Treatments and drugs

By Mayo Clinic Staff

Avoiding the workplace irritant that causes your symptoms is critical. However, once you become sensitive to a substance, tiny amounts may trigger asthma symptoms, even if you wear a mask or respirator. You may need medications to control your symptoms and prevent asthma attacks.

Treating asthma involves both preventing symptoms and treating an asthma attack in progress. The right medication for you depends on a number of things, including your age, symptoms, asthma triggers and what seems to work best to keep your asthma under control.

Long-term control medications

In most cases, these medications need to be taken daily. Types of long-term control medications include:

  • Inhaled corticosteroids. These medications include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex), ciclesonide (Alvesco), beclomethasone (Qvar) and others. They are the most commonly prescribed long-term asthma medications. You may need to use these medications for several days to weeks before you achieve maximum benefit.

    Inhaled corticosteroids have a relatively low risk of side effects and are generally safe for long-term use. A fungal infection in your mouth or throat is the most common side effect. You can usually prevent that by rinsing your mouth after inhaling these drugs.

  • Leukotriene modifiers. These oral medications include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo CR). They help prevent asthma symptoms for up to 24 hours. In rare cases, montelukast has been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any unusual reaction.
  • Long-acting beta agonists (LABAs). These inhaled medications include salmeterol (Serevent Diskus) and formoterol (Foradil). LABAs open the airways and reduce inflammation. However, they've been linked to severe asthma attacks. LABAs should only be taken in combination with an inhaled corticosteroid.
  • Combination inhalers. Medications such as fluticasone and salmeterol (Advair Diskus, Advair HFA), budesonide and formoterol (Symbicort), and mometasone and formoterol (Dulera), contain an LABA and a corticosteroid and may increase your risk of a severe asthma attack.
  • Theophylline. This is a daily pill that helps keep the airways open (bronchodilator). Theophylline (Theo-24, Elixophyllin, others) relaxes the muscles around the airways to make breathing easier. It's not used as often now as in past years because more-effective medications are available.

Quick-relief medications

Also called rescue medications, these are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your doctor recommends it. Types of quick-relief medications include:

  • Short-acting beta agonists. These inhaled bronchodilator (brong-koh-DIE-lay-tur) medications can rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA) and pirbuterol (Maxair Autohaler). These medications act within minutes, and effects last several hours.
  • Ipratropium (Atrovent HFA). This bronchodilator is used mainly for emphysema and chronic bronchitis, but it's sometimes used to treat asthma attacks.
  • Oral and intravenous corticosteroids. These medications relieve airway inflammation caused by severe asthma. Examples include prednisone and methylprednisolone (Medrol). When used long term, they can cause serious side effects, such as high blood pressure, weight gain and increased risk of infection, so they're used to treat severe asthma symptoms only on a short-term basis.

Treatment for allergy-induced asthma

If your asthma is triggered or worsened by allergies, you may benefit from allergy treatment as well. Allergy treatments include:

  • Allergy medications. These include oral and nasal spray antihistamines and decongestants as well as corticosteroid, cromolyn (NasalCrom) and ipratropium (Atrovent) nasal sprays.
  • Allergy shots (immunotherapy). Immunotherapy injections are generally given once a week for a few months, then once a month for a period of three to five years. Over time, they gradually reduce your immune reaction to specific allergens.
  • Omalizumab (Xolair). Given by injection, this is for difficult-to-control allergies and asthma.

Don't rely only on quick-relief medications

Long-term asthma control medications — such as inhaled corticosteroids — are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an asthma attack.

If you do have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your long-term control medications are working properly, you shouldn't need to use your quick-relief inhaler very often.

Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more often than your doctor recommends, see your doctor. You probably need to adjust your long-term control medication.

Jun. 12, 2014

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