For anyone with asthma, it's important to know the treatment options available and how they work to help you breathe better. Asthma medications are used for either quick relief of symptoms or long-term control, with the goal of reducing or preventing symptoms. Major types of inhaled asthma drugs include anti-inflammatory medications for long-term control and bronchodilators, which are either short- or long-acting. Asthma inhalers deliver these medications directly to the lungs, which reduces the risk of side effects in other parts of the body. Most people with asthma need both quick-relief and long-term medications to control of their symptoms.
Inhalers for Quick Relief and Flareups
Sudden or worsening asthma symptoms typically occur when the lung airways constrict, obstructing airflow. Short-acting beta 2 agonists (SABAs) are bronchodilators that provide rapid relief of asthma symptoms by relaxing the small airways. As the airways expand, airflow improves and symptoms decrease. Guidelines issued in 2007 by the National Institutes of Health (NIH) recommend inhaled SABAs as first-choice treatment during an asthma attack. Examples include albuterol (ProAir, Proventil, Ventolin) and levalbuterol (Xopenex). Inhaled ipratropium (Atrovent) -- an anticholinergic medication -- inhibits large airway constriction. Ipratropium doesn’t work as fast as SABAs, but is sometimes used with a SABA for severe asthma flareups.
Inhalers for Long-Term Control
Airway inflammation is a hallmark characteristic of asthma. Inhaled corticosteroids (ICSs) are anti-inflammatory drugs that reduce airway swelling and prevent excess mucus production for long-term control of asthma. NIH's National Asthma Control Initiative notes that ICSs are the most effective drugs for long-term management of asthma. Examples include:
- beclomethasone (Qvar)
- budesonide (Pulmicort)
- flunisolide (Aerospan)
- fluticasone (Flovent, Veramyst)
- mometasone (Asmanex).
Cromolyn sodium is a mast cell stabilizer, another class of inhaled drugs for long-term asthma control. Cromolyn prevents cells from releasing substances that cause airway inflammation, and is sometimes recommended for people whose asthma is not well controlled with an ICS.
Some asthma inhalers contain a combination of medications to help people with asthma control their symptoms. The 2007 NIH asthma guidelines recommend adding a long-acting beta 2-agonist (LABA) -- such as salmeterol (Serevent) and formoterol (Foradil, Perforomist) -- to an ICS for people whose asthma is not well controlled with an ICS alone. The LABA prevents airway constriction, but using a LABA alone is not recommended. ICS plus LABA inhalers reduce inflammation and keep the airways relaxed for long-term asthma control. Examples of these combination inhalers include:
- fluticasone and salmeterol (Advair)
- budesonide and formoterol (Symbicort)
- mometasone and formoterol (Dulera).
Warnings and Precautions
It's important to take asthma medications as directed by your doctor. Quick-relief inhalers are used during an asthma attack. Long-term controller medications are not effective for relief during an asthma attack. If your symptoms worsen or do not improve with use of your quick-relief inhaler, seek immediate medical attention.
Talk with your doctor about your asthma medications if you are pregnant or breastfeeding, as some may be better than others for you and your baby. Keep in mind, however, that the advantages of treating an active asthma attack outweigh the potential risks of quick-relief and long-term control asthma medications.
Medical adviser: Shilpi Agarwal, M.D.