If you’re living with asthma, you may need treatment from time to time or daily to control your disease. There are several types of asthma treatments available to treat severe symptoms quickly (known as rescue inhalers or quick-relief medications) or to help manage your condition and prevent flares long-term. Your primary doctor, pulmonologist, or allergist will work with you to create a treatment plan that works best for you.
Learn more about...
Why Do I Need Asthma Treatment?
Asthma is often a chronic disease that you’ll need to manage for the rest of your life. Some people only experience asthma flares when they’re exposed to certain triggers, while others may need daily maintenance medications to keep their symptoms at bay. Your doctor may talk about how “controlled” your asthma is — this means how your symptoms interfere with your day-to-day life.1
Some signs that your asthma isn’t well-controlled include:
- Experiencing asthma symptoms (shortness of breath, wheezing, coughing, chest tightness/pain) that interrupt your day or wake you up at night
- Using your quick-relief inhaler more than twice per week
- Refilling your quick-relief inhaler more than twice per year
- Waking up at night at least twice per month with asthma symptoms needing your quick-relief inhaler
If your asthma isn’t well-controlled with your current treatment plan, or if you don’t take any medications for asthma, your doctor can help. For example, if you currently only have a quick-relief inhaler, you’ll likely be prescribed a long-term controller treatment to help reduce inflammation and swelling in your airways to prevent asthma flares and symptoms. Ideally, if you respond well to your controller medication you will rarely need to use your quick-relief medication.
Types of Inhalers for Asthma
The most popular way to treat asthma is by using an inhaler to deliver medication straight to your airways. There are several types of inhalers, each with its own method to ensure your treatments are as effective as possible.2
Examples of inhalers include:
- Metered dose inhaler (MDI) — A pressurized canister placed inside a plastic container with a mouthpiece; when you press on the end of the canister, it dispenses a single dose of medication with a propellant to push it through the mouthpiece. MDIs can contain both rescue or controller medications.
- Dry powder inhaler (DPI) — A capsule with powder inside a disk- or tube-shaped device with a mouthpiece; the powder is released, and you quickly breathe in to pull the medication into your lungs
- Soft mist inhaler (SMI) — Turns a liquid medication into a mist to breathe into your lungs
In some cases, you may also need a nebulizer to deliver asthma medication to your lungs. A nebulizer is a small, portable machine that turns liquid medication into a mist. The mist is sent through a tube and to a mouthpiece or facemask for you to breathe in.3
Types of Asthma Treatments
Depending on your symptoms and needs, you may be prescribed one or more asthma treatments. Though asthma treatments are most commonly delivered using an inhaler or nebulizer, a variety of treatments for the condition may be delivered by inhaler, pill, or injection. Examples of asthma treatment types include bronchodilators, corticosteroids, leukotriene modifiers, and biologics. Each asthma treatment works in a unique way to reduce swelling, relax airway muscles, and target inflammation.
Bronchodilators
Asthma is a lung disease that causes inflammation and swelling that narrows the airways (bronchi). Bronchodilators relax the smooth muscle that lines the airways in the lungs to help open them up.4 The wider your airways are, the more air can flow through them, making it easier to breathe. Bronchodilators also help clear out extra mucus your lungs make when you’re having asthma symptoms.
There are two types of bronchodilators — short-acting and long-acting. Short-acting bronchodilators are often referred to as quick-relief medications because they act quickly to alleviate asthma symptoms, especially during an asthma attack. Their effects last anywhere from three to six hours. On the other hand, long-acting bronchodilators are used every day to keep your airways open and prevent an asthma attack. They’re typically effective for up to 12 hours.
Beta 2-Agonists
Beta 2-agonists are some of the most commonly prescribed asthma treatments.5 Short-acting beta 2-agonists (SABAs) are typically what’s found in your rescue inhaler (usually an MDI) but are also available in liquid form to be used with a nebulizer for patients with more difficult to control symptoms. SABAs are used to stop asthma attacks or before exercising to prevent new asthma symptoms. Examples include:4
- Albuterol (Ventolin®, ProAir®)
- Albuterol and ipratropium bromide (DuoNeb®)
- Levalbuterol (Xopenex®)
SABAs are only meant to be used in emergency situations and aren’t for long-term use. If you find you’re using your rescue inhaler on a regular basis to control your asthma symptoms, talk to your doctor.
Long-acting beta 2-agonists (LABAs) aren’t used as rescue medication — instead, they’re maintenance medications used to control airway swelling and narrowing. LABAs are available as DPIs that are used once or twice daily, along with an inhaled corticosteroid. Examples include:4
- Budesonide and formoterol (Symbicort®)
- Salmeterol (Serevent®)
- Fluticasone and salmeterol (Advair®)
- Fluticasone and vilanterol (Breo®)
Side effects of beta 2-agonists include feeling overly excited, hyperactive, shaky, or nervous. You may notice your heart beating faster than normal as well, or you may have trouble sleeping.
Anticholinergics
Anticholinergics work by blocking the effects of acetylcholine, a chemical messenger that tells your muscles to contract. These long-acting medications help relax the muscles in your airways to control asthma symptoms.4,6
Two inhaled anticholinergics include ipratropium bromide (Atrovent®) and tiotropium bromide (Spiriva Respimat®). Ipratropium bromide is administered with an inhaler or nebulizer, while tiotropium bromide is administered with an inhaler only. Ipratropium can be used up to 4 times per day to treat asthma, while tiotropium is longer acting and is used once daily.
