Each of the long-term control medications works in a different way. Some reduce inflammation. Others help to open up the airways. Some reduce allergy symptoms. A combination of medications might be used to get your asthma symptoms under control, including:
- Inhaled corticosteroids
- Long-acting beta agonists
- Leukotriene modifiers
- Oral corticosteroids
Short-acting beta agonists are used to treat asthma attacks Asthma symptoms start or worsen when your airways begin to get narrow. Short-acting beta agonists relax the muscles surrounding your airways within minutes.
Most adults and children with persistent asthma take inhaled corticosteroids.2 These medications reduce inflammation, making the airways less sensitive.
There are many different inhaled corticosteroids available (Table 1).3 Most have similar side effects. Common side effects are flu-like symptoms and thrush, a fungal infection in the mouth. It takes about two weeks of treatment before you will notice improvements. All the inhaled corticosteroids are about equally effective.1 None of them treat an asthma attack.
There are differences in inhaler type, schedules, and dosing.1 Inhaled corticosteroids can come in a dry powder inhaler or a metered dose inhaler. Some medications come in both forms. The instructions for using each inhaler are slightly different.
Another difference is how often you have to take your medication. Most of these medications are taken twice a day, in the morning and evening. One product (Arnuity Ellipta) is taken once a day. Some medications come in several strengths.1 This can make it easier for your health care provider to find the right dose for you.
Your health care provider will select the medication and dosage that is best for you, based on how severe your asthma is.
Table 1. Inhaled Corticosteroids
Adapted from: American Academy of Allergy, Asthma, and Immunology. Allergy and Asthma Drug Guide. Accessed 2/13/15 at: http://www.aaaai.org/conditions-and-treatments/drug-guide.aspx
Some people with moderate to severe asthma need more than inhaled corticosteroids.2 In this case, a long-acting beta agonist (abbreviated: LABA) might be used in addition. There are three LABAs used in combination, formoterol and salmeterol and vilanterol. LABAs relax the muscles that surround the airways. This helps the airways to open up. Formoterol works more quickly than salmeterol.1 The airways begin to open about five minutes after taking formoterol and 20 minutes after taking salmeterol. Salmeterol and formoterol are available as products alone but are not meant to be used alone and can only be used in combination.
For safety reasons, LABAs cannot be used alone.4 Currently, there are five inhalers that combine a corticosteroid with a LABA (Table 2).4 These products come in a dry powder inhaler, a metered dose inhaler, or both. They all must be taken twice per day. None are recommended for treating an asthma attack.
Combination inhalers are more convenient than using two separate inhalers.1 The drawback is that it is harder to adjust the inhaled corticosteroid dose without increasing the amount of LABA. If you need a higher dose of corticosteroids, you may have to use a second inhaler.
All LABA medicines have a warning that they cause an increased risk of asthma-related death. Taking too much of either LABA can cause increased heart rate, high blood pressure, chest pain, headache, tremor, or nervousness.
Table 2: Combination inhalers
US Food and Drug Administration. FDA Drug Safety Communication: Drug labels now contain updated recommendations on the appropriate use of long-acting inhaled asthma medications called Long-Acting Beta-Agonists (LABAs). Accessed 2/13/15 at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213836.htm
Rescue inhalers contain a short-acting beta agonist (abbreviated SABA), which opens your airways within minutes (Table 3).2 These medications are taken as needed. Using your rescue inhaler more than two times per week is a sign that your asthma is not well controlled.2 Talk with your healthcare provider about making changes to your long-term control medications.
All patients with asthma should have a rescue inhaler.2 Be sure to refill your prescription when you before you run out of your rescue medication. Keep your inhaler with you so that you can treat an attack early.2
The two available SABAs have similar effectiveness and side effects.1 All the SABAs can cause side effects such as tremor, nervousness, chest pain, palpitations, increased heart rate, dizziness, muscle pain, sore throat, or a runny nose. Currently, all SABA products come in metered dose inhalers.
Table 3: Short-Acting Beta Agonist
National Heart, Lung, and Blood Institute. Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma – Full Report 2007. Accessed 11/12/14 at: http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf
Add-On and alternative medications
Patients with moderate to severe asthma may need a combination of medications (Table 4).2 Some of these medications can also be used in place of inhaled corticosteroids. However, they generally do not work as well as inhaled corticosteroids.
Table 4: Add-on and alternative medications
- Fanta CH. Asthma. N Engl J Med. 2009;360:1002-1014.
- National Heart, Lung, and Blood Institute. Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma - Full Report 2007. Accessed 11/12/14 at: http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf
- American Academy of Allergy, Asthma, and Immunology. Allergy and Asthma Drug Guide. Accessed 2/13/15 at: http://www.aaaai.org/conditions-and-treatments/drug-guide.aspx
- US Food and Drug Administration. FDA Drug Safety Communication: Drug labels now contain updated recommendations on the appropriate use of long-acting inhaled asthma medications called Long-Acting Beta-Agonists (LABAs). Accessed 2/13/15 at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213836.htm