long-acting bronchodilators

Long-acting bronchodilators are beta2-agonist medications as well. They relieve symptoms for up to 12 hours. You may also hear these referred to as long-acting beta agonist or LABA. Long-acting beta agonists include indacaterol, olodaterol, and salmeterol. They should not be used more than once every 12 hours. They are not for the treatment of sudden-onset asthma symptoms or asthma attacks.

Anti-inflammatory asthma medications

Anti-inflammatory medications treat and prevent airway inflammation and swelling. They also reduce mucous. These medications usually need to be taken every day to prevent and control symptoms. They are helpful to prevent and avoid asthma attacks.

After using an anti-inflammatory medication, you won’t feel different. These medications to cause immediate changes. That’s because it takes time for airway swelling to subside and the mucus and excess fluid to clear out of the airways. Keep using it as directed even if you don’t feel anything happening right away.

When you hear the term “steroids” in asthma care, they are referring to corticosteroids. These are NOT the anabolic steroids used illegally in body building.

Inhaled corticosteroids

Inhaled corticosteroids (beclomethasone, budesonide, ciclesonide, fluticasone, mometasone) are the most effective long-term control medications available for people with asthma. Taken as prescribed, they reduce and prevent fluid and excess mucus. The also prevent swelling in the airways. Because it is inhaled, the medicine goes directly to the inflamed airways.

Oral corticosteroids

Oral corticosteroids are used to treat acute asthma flares or severe asthma. They are usually prescribed only for short periods of time (5-7 days). Taken as prescribed, they gradually reduce asthma symptoms and open the airways.

The dose of oral corticosteroids are 10 times the dose of inhaled corticosteroids. Because of this, there is an increased risk of side effects. These include behavioral problems, moodiness, and depression. They may also include weight gain, headaches, and easy bruising of the skin.

When taking long-term, side effects from corticosteroids can be more problematic. They may include eye problems, diabetes symptoms, increased risk of infections, and thinning bones. Patients should talk with their doctor about the risks verses benefits of long-term corticosteroid use.

Note: Always use inhaled corticosteroids as prescribed; do not stop using them even when you are symptom-free and appear to be well.

Montage of various asthma medications on a grey background.

Combination medications

Combination medications combine two medicines into one inhaler. The devices may contain an anti-inflammatory corticosteroid and a LABA. Or they may contain a LABA and a long-acting muscarinic antagonist, or LAMA. (LAMAs are anticholinergic medications that relieve cough, wheeze, sputum production and chest tightness. Most LAMAs are prescribed to treat COPD, but a few are approved for asthma as well.)

Combination medications are used daily and should be taken no more than once every 12 hours. They should not be used to treat severe symptoms or an asthma attack.

Leukotriene modifiers

Leukotriene modifiers are oral medications that block the action of leukotrienes. Common leukotriene modifiers include montelukast, zafirlukast, and zileuton. Leukotrienes are chemicals involved in immune system responses. These responses cause inflammation, swelling and tightening of the airways. They are available as granules, chewable or tablets. Leukotriene modifiers should not be used to treat sudden symptoms or asthma attacks.

Montelukast may cause behavioral side effects. This includes sleep disturbances, anxiety, depression, confusion, sudden mood changes and suicidal thoughts or actions. Talk with your doctor about these potential side effects before taking montelukast. Monitor for side effects during treatment.

Biologics

Biologics target cells and pathways that cause allergic inflammation and tightening of the airways (bronchoconstriction). This medication focuses on treating the source of symptoms rather than the symptoms themselves. They aim to stop symptoms before they can start.

Biologics are prescribed as an add-on therapy for severe asthma. They are usually administered as an injection or infusion every 2-4 weeks in a doctor’s office. Biologics are not used to treat asthma attacks.

When biologics are effective, they help patients gain long-term asthma control. They help improve asthma symptoms and reduce the risk of an asthma attack. The most serious side effect is anaphylaxis, a life-threatening allergic reaction. Your doctor should have epinephrine readily available for treatment after administering the biologic.

small image of Restiratory Treatments poster

Download “Respiratory Treatment Poster”

Our most popular free download is an asthma medication chart that lists asthma inhalers by brand and name as well as biologic medications used to treat asthma.

