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Asthma is a chronic lung condition. Asthma cannot be cured, but it can be managed. There are two primary categories of asthma treatment — rescue medications and maintenance medications. Lifestyle habits can also help control asthma symptoms and allow you to potentially avoid severe episodes.
If you or your child has asthma, it’s important to develop an asthma action plan with your doctor or your child’s pediatrician. An asthma action plan outlines your treatment protocol when asthma is in the well-controlled green zone, worsening yellow zone, and emergency red zone. There are many templates for creating an action plan for asthma management. Action plans can be printed out or shared electronically with your child’s school and caregivers.
Asthma medications can be inhaled using an inhaler or nebulizer, taken by mouth, and occasionally taken as an injection. Most common asthma medications are inhaled.
An inhaler is a handheld device. A metered dose inhaler (MDI) is the most commonly used inhaler. It releases a premeasured spray of asthma medicine when the inhaler is squeezed. Some people use a spacer with an MDI to make it easier to use. Dry powder inhalers deliver medicine as a powder rather than a spray, which is released when you take a deep forceful breath in.
Nebulizers are bulkier than inhalers and may need to be plugged in or require batteries. A nebulizer includes a mask or mouthpiece that allows the user to inhale liquid medication that has been turned into a mist. Using a nebulizer can take five to 10 minutes, or longer, while an inhaler is usually much quicker to use.
Both maintenance and rescue medications can be taken via nebulizer or inhaler.
Maintenance medications, also called long-term control medications or controller medications, are usually taken daily to keep asthma symptoms under control and prevent asthma attacks. There are several types of maintenance treatments, including inhaled and oral medications.
Inhaled steroids, also called inhaled corticosteroids, are among the most effective long-term asthma control medications. They are taken by inhaler daily. Corticosteroids are powerful medications that suppress immune activity and relieve inflammation in the airways. Inhaled steroids are a favored treatment for asthma because they have been shown to improve lung function and reduce the risk of emergency department visits.
Common inhaled steroid asthma medicines include:
Inhaled steroids have fewer side effects than oral steroids. A cough, hoarse voice, or sore throat are common side effects. Thrush (oral yeast infection) is one of the more troublesome side effects. Rinsing out your mouth with water after taking an inhaled steroid can reduce the likelihood of developing thrush. Using a spacer with an inhaled steroid can also reduce the chances of developing thrush.
There is mixed evidence that using steroids to treat childhood asthma may have a slight impact on growth. Your child’s doctor will work to find the lowest effective dose to control your child’s asthma and to minimize side effects.
Combination medications combine an inhaled steroid with a long-acting beta-agonist (LABA). The inhaled steroid prevents or relieves swelling in the airways, while the LABA helps to open up breathing by relaxing smooth muscle surrounding the airways.
Examples of combination treatments include:
Anticholinergic treatments can be used for asthma maintenance and as rescue treatments. They are often used for chronic obstructive pulmonary disease (COPD) and as add-on therapy for moderate to severe asthma. Anticholinergics maintain the opening of the airways and reduce mucus production. Maintenance anticholinergics are often used in conjunction with another maintenance therapy. Spiriva (tiotropium bromide) is an inhaled anticholinergic maintenance treatment approved for asthma. It is taken with an inhaler. Possible side effects include dry mouth, constipation, and stomach pain.
Anticholinergic medications are also available as combination inhalers with inhaled steroids and LABAs. Trelegy (fluticasone/umeclidinium/vilanterol) is approved for use as an asthma maintenance medication.
Leukotriene modifiers are taken by mouth either as a pill or as a liquid. Some leukotriene modifiers work by reducing swelling inside the airways and others work by relaxing the smooth muscles around the airways. They can be used on their own for mild asthma or combined with inhaled steroids in cases of more severe asthma. Adding leukotriene modifiers to inhaled steroids allows for lower steroid doses. Headache and abdominal pain are possible side effects.
Commonly prescribed leukotriene modifiers include Accolate (zafirlukast), Singulair (montelukast), and Zyflo (zileuton). In March 2020, the U.S. Food and Drug Administration (FDA) began requiring a boxed warning for Singulair due to the potential for serious mental health side effects.
Biologic immunomodulators, or biologics, work by disrupting the inflammation that leads to asthma symptoms like wheezing and difficulty breathing. Biologics are generally only prescribed in cases of severe asthma. You might be a candidate for a biologic medication if your asthma is not well controlled with daily asthma control medicines, like inhaled steroids. Biologics may reduce the incidence of asthma attacks and hospital visits.
