Medication for people with asthma

Photo of a woman using an inhaler
PantherMedia / Jelena Dragovic

Two types of medication, known as “relievers” and “controllers,” are used in the treatment of . Reliever medication works quickly and is used to treat acute symptoms. Controller medication works slowly over time and is taken regularly to try to prevent attacks.

Most people who have chronic will have repeated episodes of typical symptoms such as shortness of breath, wheezing, coughing and chest tightness. But even during phases when they don't have any symptoms, the disease is still active and needs to be treated. If isn't treated properly, attacks might start occurring more frequently, and people’s physical fitness and quality of life may become worse.

But it's usually possible to keep even severe under control with the help of certain medications and measures, such as getting regular exercise. To be able to do this, though, it's important to understand your own and the related treatments.

What medications can be used for asthma?

Two groups of medications are used in the treatment of :

  • Reliever ("rescue") medication: These medications quickly open up the airways and relieve acute symptoms. They help during an attack, but may also be used to prevent attacks, for instance before doing physical exercise. In mild , this treatment is often enough to keep the disease under control.
  • Controller ("preventer") medication: These medications reduce the inflammation in the lungs, preventing 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 attacks when they happen is usually not enough to cope well with in the long term. So people with more severe 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 symptoms, and how bad they are. The symptoms range from occasional mild symptoms, for which reliever medication is enough, to severe persistent , 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 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.

When is reliever medication used?

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 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 is poorly controlled. Then long-term controller medications can be taken regularly and continuously to treat the underlying in the airways.

What controller medications can be used?

The following controller medications can be used:

  • Corticosteroids (glucocorticoids): Inhaled steroids are the most commonly used controller medications. They can reduce the chronic , preventing the narrowing of the airways and shortness of breath. If the 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 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 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.

What are the possible side effects?

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 medication usually causes fewer side effects than swallowing it in the form of tablets. In mild , 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 , though, the consequences of the condition are considerably worse than the long-term side effects of the medication.

Corticosteroids

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 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.

Beta2-agonists

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 attacks.

Leukotriene receptor antagonists

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

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on November 30, 2017
Next planned update: 2021

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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