The types and doses of asthma medications you need depend on your age, your symptoms, the severity of your asthma and medication side effects.

Because your asthma can change over time, work closely with your health care provider to track your symptoms and adjust your asthma medications, if needed.

Category	Purpose	Types
Long-term asthma control medications	Taken regularly to control chronic symptoms and prevent asthma attacks — the most important type of treatment for most people with asthma	Inhaled corticosteroids Leukotriene modifiers Long-acting beta agonists (LABAs) Long-acting muscarinic antagonists (LAMAs) Combination inhalers Theophylline
Quick-relief medications (rescue medications)	Taken as needed for rapid, short-term relief of symptoms — used to prevent or treat an asthma attack	Short-acting beta agonists such as albuterol Ipratropium (Atrovent HFA) Oral corticosteroids (for severe asthma attacks)
Medications for allergy-induced asthma	Taken regularly or as needed to reduce your body's sensitivity to a particular allergy-causing substance (allergen)	Allergy shots (immunotherapy) Under-the-tongue (sublingual) immunotherapy tablets Allergy medications
Biologics	Taken with control medications to stop underlying biological responses that cause inflammation in the lungs — used to better manage severe asthma symptoms	Benralizumab (Fasenra) Dupilumab (Dupixent) Mepolizumab (Nucala) Omalizumab (Xolair) Reslizumab (Cinqair) Tezepelumab-ekko (Tezspire)

Many people with asthma need to take long-term control medications daily, even when they don't have symptoms. There are several types of long-term control medications, including the following.

Inhaled corticosteroids

These anti-inflammatory drugs are the most effective and commonly used long-term control medications for asthma. They reduce swelling and tightening in your airways. You may need to use these medications for several months before you get their maximum benefit.

Inhaled corticosteroids include:

• Fluticasone (Flovent HFA, Arnuity Ellipta, others)
• Budesonide (Pulmicort Flexhaler)
• Mometasone (Asmanex Twisthaler)
• Beclomethasone (Qvar RediHaler)
• Ciclesonide (Alvesco)

Regular use of inhaled corticosteroids helps keep asthma attacks and other problems linked to poorly controlled asthma in check. In children, long-term use of inhaled corticosteroids can delay growth slightly, but the benefits of using these medications to maintain good asthma control generally outweigh the risks.

Inhaled corticosteroids don't generally cause serious side effects. When side effects occur, they can include mouth and throat irritation and oral yeast infections. If you're using a metered dose inhaler, use a spacer and rinse your mouth with water after each use to reduce the amount of drug remaining in your mouth.

Leukotriene modifiers

These medications block the effects of leukotrienes, immune system chemicals that cause asthma symptoms. Leukotriene modifiers can help prevent symptoms for up to 24 hours. Examples include:

• Montelukast (Singulair)
• Zafirlukast (Accolate)
• Zileuton (Zyflo)

In rare cases, montelukast is linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. See your health care provider right away if you have any unusual reaction.

Long-acting beta agonists (LABAs)

These bronchodilator (brong-koh-DIE-lay-tur) medications open airways and reduce swelling for at least 12 hours. They're used on a regular schedule to control moderate to severe asthma and to prevent nighttime symptoms. Although they're effective, they've been linked to severe asthma attacks. For this reason, LABAs are taken only in combination with an inhaled corticosteroid.

The most commonly used LABAs for asthma are:

• Salmeterol (Serevent)
• Formoterol

Long-acting muscarinic antagonists (LAMAs)

These medications are also bronchodilators. If an LABA cannot be used, a LAMA along with an inhaled corticosteroid can be an option. A LAMA can also be added to a LABA and inhaled corticosteroid if better control of your asthma is needed.

The LAMA tiotropium (Spiriva Respimat) may be added to the treatment plan for severe asthma.

Combination inhalers:

Corticosteroids and long-acting beta agonists

Some inhaled asthma medication combinations contain both a corticosteroid and a bronchodilator:

• Fluticasone and salmeterol (Advair Diskus, AirDuo Digihaler, others)
• Budesonide and formoterol (Symbicort)
• Mometasone and formoterol (Dulera)
• Fluticasone and vilanterol (Breo Ellipta)

These asthma medications — sometimes called short-acting beta agonists (SABA) — open the lungs by relaxing airway muscles. Often called rescue medications, they can ease worsening symptoms or stop an asthma attack in progress. They begin working within minutes and are effective for 4 to 6 hours. They're not for daily use.