Biologics are administered via infusion or injection. You may have to receive the treatment at a doctor’s office. Headache, sore throat, fatigue, and allergic reaction are possible side effects.
Below are examples of biologics for asthma. Some biologics are approved for use in children while some are only approved for adults.
The following medications and procedures are other possible maintenance treatments for asthma.
Theophylline can be used to prevent shortness of breath, wheezing, and chest tightness. It has been used as a treatment for asthma since the 1930s. Theophylline is taken as a pill or swallowed as a liquid. It requires regular monitoring of blood levels and can interact with many other medications. It is not usually used as a first-line therapy for asthma.
Bronchial thermoplasty is an outpatient procedure for treating severe, persistent asthma. A bronchial thermoplasty is performed using a bronchoscope that is inserted into a person’s nose or mouth and then into the lungs. It works by using thermal energy to reduce the smooth muscle in the airways that can constrict breathing. The procedure is done under moderate sedation.
Rescue medications, also called quick-relief medicines, are used to quickly relieve the symptoms of asthma attacks. They are generally used on an as-needed basis to treat acute asthma symptoms. They are not intended to be used on a regular basis, but they are a key part of your asthma treatment plan. If you need rescue medications regularly, it may indicate that your asthma is not well controlled.
Short-acting beta-agonists (SABAs) relieve shortness of breath by relaxing the smooth muscles around the airways. This opens the airways and makes breathing easier. Possible side effects of short-acting beta-agonists include fast heart rate and jitteriness.
Albuterol, sold under the brand names Proventil HFA, ProAir, and Ventolin HFA, among others, is one of the most commonly used SABAs. Albuterol can be taken via nebulizer or inhaler. Xopenex (levalbuterol) is another SABA with less side effects than albuterol. It is used in people who cannot tolerate albuterol. Albuterol is sometimes referred to as salbutamol.
Rescue anticholinergics make it easier to breathe by relaxing the airways and preventing them from narrowing. They may also help prevent a bronchospasm (muscle tightening that narrows the airway) and reduce mucus production. Atrovent (ipratropium) is an anticholinergic medication for asthma. Possible side effects include dry mouth, nausea, or dizziness.
Anticholinergics may be used in combination with albuterol to treat severe asthma exacerbations. On their own, they may not be as effective as SABAs, but they may be a better option for those who do not tolerate SABAs well.
Oral steroids can be administered in the case of severe asthma attacks. They are often taken as pills or syrups. Oral steroids effectively reduce airway swelling and mucus. Prednisone and methylprednisolone are examples of steroids used to treat asthma.
A short course of medication, sometimes called a “burst,” of two days to a week may be prescribed. Occasionally, a longer course of steroids is required. Short-term treatment with steroids can cause fluid retention, mood changes, and increased appetite.
Lifestyle changes and household habits can help you manage asthma by allowing you to avoid common triggers. Lifestyle habits are not a replacement for long-acting asthma medications.
Household allergens, like dust mites and pet dander, can trigger asthma. Dusting often, cleaning bed linens in hot water weekly, and minimizing stuffed animals for children can help reduce dust mites. Keeping pets out of bedrooms and off couches or upholstered furniture can help minimize reactions to pet dander.
Cigarettes and other types of smoke can trigger asthma symptoms. Doing your best to avoid exposure to secondhand smoke can help reduce the likelihood of an asthma attack.
About 1 in 5 adults with asthma in the United States smoke. There are resources to support people looking to quit smoking. Talk to your doctor about ways to help stop smoking.
Stress can trigger asthma symptoms. Finding ways to manage stress, such as meditation, exercise, or therapy, can help control asthma symptoms.
Avoiding foods that cause allergic reactions is important for managing asthma. Some people with asthma find that sulfites can trigger symptoms. Sulfites are preservatives often found in wine, pickles, and shrimp.
While exercise may trigger asthma symptoms, it is possible — and recommended — for people with asthma to engage in physical activity safely. Warming up and cooling down before and after exercise is one way to help minimize symptoms. Your doctor may also recommend taking an asthma medication before exercising.
Some people with asthma report relief from certain symptoms when they use complementary or alternative treatments, such as acupuncture, massage, or herbal supplements. It is important to notify your doctor of any natural treatments you use, since some can interact with medications in dangerous ways or make them less effective. Complementary therapies should not replace prescribed medications, which have been proven effective in clinical studies.
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Deborah Pedersen, M.D.
has specialized in allergy and asthma care as well as pediatrics for over 16 years. Review provided by VeriMed Healthcare Network.
Learn more about her here.
Alison Channon
has nearly a decade of experience writing about chronic health conditions, mental health, and women's health.
Learn more about her here.
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