Treatment for Asthma

Medication as treatment for asthma:

The two types of asthma medications used to treat asthma include long-term control medication and short-term, quick-relief medication. Though the goal of both medications is to treat asthma symptoms, they are used for different purposes. Long-term control medication is usually taken every day to control asthma symptoms and to prevent the occurrence of asthma attacks. Quick-relief medication is primarily taken to relieve the sudden onset of asthma symptoms (such as during an asthma attack), and in cases in which the asthma symptoms only occur occasionally.

The type of medication prescribed by your physician to treat your asthma symptoms depends on the type and severity of your asthma, as well as your other individual medical needs.

Long-term asthma control medications:

Long-term asthma control medications may include inhaled anti-inflammatory drugs (medications that reduce or prevent the swelling in the airways) and long-acting bronchodilators (medications that open the airways by relaxing muscles around and in the airways that tighten during asthma). The goal of long-term medications is to reduce and prevent swelling in the airways that can trigger asthma attacks. According to the National Heart, Lung, and Blood Institute (NHLBI), long-term control medications may be recommended for people who:

  • experience asthma symptoms three or more times a week.
  • experience asthma symptoms at night three or more times a month.

When a person first starts taking long-term control medications, it may take a few weeks for the medications to become effective. It is very important that long-term control medication is taken every day, even if the person is feeling well, to continue managing the asthma at an optimal level.

Long-term asthma control medication may include:

  • inhaled corticosteroids - anti-inflammatory medication that prevents swelling of the airways when exposed to asthma triggers. Steroids, which also reduce mucus in the lungs, are sometimes used to prevent and control mild, moderate, and severe asthma.
  • inhaled cromolyn and nedocromil - nonsteroidal, anti-inflammatory medications that are often used to treat children with mild asthma. Both cromolyn and nedocromil cannot stop symptoms during an asthma attack. They only are used to help prevent an asthma attack from occurring.
  • inhaled long-acting beta2-agonists - mainly used to control moderate-to-severe asthma and to prevent nighttime symptoms, these bronchodilator medications relax muscles around the tightened airways so that the airways reopen. These medications do not reduce swelling, so they are often prescribed along with an anti-inflammatory medication, such as an inhaled steroid.
  • sustained-release theophylline or sustained-release beta2-agonist tablets - bronchodilators used to prevent nighttime symptoms. Theophylline needs to build up in the blood stream over time to be effective in treating asthma.
  • leukotriene modifiers - these medications block the action of chemicals called leukotrienes, which occur in white blood cells and may cause inflammation and narrowing of the airways. Leukotriene modifiers cannot stop symptoms during an asthma attack. They only are used to prevent an asthma attack from occurring. Leukotriene modifiers seem to be more effective in people with aspirin-sensitive asthma (a type of asthma triggered by an allergic reaction to aspirin or other nonsteroidal anti-inflammatory medications).
  • anti-IgE (omalizumab)  - approved in 2003 as a new class of therapy for patients with moderate to severe persistent allergic asthma. These medications reduce allergic reactions by causing free IgE to disappear from the body and preventing it from attaching to allergens. 

Examples of long-term asthma control medication:

Category Generic medication examples
inhaled corticosteroids beclomethasone, budesonide, flunisolide, fluticasone, triamcinolone
inhaled cromolyn and nedocromil cromolyn sodium, nedocromil sodium
leukotriene modifiers (tablets) zafirlukast, zileuton
long-acting beta2-agonists salmeterol (inhaled), albuterol (tablets)
theophylline (tablets or liquids) theophylline

Omalizumab (Xolair®) is a newer long-term asthma control medicine that works by binding to one of the antibodies that trigger allergic asthma attacks. It is an injection administered twice monthly to patients age 12 and older. Because of the potential for a severe allergic reaction (anaphylaxis) to this medication, it should be given only at a physician's office experienced with omalizumab.

Long-term asthma control medication may affect individuals differently. Your physician will prescribe the appropriate asthma control medication based on your individual needs.

