Asthma Prevention and Control Medications

Long-term asthma medicines help prevent and control asthma symptoms. They should be taken while also avoiding triggers and maintaining a healthy diet and exercise. This treatment method lowers the risk of asthma attacks and other complications.¹

There are many different drugs taken long-term to treat asthma. Doctors will usually follow a stepwise approach to choose which drug to prescribe. Inhaled corticosteroids (ICSs) are often the first type of drug your doctor will prescribe for long-term control of asthma. Your doctor may also prescribe a long-acting beta agonist (LABA) for you to take with the ICS. If the first prescription does not control your symptoms, your doctor will likely increase your dose or add a different drug.²

Medicines that prevent and control asthma attacks

Asthma control drugs control symptoms on a day-to-day basis. They reduce inflammation and lower the risk of asthma attacks. These drugs are the cornerstone of asthma treatment. They are generally taken every day and for the long term.^1,3

These are different than quick-relief medicines. Quick-relief drugs relieve symptoms during an asthma attack. An example is short-acting beta agonists (SABAs). These are taken only as-needed.^3,4

The main long-term prevention and control drugs include:

Inhaled corticosteroids (ICSs)

Corticosteroids (also called steroids) are usually the first drug used to control asthma. They reduce airway inflammation and sensitivity. Some examples of ICSs are:^1,3

• Alvesco® (ciclesonide)
• Pulmicort Flexhaler® (budesonide)
• Arnuity Ellipta® (fluticasone furoate)
• Asmanex HFA® (mometasone furoate)
• Flovent HFA® (fluticasone propionate)

Generic forms of these ICSs are also available.

Long-acting beta agonists (LABAs)

LABAs relax the muscles around the airways. They are used together with ICSs. Some examples of inhalers that combine ICSs and LABAs are:^1,3

• Advair HFA® (fluticasone propionate/salmeterol)
• Airduo Digihaler® (fluticasone propionate/salmeterol)
• Dulera® (mometasone/formoterol fumarate)
• Symbicort® (budesonide/formoterol fumarate)
• Breo Ellipta® (fluticasone furoate/vilanterol)

Generic forms of many of these ICS-LABAs are also available.

Long-acting muscarinic antagonists (LAMAs)

LAMAs block a protein on nerve cells (neurons) called muscarinic receptors. This reduces airway narrowing and mucus secretion. One example of a LAMA is Spiriva® (tiotropium).^1,3

Leukotriene receptor agonists (LTRAs)

LTRAs are also called leukotriene modifiers. They block the action of leukotrienes. Leukotrienes are chemicals your body releases after you are exposed to an allergen. Some examples of LTRAs are:^1,3

• Singulair® (montelukast)
• Accolate® (zafirlukast)
• Zyflo® (zileuton)

Generic forms of many of these LTRAs are also available.

Theophylline

Theophylline reduces the activity of chemicals in your body that promote inflammation. It also relaxes the muscles around your airways. It is available as a generic and as some brand names, including Theo-24®. However, it is rarely prescribed anymore.^1,3

Oral corticosteroids

Oral corticosteroids reduce inflammation. They are usually only used for a short time. Examples of oral corticosteroids include prednisone and methylprednisolone. These are available in generic and brand-name forms.^1,3

Biologics

Biologics are drugs made from components of living cells. They are designed to target or block a specific molecule or cell in your body. Examples of biologics used to treat asthma include:^1,3

• Xolair® (omalizumab)
• Nucala® (mepolizumab)
• Cinqair® (reslizumab)
• Fasenra® (benralizumab)
• Dupixent® (dupilumab)

Allergy shots (immunotherapy)

Immunotherapy is useful when there is a clear link between allergies and asthma symptoms. In this treatment, you receive shots that contain a small amount of the allergen that causes you symptoms. Immunotherapy reduces immune reactions to specific allergens.^3,5

You start with shots once a week for a few months. Then, you receive shots once a month for 3 to 5 years. The dose of allergen in the shot slowly increases over time.^3,5

Stepwise approach to treating asthma

Experts recommend a stepwise approach to treating asthma. This means increasing or decreasing the drugs you take for asthma depending on your symptoms. If a drug does not control your symptoms in 2 to 6 weeks, doctors may increase your treatment up a step. If your symptoms are controlled for at least 3 months, you may go down a step. This helps you control symptoms with the least medicine necessary.^2,6

The exact steps depend on your age and severity of your symptoms. Step 1 is for intermittent asthma. This means symptoms occur less than twice a month, or symptoms are happening for the first time. Steps 2 to 6 refer to persistent asthma. This means symptoms occur anywhere from weekly to daily, with varying severity.^7,8

The tables below show the preferred treatment approach recommended by the National Asthma Education and Prevention Program and the Global Initiative for Asthma (GINA). If your doctor follows different guidelines, the steps your doctor recommends for you may be different.^2,6,7

Note that GINA now recommends SABAs not be used alone. GINA suggests low-dose ICS-formoterol for as-needed quick relief, or low-dose ICS whenever you take SABAs.^2,7

Other individual factors and personal preference also may affect the choice of medication. For example, LTRAs and theophylline are sometimes used as alternatives.^2,7

At all steps, also avoid known triggers, get regular exercise, maintain a healthy diet and manage stress.⁷

Age 0-4 years old

• Step 1:
  • SABA (as needed)
• Step 2:
  • Low-dose ICS (daily)
  • SABA (as needed)
  • Consult a specialist before Step 3
• Step 3:
  • Low-dose ICS-LABA (daily)
  • SABA (as needed)
• Step 4:
  • Medium-dose ICS-LABA (daily)
  • SABA (as needed)
• Step 5:
  • High-dose ICS-LABA (daily)
  • SABA (as needed)
• Step 6:
  • High-dose ICS-LABA (daily)
  • Oral corticosteroid (daily)
  • SABA (as needed)

Age 5-11 years old

• Step 1:
  • SABA (as needed)
• Step 2:
  • Low-dose ICS (daily)
  • SABA (as needed)
  • Recommend immunotherapy
• Step 3:
  • Low-dose ICS-LABA (daily and as needed)
  • Recommend immunotherapy
  • Consult a specialist before Step 4
• Step 4:
  • Medium-dose ICS-LABA (daily and as needed)
  • Recommend immunotherapy
• Step 5:
  • High-dose ICS-LABA (daily)
  • SABA (as needed)
  • Consider Omalizumab
• Step 6:
  • High-dose ICS-LABA (daily)
  • Oral corticosteroid (daily)
  • SABA (as needed)
  • Consider Omalizumab

Age 12+ years old

• Step 1:
  • SABA (as needed)
• Step 2:
  • Low-dose ICS (daily)
  • SABA (as needed)
  • Recommend immunotherapy
• Step 3:
  • Low-dose ICS-LABA (daily and as needed)
  • Recommend immunotherapy
  • Consult a specialist before Step 4
• Step 4:
  • Medium-dose ICS-LABA (daily and as needed)
  • Recommend immunotherapy
• Step 5:
  • Medium-dose ICS-LABA (daily)
  • SABA (as needed)
  • Consider biologics
• Step 6:
  • High-dose ICS-LABA (daily)
  • Oral corticosteroid (daily)
  • SABA (as needed)
  • Consider biologics