Medication for people with asthma

Two groups of medications are used in the treatment of asthma:

• Reliever ("rescue") medication: These medications quickly open up the airways and relieve acute symptoms. They help during an asthma attack, but may also be used to prevent asthma attacks, for instance before doing physical exercise. In mild asthma, this treatment is often enough to keep the disease under control.
• Controller ("preventer") medication: These medications reduce the inflammation in the lungs, preventing asthma symptoms over the long term. Controllers usually have steroids in them, and are used every day – even if you don't have any acute symptoms.

Simply treating asthma attacks when they happen is usually not enough to cope well with asthma in the long term. So people with more severe asthma use controller medication on a regular basis, not only when they have symptoms.

The dose of medication and the way in which it is used will mainly depend on how often you have asthma symptoms, and how bad they are. The symptoms range from occasional mild symptoms, for which reliever medication is enough, to severe persistent asthma, where continuous treatment with medication is needed. Possible forms of administration include metered-dose inhalers (liquid sprays), dry powder inhalers, tablets and – for severe attacks – injections.

Depending on the severity of the symptoms, different medications might be combined too. Some medications are prescribed at a fixed dose, while the dose of others can and should be adjusted according to your own needs.

To make sure that the medication reaches the small bronchi too, you have to learn how to breathe it in ("inhale" it) properly. This is sometimes difficult, especially for children. There are a number of devices which aim to make it easier to inhale medication deeply into the lungs.

Reliever ("rescue") medications act fast, quickly making it easier to breathe again. Examples of this kind of medication include short-acting beta2-agonists, which are commonly used. They relax tightened airway muscles and open up the airways.

Rescue medications like this are normally used with a metered-dose inhaler. However, during severe asthma attacks the airways are very narrow and contain a lot of mucus, so it's difficult to breathe in enough of the medication. In such urgent cases, it therefore has to be given in the form of an injection or an intravenous drip.

Having to use a reliever several times per week is a sign that your asthma is poorly controlled. Then long-term controller medications can be taken regularly and continuously to treat the underlying inflammation in the airways.

The following controller medications can be used:

• Corticosteroids (glucocorticoids): Inhaled steroids are the most commonly used controller medications. They can reduce the chronic inflammation, preventing the narrowing of the airways and shortness of breath. If the asthma isn't well controlled despite inhaling steroids, the dose can be increased. It's also possible to combine different medications.
• Beta2-agonists: If steroids aren't enough, a beta2-agonist can be used too. This opens up the airways. But beta2-agonists have to be used together with a steroid drug because they can make the symptoms worse when taken on their own, and may even cause severe asthma attacks. The beta2-agonist and corticosteroid can either be inhaled separately or together. There are inhalers that allow you to inhale both medications at the same time. This is known as a fixed combination.
• Leukotriene antagonists: These medications block the action of chemical messengers that play a role in the inflammatory response in the airways. They aren't as effective as steroids. Combination treatment with a leukotriene antagonist and a steroid drug is less effective at preventing asthma attacks than combination treatment with a beta2-agonist and a steroid drug.

For each type of medication, there are a number of different drugs that can be used. It is currently thought that the different drugs within each group of medications work just as well as each other.

The side effects depend on the type of medication, how large a dose you take and how you take it. You will find detailed information about this in the package insert that comes with the medication.

Inhaling asthma medication usually causes fewer side effects than swallowing it in the form of tablets. In mild asthma, the side effects of some medications sometimes outweigh their potential benefits. If that is the case, it might be better not to take them. In moderate to severe asthma, though, the consequences of the condition are considerably worse than the long-term side effects of the medication.

Many people are worried about long-term side effects of steroids. But long-term steroid treatment usually doesn't have any negative effects if the medication is chosen and used correctly.

There are concerns that long-term use of steroids in children could impair their growth. But this hardly ever happens, and if it does, then it's only temporary. Research has shown that children grow a little more slowly in the first year of treatment, but develop normally after that. This suggests that they grow to the same final adult height as other children with asthma who don't inhale corticosteroids. Still, to be on the safe side, young patients are usually only prescribed the lowest possible doses of steroids and, if possible, only steroids which are inhaled.

Corticosteroids can cause coughing and hoarseness, and increase the risk of fungal infections in the mouth. To prevent these side effects, people are advised to rinse their mouth after inhaling corticosteroids. In older people, corticosteroids can somewhat increase the risk of cataracts. The higher the dose of corticosteroids and the longer they are used for, the greater the risk of cataracts.

Long-acting beta2-agonists (LABAs) should always be taken together with steroids. Research suggests that preventive treatment with LABAs alone could lead to life-threatening asthma attacks.

These medications are usually well tolerated. The possible side effects include gastrointestinal (stomach and bowel) problems and sleep problems.