How are inhalers used to treat asthma?

Many asthma medicines are delivered using an inhaler or a nebulizer. Inhalers and nebulizers are devices that allow the asthma medications to be inhaled. This means you breathe them in, and they go straight to the airways. There are four types of delivery devices:

  • metered-dose inhaler (MDI): a pressurized device that releases medication in a fine spray for you to inhale
  • slow-moving mist inhaler: like an MDI, with a slower-moving mist
  • dry powder inhaler (DPI): releases medication as a fine powder for inhaling

Visit our online store to download our free respiratory treatment poster or purchase print copies. The respiratory treatment poster is an asthma medication chart. It lists asthma inhalers by brand name as well as biologic medications used to treat asthma.

How to Use a Metered Dose Inhaler

How to Use a Slow-Moving Mist Inhaler

How to Use a Dry Powder Inhaler

Improving asthma with tools and devices

Asthma is a cyclical disease, with episodes that come and go. Asthma flare ups don’t just “happen,” however. Subtle warning signs are there if you know where and how to look. By the time you begin coughing or wheezing, it’s too late. Your lungs are already congested and compromised. That’s why you need to pay close attention to the subtle signs. Follow the asthma treatment plan prescribed by your doctor.

The following management tools are proven to be excellent for anticipating, treating, and shortening an asthma attack. Always keep in mind that the real goal is to prevent or minimize asthma symptoms.

Asthma holding chamber or spacer

A valved holding chamber is a handheld device that attaches to a metered-dose inhaler (MDI). It captures the medicated mist as it sprays out. The medication is trapped long enough inside the holding chamber to be inhaled at your own speed. It also pulls out large particles of medication and prevents them from settling in your mouth or throat.

A spacer is like a valved holding chamber, but it does not suspend the medication. So, when using it you must coordinate your breath to begin slightly before actuating the MDI.

Holding chambers are available for use with and without masks. Masks are often essential for children, the elderly, or some disabled people. Anyone who cannot close their lips securely around the mouthpiece should use a mask. Anyone who needs to take several breaths to inhale the medication fully should use a mask.

Photo of boy with Holding-chamber

How to use a spacer or holding chamber

Nebulizers

Nebulizers turn liquid asthma medicine into a fine aerosol. This allows the medicine to be deeply inhaled into the airways. They are powered by a compressed air machine. They can be battery operated or plugged into an electrical outlet.

Studies show nebulizers are not more effective than MDIs. But they do offer an alternative for patients. Nebulizers are helpful for those who have difficulty with MDI coordination. Or they may help someone who prefers a slower delivery of medication.

Some say they benefit from taking extra time during an asthma attack for a nebulizer treatment. It gives them a chance to sit down, relax and breathe normally while relieving inflammation and bronchospasm.

Discuss with your doctor or pharmacist if a nebulizer is right for you and your family.

How to use a nebulizer

Photo of older woman taking a nebulizer treatment

What is bronchial thermoplasty?

Bronchial thermoplasty is an outpatient surgical procedure. It is for adults ages 18 and older with poor asthma control. These people have severe persistent asthma symptoms despite using standard therapy. This includes a combination of inhaled corticosteroids and a long-acting bronchodilator.

The procedure is performed in three outpatient visits under moderate or general anesthesia. A pulmonologist or other qualified physician inserts a long, slender tube called a bronchoscope into the lungs and surrounding airways. They then heat and shrink the size of muscle tissue. This allows more air to pass through and make breathing easier.

Side effects may include a short-term worsening of asthma symptoms. These side effects usually resolve within a week.

If you have severe and difficult-to-control asthma, talk with your doctor to determine if the procedure is right for you. Be sure to check your health insurance to confirm if the procedure is covered.

Treatments for Eosinophilic Asthma: visit eosasthma.org
Illustration of a lung Xray with doctors looking it over, and aspirin on the ground to symbolize AERD

Choosing the Right Asthma Delivery Device

Have you ever wondered how your doctor decides which is the best way for you to take your asthma medicine?

