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Medications for Asthma

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The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Talk to your doctor about your treatment goals and preferences and work together to come up with a treatment plan that is right for you.

Prescription Medications

Short-acting rescue medicines

  • Short acting beta-2-agonists (such as albuterol, levalbuterol)
  • Anticholinergics such as ipratropium bromide (Atrovent)
  • Systemic corticosteroids (such as prednisone, prednisolone)

Long-term control medicines

  • Inhaled corticosteroids (such as fluticasone, budesonide)
  • Oral corticosteroids (for severe persistent asthma)
  • Mast cell stabilizers (such as cromolyn sodium, nedocromil)
  • Long-acting Beta-2-antagonists (such as salmeterol, formoterol)
  • Methylxanthines (such as theophylline)
  • Leukotriene modifiers (such as montelukast, zafirlukast)
  • Immunodilators (such as omalizumab)
  • Combination agents (inhaled corticosteroids and long-acting beta-2-agonist)
Short-acting Rescue Medications

Short-acting rescue medicines are used to treat acute asthma symptoms.

Beta-2-agonists (Inhalers):
Asthma Inhaler for a Child
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Copyright © Nucleus Medical Media, Inc.

Children will be more likely to benefit from inhaled medicines if a spacer is used with metered-dose asthma inhalers. The University of Arizona offers a table that compares the different brands of spacers. A study, though, found that there was no difference in how medicine was delivered with homemade versus store-bought spacers. Talk to your doctor to find out what is right for you or your child.

Common names of beta-2-agonists (inhalers) include:

  • Albuterol (Proventil, Ventolin)
  • Levalbuterol (Xopenex MDI)
  • Pirbuterol (Maxair)

These drugs are bronchodilators, meaning they open the airways by relaxing the muscles around bronchial tubes. This can provide quick relief of acute symptoms. They can also be used as preventive medicines prior to exercise. You must be careful not to overuse these drugs and contact your doctor immediately if your symptoms are not controlled.

Common side effects include:

  • Fast heartbeat
  • Headache
  • Nervousness
  • Tremor
Ipratropium Bromide (Atrovent)

Ipratropium is a bronchodilator. This is a type of medicine that opens up narrowed breathing passages and may decrease mucus secretion. Tiotropium, a closely related medicine, has also been studied for use in patients with asthma. These medicines are taken by inhalation to help control the symptoms of lung diseases, particularly chronic bronchitis, and emphysema. Ipratropium and tiotropium help decrease coughing, wheezing, shortness of breath, and troubled breathing by increasing the flow of air into the lungs.

When ipratropium inhalation is used to treat acute, severe attacks of asthma, bronchitis, or emphysema, it is usually used in combination with other bronchodilators. While these drugs are not commonly used to treat asthma except in the emergency room setting, there is some evidence that tiotropium can reduce the need for oral or inhaled corticosteroids in people with very severe and persistent asthma.

Common side effects include:

  • Cough
  • Dryness of mouth
  • Unpleasant taste
Corticosteroids (Oral)

Common names include:

  • Methylprednisolone
  • Prednisone
  • Prednisolone

These drugs are sometimes used for a short duration to prevent the progression of moderate or severe symptoms, reverse inflammation, speed recovery, and reduce the risk of relapse. They are not truly rescue medicines, but help prolong the effect of beta-2 agonist rescue.

Possible side effects include:

  • Indigestion
  • Lowered resistance to infections
  • Abnormalities in glucose metabolism
  • Increased appetite
  • Mood alteration
  • Fluid retention
Long-term Control Medications

Long-term “control” medicines are used to achieve and maintain long-term management of symptoms and reduce inflammation.

Corticosteroids (Inhaler)

Common names include:

  • Beclomethasone (Beclovent, Vanceril, Qvar)
  • Budesonide (Pulmicort)
  • Flunisolide (Aerobid)
  • Fluticasone (Flovent)
  • Mometasone

These drugs suppress, control, and reverse inflammation. They can reduce the need for oral corticosteroids and play a role in the long-term management of asthma.

Possible side effects include:

  • Oral thrush
  • Cough
Corticosteroids (Oral)

Common names include:

  • Methylprednisolone (Medrol)
  • Prednisolone (Pediapred, Orapred)
  • Prednisone (Deltasone, Orasone)

These drugs help reduce inflammation and prevent escalation of symptoms. Oral corticosteroids can produce more side effects than inhaled corticosteroids. Long-term use of oral corticosteroids is not generally recommended. However, your doctor may prescribe oral corticosteroids for long durations only when other treatments have failed to restore normal lung function and the risks of uncontrolled asthma are greater than the side effects of the medicine.

Possible side effects include:

  • Indigestion, nausea, and possibly bleeding in the stomach
  • Lowered resistance to infections
  • Growth suppression (in children)
  • Obesity
  • Diabetes mellitus
  • Hypertension (high blood pressure)
  • Osteoporosis (thinning of the bones)
  • Cataracts
  • Adrenal suppression
  • Muscle weakness
Mast-cell Stabilizer Inhalers

Common names include:

  • Cromolyn sodium (Intal)
  • Nedocromil (Tilade)

These drugs are occasionally used for long-term prevention of symptoms. They may modify inflammation and can be used as preventive treatment prior to exercise.