Side effects of anticholinergics include nausea, vomiting, an unusual taste in your mouth, and a dry throat. They may also affect your bladder muscles, making it difficult to urinate.
Corticosteroids
Corticosteroids are synthetic (laboratory-made) hormones that help calm inflammation throughout the body. They’re available as inhaled medications or pills to treat asthma by reducing swelling in the airways.
Inhaled corticosteroids reduce the need for quick-relief medications and lower the risk of asthma attacks. They’re typically used once or twice daily and can be combined with LABAs for better symptom management. Examples of inhaled corticosteroids include:7
- Budesonide (Pulmicort Flexhaler™)
- Fluticasone propionate (Flovent® HFA)
- Fluticasone furoate (Arnuity™ Ellipta®)
Oral corticosteroids are used to treat asthma attacks that don’t respond to quick-relief medications. Examples include prednisone, methylprednisolone, and dexamethasone.8
While they can be used over the long term to reduce the risk of severe attacks and hospitalization, it’s best not to take oral corticosteroids for an extended period of time. Long-term use can lead to unwanted side effects, including weight gain, high blood pressure, eye problems, and brittle bones (osteoporosis).9
Leukotriene Modifiers
Leukotrienes are chemicals your body creates when you’re exposed to an allergen or substance you’re allergic to. They’re responsible for creating asthma symptoms such as airway inflammation and narrowing, wheezing, extra mucus production, and coughing. By blocking leukotrienes, you can better control your asthma.10
Leukotriene modifiers work by stopping your body from making more leukotrienes or blocking their effects. There are currently 3 leukotriene modifiers approved by the U.S. Food and Drug Administration (FDA):
- Montelukast (Singulair®)
- Zileuton (Zyflo®)
- Zafirlukast (Accolate®)
Leukotriene modifiers are long-term maintenance medications that must be taken every day by mouth to be effective — don’t skip a dose or stop taking them, even if your breathing has improved. Possible side effects of leukotriene modifiers include:
- Headache
- Flu or cold symptoms such as runny nose, sore throat, or cough
- Skin rash
- Fatigue
- Fever
- Upset stomach
- Heartburn
- Diarrhea
Be sure to let your doctor know if you have any history of liver problems. Some leukotriene modifiers can harm your liver, so you’ll need additional monitoring while taking them.
Biologics
Biologics are laboratory-made proteins designed to specifically target parts of the immune system responsible for creating inflammation. In recent years, the FDA has approved several biologics for treating severe asthma that can’t be controlled with standard therapies. They work by dampening inflammation at different sources throughout the body to prevent asthma attacks and reduce symptom severity.11
Some biologics for asthma target white blood cells known as eosinophils. These cells normally help protect your body against parasites and other foreign invaders. However, having too many eosinophils in your lungs causes inflammation, making breathing difficult. Eosinophilic asthma can be severe and often gets worse when you come in contact with an allergen such as pollen, pet dander, or dust mites.12 Other biologics target the allergic antibody IgE or pro-inflammatory chemicals made by immune cells or the lining of the airways.
Examples of approved biologics for treating asthma include:13
- Benralizumab (Fasenra®)
- Dupilumab (Dupixent®)
- Mepolizumab (Nucala®)
- Omalizumab (Xolair®)
- Reslizumab (Cinqair®)
- Tezepelumab (Tezpire®)
Protein drugs like biologics must be injected underneath the skin (subcutaneously) or into a vein (intravenously, IV) to be effective. Depending on your medication, you may need an injection every 2 to 8 weeks at home or at a clinic to control your asthma.
Common side effects of biologics for asthma include:
- Increased risk of infection
- Redness, swelling, or pain at the injection site
- Eye inflammation (for dupilumab)
- Fatigue
- Headaches
- Achy muscles or joints
- Sore throat
Immunotherapy
Immunotherapy is a well-established treatment for asthma that involves training your immune system to be less sensitive to allergens. It is more commonly associated with hayfever treatment (“allergy shots”). By exposing you to small doses of allergens over time, your body builds a tolerance to them. As a result, you’ll experience fewer asthma symptoms and lower your risk of an asthma attack.14
There are two types of immunotherapies — sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT). SLIT uses a liquid medication or pill placed under the tongue that’s absorbed into your body. On the other hand, SCIT is an allergy shot injected just underneath your skin.
According to the National Heart, Lung, and Blood Institute (NHLBI), immunotherapies are currently only approved by the FDA for treating allergies. However, they’re recommended for adults and children ages 5 and above who have confirmed allergies and whose asthma symptoms are triggered by a specific allergen.14
Asthma Action Plan
After you receive an asthma diagnosis, it’s important to come up with an asthma action plan to break down what to do in case of an asthma attack or emergency. An asthma action plan is a written document made with your doctor that covers the following:15
- What your allergens are and how to avoid them
- Signs of an asthma attack and what you should do
- Which medications are used daily and in an emergency
- When to call your doctor or seek emergency medical care
- Who to contact if you’re having an asthma attack or emergency
Taking extra steps before you have an emergency can help you be better prepared and know what to do. Be sure to share your asthma action plan with family and friends so they know how to help in an emergency as well.
The Future of Asthma Treatments
Clinical trials continue to investigate new asthma treatments and ways to monitor your disease and symptoms.