Options include syrups, granules, tablets, or capsules that you swallow. Or they are aerosols and powders that you inhale from a metered-dose inhaler (MDI), dry powder inhaler (DPI) or nebulizer. Attaching a valved holding chamber to an MDI allows patients to direct the medicine into the airways by holding it and inhaling at their own speed.

Healthcare providers prescribe treatments effective in disease control. They also want treatments that are convenient for patients’ needs and lifestyles. You should be part of the decision process. Discuss with your healthcare provider your needs and lifestyle.

Here are 5 patient-focused factors that are part of the decision process:

  1. Age. This is always an important consideration, but especially with infants. Infants have smaller airways and lungs and breathe faster. National asthma guidelines say children should use a holding chamber when using an MDI. This is because the aerosolized spray comes out faster than most kids can inhale.
  2. Ability to follow directions. This consideration crosses all age groups. It includes when and how to take a particular medication. Even adults may confuse the directions for using MDIs and DPIs.
  3. Hand-breath coordination. Young children should be able to use an MDI with a holding chamber and mask. But they may not be able to breathe in long enough to use a DPI in a diskus device. Older individuals with asthma may want to use a holding chamber. This is if they are not able to manage the hand-breath coordination of an MDI or use a DPI or nebulizer. Some DPIs are breath actuated. This eliminates the need for a coordinated effort to deliver and inhale the medication. Albuterol is now available in a DPI.
  4. Where you are going to use it? Most people with asthma keep their daily maintenance medications at home. But some may travel or spend their days at work or in school. People must first make sure their quick-relief inhaler is easily accessible, even if their asthma is well controlled. For people on the go, delivery systems need to be convenient, portable and low maintenance. MDIs with holding chambers offer low-cost, convenient and effective delivery of albuterol. This works for either premedication or quick-relief.
  5. Patient preference and convenience. Your needs and preferences are an important consideration in the final selection of asthma treatment. The medications will not help if you don’t use them! Talk with your doctor about what works best for you.

To benefit from your medication, it must be taken at the right dose, at the right time and in the right way. Since there can be obstacles to any of these steps, review your Asthma Action Plan at every doctor’s visit. Demonstrate your delivery technique to be sure that you are taking your medication correctly. Discuss any problems you may have with asthma control.

If your asthma symptoms persist, talk with your doctor about the need to adjust your medications. Talk with your doctor about concerns over cost. Any barrier to using your medication can affect your asthma control.

How do I know if my asthma treatment plan needs updating?

Asthma is a condition that requires constant attention. An up-to-date Asthma Action Plan is important for disease control and to prevent asthma attacks. If you start to regularly experience symptoms during everyday activities, visit your asthma specialist to discuss whether you need to adjust your treatment plan.The “Rules of Two(R)” is another way to find out if your treatment plan is working. If you answer “yes” to any of these questions, make plans to visit your asthma specialist.

  • Do you need to use your quick-relief inhaler TWO or more times a week? (except to prevent symptoms before exercise)
  • Does your asthma wake you up TWO or more times a month? (Nighttime symptoms are a sign of nocturnal asthma)
  • Do you refill your quick-relief inhaler TWO or more times a year?
  • Do you use prednisone TWO or more times a year for flares of asthma?
  • Does your peak flow vary when more than TWO TIMES 10 (20%) from baseline when you have asthma symptoms?

The Rules of Two(R) is a registered trademark of the Baylor Healthcare System.

Rules of Two printout with graphic of a doctor pointing to the rules.

How do you decide what treatment is right for your asthma?

Patients want to have a say in their care and treatment choices. We call it Shared Decision-Making. This is where your asthma specialist discusses with you the pros and cons of a specific test or treatment. You then work together to decide what is best for you. These decisions will guide the development of your Asthma Action Plan.

Studies show when patients and healthcare providers partner on decisions, it improves health outcomes. Shared Decision-Making helps improve patients’ knowledge of their condition. They are also more likely to follow their treatment plans and go to follow-up appointments.