Possible side effects include:

  • Unpleasant taste
  • Cough
Long-acting Beta-2-agonists

Common names include:

  • Salmeterol (Serevent)

These drugs provide long-term prevention of symptoms, especially nighttime symptoms and are often added to anti-inflammatory therapy such as inhaled corticosteroids. They may also be used as preventive treatment prior to exercise or contact with a known allergen. However, they should not be used during an acute attack.

Possible side effects include:

  • Rapid heart beat
  • Tremor
  • Difficulty sleeping, nervousness

Long-acting inhalers, like salmeterol, may increase the risk of asthma-related death, intubation (putting a tube in the windpipe to breathe), and hospitalization. These medicines are almost always prescribed together with an inhaled corticosteroid. Note: If you have any concerns, talk to your doctor.

Methylxanthines

Common names include:

  • Theophylline (Theo-Dur, Uniphyl, Slo-bid)

This type of drug provides long-term control and prevention of symptoms, especially nighttime symptoms. It works by opening the airways and relaxing the muscles around the bronchial tubes. It also increases the ability to clear mucus out of the airway.

Possible side effects include:

  • Headache
  • Fast heartbeat
  • Difficulty with urination
  • Nervousness
  • Trouble sleeping
  • Upset stomach
Leukotriene Modifiers
  • Zafirlukast (Accolate)
  • Montelukast (Singulair)
  • Zileuton—used for long-term control and prevention in mild persistent asthma. Blocks the production of leukotrienes. Possible side effects include elevation of liver enzymes and interactions with other medicines

Leukotriene inhibitors are medicines that decrease inflammation by preventing the action of leukotrienes. These types of medicines are not used to relieve acute symptoms, but can be used to prevent your symptoms from occurring.

Possible side effects include:

  • Flu-like symptoms
  • Nervousness, excitability
  • Headache
  • Stomach pain
  • Cough
Immunomodulators

Common names include:

  • Omalizumab—used for long-term control and prevention of moderate or persistent allergic asthma. Binds to IgE. This medicine is injected. Pain and bruising at the injection site may occur. Anaphylaxis has been reported.

These drugs provide long-term control and prevention of symptoms in mild, persistent asthma. They work by blocking the action of leukotrienes—chemicals that play a role in inflammation and allergic reactions.

Possible side effects include:

  • Rapid heart beat
  • Tremor
  • Difficulty sleeping, nervousness

Common names include:

  • Fluticasone and salmeterol (Advair)
  • Budesonide and formoterol (Symbicort)

These drugs provide long-term control and prevention of symptoms by combining the effects of a long-acting beta-2-agonist and inhaled steroid into one formulation (which makes dosing more convenient).

The side effects are similar to those described above for the individual medicines.

Special Considerations

Whenever you are taking a prescription medicine, take the following precautions:

  • Take your medicine as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Ask what the results and side effects may be. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medicine and herb or dietary supplements.
  • Plan ahead for refills so you do not run out.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Copyright © EBSCO Publishing
All rights reserved.

References

  • Asthma treatment and management. American Academy of Allergy, Asthma, & Immunology website. Available at: http://www.aaaai.org/conditions-and-treatments/asthma.aspx. Accessed September 13, 2012.

  • Asthma in adults and adolescents. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com. Updated September 7, 2012. Accessed September 13, 2012.

  • Asthma exacerbation in adults and adolescents. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com. Updated August 27, 2012. Accessed September 13, 2012.

  • Cates CJ, Lasserson TJ, Jaeschke R. Regular treatment with formoterol and inhaled steroids for chronic asthma: serious adverse events. Cochrane Database Syst Rev. 2009;(2):CD006924.

  • Mosby's 2007 Medical Drug Reference. Mosby-Year Book; 2007.

  • National asthma education and prevention program expert panel, report 3; Guidelines for the diagnosis and management of asthma 2007. National heart, lung, and blood institute. http://www.nhlbi.nih.gov/guidelines/asthma. Accessed September 13, 2012.

  • Park HW, Yang MS, Park CS, et al. Additive role of tiotropium in severe asthmatics and Arg16Gly in ADRB2 as a potential marker to predict response. Allergy. 2009;64(5):778-783.

  • 1/6/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Levenson M. Long-acting beta-agonists and adverse asthma events meta-analysis. Joint Meeting of the Pulmonary-Allergy Drugs Advisory Committee, Drug Safety and Risk Management Advisory Committee and Pediatric Advisory Committee. December 10-11, 2008.

  • 2/24/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Rodriguez-Martinez C, Sossa M, Lozano J. Commercial versus home-made spacers in delivering bronchodilator therapy for acute therapy in children. Cochrane Database Syst Rev. 2009;(1):CD005536.

  • 5/21/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Wilson SR, Strub P, Buist AS, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med. 2010;181(6):566-577.

  • 10/8/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Ducharme F, Chroinin M, Greenstone I, Lasserson T. Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children. Cochrane Database Syst Rev. 2010;(5):CD005535.

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