Asthma Prevention and Control Medications

Reviewed by: HU Medical Review Board | Last reviewed: June 2023

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. Combination inhalers that have an inhaled corticosteroid (ICS) and a long-acting beta-agonist (LABA) are often the first type of drug your doctor will prescribe for long-term control of asthma. 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 for moderate or high-risk asthma but are sometimes prescribed for as-needed use for mild and low-risk asthma.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:

Long-acting beta agonists (LABAs)/Inhaled corticosteroids (ICSs)

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)
  • Breo Ellipta® (fluticasone furoate/vilanterol)
  • Dulera® (mometasone/formoterol fumarate)
  • Symbicort® (budesonide/formoterol fumarate)

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

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

Generic forms of these ICSs 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

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

  • Cinqair® (reslizumab)
  • Dupixent® (dupilumab)
  • Fasenra® (benralizumab)
  • Nucala® (mepolizumab)
  • Tezspire® (tezepelumab-ekko)
  • Xolair® (omalizumab)

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 the 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. Additional steps refer to persistent asthma. This means symptoms occur anywhere from weekly to daily, with varying severity.7,8

The National Asthma Education and Prevention Program and the Global Initiative for Asthma (GINA) recommend 2 tracks of steps that can be followed:2,6,7

  • For mild or low-risk asthma, step 1 consists of an as-needed LABA/ICS medicine.
  • For moderate, severe, or high-risk asthma, step 1 consists of everyday LABA/ICS medicine at increasing doses or frequency. Some doctors may start with an ICS alone.

If your doctor follows different guidelines, the steps your doctor recommends for you may be different.

Other individual factors and personal preferences also may affect the choice of medication. At all steps, also avoid known triggers, get regular exercise, maintain a healthy diet, and manage stress.2,7

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