➤ Shared Decision Making for Adults with Asthma 

➤ Shared Decision Making for Children with Asthma

Illustration showing the benefits of shared decision making

Various asthma medications on a blue background: including steroid pills, inhaler, corticosteroid dry inhaler, and biologies.

How do I reduce the need for medications?

Sometimes asthma symptoms seem to come out of nowhere. Other times, you can predict them. You can make sense of the asthma rollercoaster by tracking when and how symptoms happen.

Learn the early warning signs of an asthma attack. If you know what to look for, you will notice when an asthma attack is developing. These will vary from one person to another. But it can be as simple as a tickle in the throat or chest, a sharp or sudden cough, or a feeling of extreme tiredness.

This is important because it takes less medication to stop symptoms from worsening than it does to treat a full-blown asthma flare-up. By the time you begin to cough or wheeze, your lungs are already congested and compromised.

Understanding Asthma Triggers

Part of non-medication asthma treatment involves understanding your asthma triggers. An asthma trigger is something that can cause a flare-up or make your symptoms worse. For some people, an asthma trigger may be pollen. For another it may be exercise or cold air. For someone else, it may be pet dander or dust mites. Some people find that respiratory infections, such as a cold or the flu, trigger symptoms. Every person has different asthma triggers.

When you learn your asthma triggers, you’ll find ways to reduce your need for asthma medications. Notice your triggers in your home, work or school. Then try your best to avoid contact with them or plan for preventative treatment.

What if I can’t afford asthma medication?

Asthma medications vary in price. Some are costly, and some are inexpensive. If you are unable to afford your asthma medicines, consider these alternatives:

 

  • Shop around. Compare prices at other pharmacies or check prices at GoodRx.
  • Contact the manufacturer. We have compiled a list of asthma medication patient assistance programs. This will assist you in finding an affordable medication to help control your asthma.
  • Use an alternative medication prescribed by your doctor. Sometimes your doctor can recommend a less costly asthma medicine.

Don’t go without taking your asthma medicine as prescribed. Be sure to work together with your doctor so you find a solution.

Understanding Asthma magazine mockup with Asthma Action Plan form on the open page

Download Our Free “Understanding Asthma” Guide

How do I monitor my daily asthma symptoms?

National asthma guidelines suggest using a daily symptom diary. This could be Allergy & Asthma Network’s AsthmaTracker™. It helps you keep track of symptoms, peak expiratory flow rates, and medications used.

What is an AsthmaTracker?

The AsthmaTracker™ can help you track how well your symptoms respond to your treatment plan. You write down your symptoms, peak expiratory flow rate and medication use each day. This will help you notice a pattern to your symptoms. With this you can develop strategies to stop the symptoms before they can stop you.

What is a peak flow meter?

A peak flow meter is a handheld device that measures the peak expiratory flow rate (PEFR). This is how much air you can forcibly push out of your lungs at a particular time.

Asthma Storylines – an app for managing asthma

The free Asthma Storylines app is a self-care tool for managing asthma. Track symptoms, learn more about daily patterns and record topics to discuss with your healthcare team.

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Image of doctor holding up phone towards camera. The phone has the Asthma Storyline app on it.

Are there other conditions that may look like asthma or complicate asthma?

There are other types of respiratory conditions that are different than asthma.  The symptoms, diagnosis and treatment can vary depending upon the condition. Here are some of them.

AERD

COPD

respiratory syncytial virus (RSV)

alpha-1 antitrypsin deficiency

COVID-19

sleep apnea

bronchiectasis

influenza, infections & viruses

vocal cord dysfunction


Reviewed by:
James Sublett, MD, FACAAI, FAAAI, is a board-certified allergist and immunologist with Family Allergy & Asthma in Louisville, Kentucky. He earned his medical degree from the University of Louisville. He is Past President of the American College of Allergy, Asthma & Immunology (ACAAI).

Dennis Williams, PharmD, is an Associate Professor at the University of North Carolina Eshelman School of Pharmacy. He practices at UNC Medical Center with the pulmonary medicine medical service. He has served as a member of the National Asthma Education Program Coordinating Committee and the National Asthma Educator Certification Board. He serves on Allergy & Asthma Network’s Board of Directors.