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Asthma Prevention and Control Medications

Editorial Team

By Editorial Team

6 min read

Reviewed by: HU Medical Review Board | Last Reviewed: October 2021. | Last updated: February 2023

The main treatment for asthma is using asthma control medicine on a regular basis. Asthma control drugs reduce inflammation in the airways. When the airways are less inflamed, they become less sensitive, or hyperresponsive. This reduces your risk of having an asthma attack. You may need 1 or more drugs to get your asthma under control.1

Control drugs do not work fast enough to treat an asthma attack. If you are having an asthma attack, you will need to use a rescue inhaler to quickly open up your airways.

Stepwise approach to treating asthma

The National Asthma Education and Prevention Program recommends a stepped approach to asthma treatment based on age and asthma severity. Where you begin on the steps depends on how intense your asthma is at first. If your doctor follows other guidelines, your treatment may be different.

If 1 drug is not enough to control your asthma in 2 to 6 weeks, your treatment goes up 1 step. This may mean increasing the dose or adding another drug. If your asthma is well controlled for at least 3 months, you may go down 1 step. Going down a step means your doctor will try a lower dose or cutting out a drug to see if your asthma stays under control.1

In general, the types of asthma control medicines prescribed for the 6 steps of asthma severity include:1

  • Inhaled steroids
  • Short-acting beta agonists (SABAs)
  • Long-acting beta agonists (LABAs)
  • Long-acting muscarinic antagonists (LAMAs)
  • Leukotriene receptor antagonists (LTRAs)
  • Theophylline
  • Asthma biologics
  • Immunotherapy

The recommendations for when these drugs are prescribed change based on a person’s age and asthma severity.

Table 1. Stepwise approach to asthma management for children ages 0 to 4 years.6

Step 1
  • Short course of ICS (daily) and SABA (as needed)
Step 2
  • Low-dose ICS (daily) and SABA (as needed)
  • Alternative: LTRA (daily) and SABA (as needed)
Consult an asthma specialist before Step 3
Step 3
  • Low-dose ICS-LABA (daily) and SABA (as needed)
  • Alternative: low-dose ICS and LTRA (daily) and SABA (as needed)
  • Alternative: medium-dose ICS (daily)
Step 4
  • Medium-dose ICS-LABA (daily) and SABA (as needed)
  • Alternative: medium-dose ICS and LTRA (daily) and SABA (as needed)
Step 5
  • High-dose ICS-LABA (daily) and SABA (as needed)
  • Alternative: high-dose ICS and LTRA (daily) and SABA (as needed)
Step 6
  • High-dose ICS-LABA and oral corticosteroid (daily) and SABA (as needed)
  • Alternative: High-dose ICS and LTRA and oral corticosteroid (daily) and SABA (as needed)

ICS=inhaled corticosteroids, LABA=long-acting beta agonists, LAMA=Long-acting muscarinic antagonists, LTRA=Leukotriene receptor antagonists, SABA=short-acting beta agonists

Additional Figure 1 notes

  • Every step: Reduce exposure to triggers, exercise, eat healthy, and manage stress
  • Steps 2, 3, and 4: Consider immunotherapy for allergies
  • Steps 5 and 6: Consider adding asthma biologics

Table 2. Stepwise approach to asthma management for children ages 5 to 11 years.2,6

Step 1
  • SABA with low-dose ICS (as needed)
  • Alternative: low-dose ICS (daily) and SABA (as needed)
Step 2
  • Low-dose ICS (daily) and SABA (as needed)
  • Alternative: LTRA (daily) and SABA (as needed)
  • Consider: Add allergy shots
Step 3
  • Low-dose ICS-formoterol (daily and as needed)
  • Alternative: medium-dose ICS (daily) and SABA (as needed)
  • Alternative: low-dose ICS-LABA (daily) and SABA (as needed)
  • Alternative: low-dose ICS and LTRA/LAMA (daily) and SABA (as needed)
  • Consider: Add allergy shots
Consult an asthma specialist before Step 4
Step 4
  • Low-/medium-dose ICS-formoterol (daily and as needed)
  • Alternative: medium-dose ICS-LABA (daily) and SABA (as needed)
  • Alternative: medium-dose ICS and LTRA/LAMA (daily) and SABA (as needed)
  • Consider: Add allergy shots
Step 5
  • High-dose ICS-LABA (daily) and SABA (as needed)
  • Alternative: high-dose ICS and LTRA/LAMA (daily) and SABA (as needed)
  • Consider: Add omalizumab or dupilumab
  • Consider: Add other biologics or oral corticosteroids

ICS=inhaled corticosteroids, LABA=long-acting beta agonists, LTRA=Leukotriene receptor antagonists, SABA=short-acting beta agonists

Additional Figure 2 notes

  • Every step: Reduce exposure to triggers, exercise, eat healthy, and manage stress
  • Steps 2, 3, and 4: Consider immunotherapy for allergies
  • Steps 5 and 6: Consider adding asthma biologics

