Medically Reviewed By William C. Lloyd III, MD, FACS
— Written By Sarah Lewis, PharmD
Updated on August 25, 2021
Asthma is a chronic lung disease that causes inflammation and swelling of the airways of the lungs. People with asthma experience flare-ups, which are sudden attacks of symptoms. These symptoms include shortness of breath, chronic cough, chest tightness, and wheezing. Typically, symptoms occur after exposure to a trigger, such as allergens, cold air, exercise, stress, and tobacco smoke.
If you have asthma, you already know the importance of avoiding your triggers. The second important part of asthma treatment is using medications to manage your disease.
Classes of Asthma Drugs
There are two main types of drugs doctors prescribe to control asthma. It’s important to understand when and why to use each type. The first kind of medication is your long-term control medicine. You might call it your “maintenance” asthma medicine. You use these medicines on a regular basis to control asthma and prevent attacks. The other kind of medicine is your quick-relief, or “rescue” medicine. Should an asthma flare-up occur, you use rescue inhalers to relieve symptoms.
Doctors follow expert guidelines when choosing which medicines to use in treating asthma. Classes of asthma drugs include:
Immunomodulators. These biologic drugs are monoclonal antibodies that regulate the immune system’s response to allergens. They are maintenance medicines. Common side effects include flu-like symptoms and injection site reactions, such as pain, redness and itching.
Inhaled corticosteroids. Corticosteroids are powerful anti-inflammatory drugs. By delivering medicine directly into the lungs, they are very effective as long-term control medicines. This also decreases the risk of side effects.
Leukotriene modifiers. These drugs reduce the action of a chemical involved in swelling and inflammation in the lungs. Your doctor might use this class as a second-line or add-on long-term control medicine. Although rare, liver problems can occur.
Long-acting beta agonists (LABAs). LABAs are bronchodilators—they open the airways to provide long-term control. This class should only be used in combination with inhaled corticosteroids in people with asthma because using them alone increased the risk of life-threatening asthma attacks.
Short-acting beta agonists (SABAs). SABAs are also bronchodilators. However, they are rescue medicines because they act very quickly to relax the airways. Rescue inhaler side effects include dizziness, nervousness, shakiness and headache.
After starting treatment, your doctor will regularly monitor your asthma control. Your doctor will want to know how often you experience symptoms, if you have symptoms at night, and how often you use your rescue medicine. You will also need to regularly take peak flow measurements and record them. Your doctor will use all this information to decide whether your current treatment is working.
Common Asthma Medications
Your doctor has more choices to make within each class of asthma medicine. Finding the right treatment for you may involve some trial and error. Here are 10 drugs commonly prescribed for asthma:
Albuterol (Accuneb, Proair HFA, Proair Respiclick, Proventil HFA, Ventolin HFA) is a SABA. It comes as a nebulizer solution and as inhalers you use for quick relief. It is the most commonly prescribed rescue inhaler for asthma.
Beclomethasone (Beclovent, QVAR) is an inhaled corticosteroid. The usual dose is twice daily for long-term control. To decrease side effects, rinse your mouth and spit after using an inhaled corticosteroid.
Budesonide (Pulmicort, Pulmicort Flexhaler) is also an inhaled corticosteroid. It comes as both a nebulizer solution and an inhaler. You usually take it twice a day.
Budesonide/formoterol (Symbicort) is a combination of an inhaled corticosteroid and a LABA. It comes as an inhaler you use twice daily.
Fluticasone (Flovent HFA) is an inhaled corticosteroid you take twice a day.
Fluticasone/vilanterol (Breo Ellipta) combines an inhaled corticosteroid and a LABA that you use once a day.
Mometasone (Asmanex Twisthaler) is an inhaled corticosteroid. The dosing can be once or twice daily.
Mometasone/formoterol (Dulera) is another combination of an inhaled corticosteroid and a LABA. You use this inhaler twice a day.
Montelukast (Singulair) is a leukotriene modifier. It comes as a tablet, chewable tablet, and dissolvable granules. You take it once a day in the evening for long-term control.
Omalizumab (Xolair) is an immunomodulator. Your doctor injects this medicine subcutaneously—under the skin. Typically, you need an injection every 2 to 4 weeks. It’s important to keep your appointments to maintain long-term control.
There are several other options available for treating asthma. If your current asthma treatment is not controlling your symptoms, talk with your doctor. It may be possible to get better results with a different drug.
Researchers continue to look for new asthma treatments. There are several drugs in clinical trials for treating asthma. Many of them are biologics, similar to Xolair. However, there is also at least one new oral medication that works differently and may compete with biologic drugs. Talk with your doctor to find information about new asthma medications as they come to market.