Quick-relief asthma medication:

Quick-relief asthma medication quickly relaxes the muscles in and around the airways that tighten during an asthma attack. The sooner a person takes quick-relief medication at the onset of asthma symptoms, the faster the asthma will be back under control. Although quick-relief medications may relieve symptoms, the relief may only last about four hours. It is important to note that quick-relief asthma medications do not keep symptoms from recurring. Only long-term asthma control medications can help prevent the recurrence of symptoms. Some people with severe or frequent asthma may use both types of medications to control their asthma (as advised by their physician) - the long-term asthma control medication to keep the inflammation controlled and the quick-relief medication in the event of an asthma attack.

When using more and more of the quick-relief asthma medications to obtain relief, the asthma may become uncontrolled and an adjustment of the long-term asthma control medication may be necessary. Always consult your physician.

Quick-relief medications may include:

  • inhaled short-acting beta2-agonists - short-acting beta2-agonists are bronchodilator medications to help relax muscles in and around the tightened airways so that the airways reopen.
  • inhaled anticholinergics - medications that block a chemical called acetylcholine. Acetylcholine can stimulate muscle contractions, increase mouth and lung secretions, and slow the heartbeat, resulting in an asthma attack.

Examples of quick-relief asthma medication:

Category Generic medication examples
inhaled short-acting beta2-agonists albuterol, bitolterol, pirbuterol, terbutaline
inhaled anticholinergics ipratropium bromide

Your physician may also prescribe short course of oral corticosteroids (in tablet or liquid form) during periods of flare-ups with your asthma. Oral corticosteroids are anti-inflammatory medications that may prevent swelling of the airways and reduce mucus in the lungs. Oral corticosteroids do not give immediate relief, but are often used together with your quick-relief inhaled medications to provide better asthma control.

Short-term, quick-relief asthma medication may affect individuals differently. Your physician will prescribe the appropriate asthma control medication based on your individual needs.

Inhalation devices for asthma:

Several types of inhalation devices are used in the treatment of asthma or other chronic obstructive pulmonary diseases, such as emphysema. Inhalers are often effective in delivering medication directly to the lungs, with fewer side effects than medications taken by mouth or injection. There are several types of inhalation devices. The type of inhalation device will vary, depending on your medical history, preference, and severity and frequency of the symptoms. Inhalers can contain anti-inflammatory medications or bronchodilator medications. The most common types of inhalation devices including the following:

  • metered-dose inhaler (MDI)
    The most common type of inhaler, the metered-dose inhaler, uses a chemical propellant (hydrofluoroalkane or HFA) to emit the medication out of the inhaler.

    A metered-dose inhaler is held in front of or inserted into the mouth as the medication is released in puffs. Consult your physician for specific instructions on how to properly use a metered-dose inhaler.

    As of December 31, 2008, albuterol inhalers containing chlorofluorocarbons are no longer available. This change was made because CFCs affect the earth’s ozone layer, contributing to its depletion.

    According to the US Food and Drug Administration (FDA), HFA inhalers may taste and feel different than a CFC inhaler. However, the medication itself will be the same. The American Academy of Allergy, Asthma, and Immunology lists the following as differences that may be experienced using an HFA inhaler:

    • slight difference in smell and taste
    • a mist that is less forceful and feels warmer
    • inhaler may need to be cleaned and cared for in a different manner
  • nebulizer
    A nebulizer is a type of inhaler that sprays a fine, liquid mist of medication. This is done through a mask, using oxygen or air under pressure, or an ultrasonic machine (often used by persons who cannot use a metered-dose inhaler, such as infants and young children, and persons with severe asthma). A mouth piece is connected to a machine via plastic tubing to deliver medication to the patient. Consult your physician for specific instructions on how to properly use a nebulizer.
  • dry powder or rotary inhaler
    A breath-activated, non-pressurized dry powder inhaler that may be used for children and adults, this type of inhaler does not use chlorofluorocarbon (CFC) to propel the medication out of the device. Consult your physician for specific instructions on how to properly use a dry powder or rotary inhaler.

Talk with your physician for more information before taking any asthma medications.

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