Table 3. Stepwise approach to asthma management for anyone 12 years or older.2,6

Step 1
  • Low-dose ICS-formoterol (as needed)
  • Alternative: SABA with ICS (as needed)
Step 2
  • Low-dose ICS-formoterol (as needed)
  • Alternative: SABA with ICS (as needed)
  • Alternative: low-dose ICS (daily) and SABA (as needed)
  • Alternative: LTRA (daily) and SABA (as needed)
  • Consider: Add allergy shots
Step 3
  • Low-dose ICS-formoterol (daily and as needed)
  • Alternative: low-dose ICS-LABA (daily) and SABA (as needed)
  • Alternative: medium-dose ICS (daily) and SABA (as needed)
  • Alternative: low-dose ICS and LTRA/LAMA (daily) and SABA (as needed)
  • Consider: Add allergy shots
Consult an asthma specialist before Step 4
Step 4
  • Medium-dose ICS-formoterol (daily and as needed)
  • Alternative: medium-/high-dose ICS-LABA (daily) and SABA (as needed)
  • Alternative: medium-dose ICS and LTRA/LAMA (daily) and SABA (as needed)
  • Consider: Add allergy shots
Step 5
  • Medium-dose ICS-formoterol (daily and as needed) and LAMA (daily)
  • Alternative: medium-/high-dose ICS-LABA and LAMA (daily) and SABA (as needed)
  • Consider: Add biologics, azithromycin, or low-dose oral corticosteroids

ICS=inhaled corticosteroids, LABA=long-acting beta agonists, SABA=short-acting beta agonists

Additional Figure 3 notes

  • Every step: Reduce exposure to triggers, exercise, eat healthy, and manage stress
  • Steps 2, 3, and 4: Consider immunotherapy for allergies
  • Steps 5 and 6: Consider adding asthma biologics

Inhaled steroids

Inhaled steroids (inhalers) are the backbone of asthma treatment for most adults and children with long-term asthma. Inhaled steroids make the airways less inflamed and less sensitive. This leads to less severe asthma symptoms and better lung function. You are less likely to have an asthma attack or need to visit the emergency room if you take inhaled corticosteroids.1,2

There are many types of inhaled steroids available, such as:1

Different inhaled steroids may be given at different stages of asthma severity.1

Long-acting beta agonists

Long-acting beta agonists (LABAs) relax the muscles that surround the airways. LABAs are used together with inhaled corticosteroids to treat people with moderate to severe asthma. LABAs reduce asthma symptoms, asthma attacks, and rescue medication use.1

LABAs are packaged alone or in combination inhalers with a corticosteroid. Combination inhalers include an inhaled steroid and a LABA in 1 device. Some common brands include:2

  • Advair (fluticasone propionate/salmeterol)
  • Dulera (mometasone/formoterol fumarate)
  • Symbicort (budesonide/formoterol fumarate)
  • Breo (fluticasone furoate/vilanterol)

Your doctor may ask you to stop taking a LABA for a period of time to see if your asthma stays controlled without it.1

Leukotriene modifiers

Leukotriene receptor antagonists (LTRAs) block leukotrienes. Leukotrienes are chemicals the body releases after being exposed to an allergy trigger. LTRAs may also be called leukotriene modifiers. These are pills taken by mouth.1,2

LTRAs can be used instead of inhaled steroids for people with mild to moderate asthma (Step 2). Leukotriene modifiers can also be used in addition to inhaled corticosteroids for moderate asthma (Steps 3 and 4). This group of drugs does not work as well as inhaled steroids to control and prevent asthma but can be useful to some people.1

There are many brands of LTRAs. Some include:2

Oral steroids

Oral corticosteroids reduce inflammation. These drugs may be used short-term at the start of an asthma attack or after an attack. Common names of oral steroids include methylprednisolone, prednisolone, and prednisone.1

Biologics

Biologics are drugs that target a specific molecule, cell, or antibody that is causing a person’s asthma. Biologics are given by an injection under the skin or as an infusion into a vein.3

Biologics are used for moderate to severe asthma that is not well controlled by other drugs. This includes people who are regularly admitted to the hospital, use a rescue inhaler several times a day or week, or who are taking oral steroids.3

There are several biologics for asthma, including:3

Allergy shots and under-the-tongue allergy treatments (Immunotherapy)

Immunotherapy for asthma includes allergy shots and under-the-tongue allergy treatments. You start by taking a very small dose of an allergen. The dose increases over time. A course of allergy shots can take 3 to 5 years. During that time, your body builds up a tolerance to the allergen, making you less likely to react.

Immunotherapy is most useful when there is a clear link between an allergen and symptoms. It seems to work best to treat grass, cat, dust mite, and ragweed allergies, and less well for cockroach and mold allergies.1,4,5

Allergy shots are given in a doctor’s office. Under-the-tongue allergy treatment is taken in a doctor’s office the first time and at home after that.4,5

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