Some people use a quick-relief inhaler before exercise to help prevent shortness of breath and other asthma symptoms. Possible side effects include jitteriness and a rapid heartbeat (palpitations).

Quick-relief medications include:

• Albuterol (ProAir HFA, Ventolin HFA, others)
• Levalbuterol (Xopenex HFA)

If your symptoms are minor and infrequent or if you have exercise-induced asthma, you might manage your symptoms with one of these medications alone. However, most people with persistent asthma also need an inhaled corticosteroid or other long-term control medication.

If you need to use your inhaler more often than your health care provider recommends, your asthma is not under control — and you may be increasing your risk of a serious asthma attack. Talk with your provider about adjusting your therapy.

Ipratropium

Ipratropium (Atrovent HFA) is a short-acting bronchodilator that's usually prescribed for emphysema or chronic bronchitis but is sometimes used to treat asthma attacks. It may be used either with or instead of a SABA.

A combination of ipratropium and albuterol (Combivent) may sometimes be used to treat asthma.

Theophylline

You take this bronchodilator daily in pill form to treat mild asthma. Theophylline (Theo-24) relaxes the airways and decreases the lungs' response to irritants. Although theophylline isn't used much anymore, it can be helpful for nighttime asthma symptoms. You might need regular blood tests to make sure you're getting the correct dose.

Oral corticosteroids for serious asthma attacks

These medications may be taken — usually for a limited time — to treat severe asthma attacks. Examples include:

• Prednisone
• Methylprednisolone

Oral corticosteroids can cause bothersome short-term side effects and more-serious side effects if they're taken for a long period. Long-term side effects can include cataracts, thinning bones (osteoporosis), muscle weakness, decreased resistance to infection, high blood pressure and reduced growth in children.

Medications that focus on treating allergy triggers (allergens) that can cause asthma include:

• Allergy shots. Allergy shots (immunotherapy) may be an option if you have allergic asthma that can't be controlled by avoiding triggers. You begin with skin tests to determine which allergens trigger your asthma symptoms. Then you'll get a series of injections containing small doses of those allergens.

  You generally receive injections once a week for a few months, and then once a month for 3 to 5 years. In some cases, immunotherapy can be done more quickly. Over time, you should lose your sensitivity to the allergens.

• Under-the-tongue (sublingual) immunotherapy tablets. Rather than getting shots, you take tiny amounts of allergen in pill form that dissolves in your mouth. Pills are usually taken daily. Sublingual immunotherapy tablets don't work for all allergens but can be helpful for grass and ragweed pollens and dust mites.

• Allergy medications. These include oral and nasal spray antihistamines and decongestants, as well as corticosteroid and cromolyn nasal sprays. Allergy medications are available in nonprescription and prescription form. They can help with allergic symptoms such as a runny nose, itchy eyes, congestion, sneezing and sinus pressure, but aren't substitutes for asthma medications.

  Nasal corticosteroid sprays help reduce inflammation and are a safe, long-term treatment for most people. Because it has few, if any, side effects, cromolyn is safe to use over long periods of time. Decongestant nasal spray should not be used for more than 2 to 3 days at a time because it can worsen symptoms when used continuously (rebound swelling).

Your health care provider may recommend treatment with biologics if you have severe asthma with symptoms that are not easily managed by control medications. Biologics reduce inflammation by targeting immune system antibodies or specific cells. Taken together with other asthma medications, biologics help people with more-severe forms of asthma gain greater symptom control.

Your provider will typically do bloodwork to decide which biologic will work best for you. Some biologics are given as a shot (injection) and some are given by a vein (intravenously).

Biologic for allergic asthma

Omalizumab (Xolair) is sometimes used to treat asthma triggered by airborne allergens. If you have allergies, your immune system identifies a harmless airborne substance — such as pollen, dust mites and pet dander — as being harmful. This substance is called an allergen.

Your immune system is how your body protects itself, so it produces immunoglobulin E (IgE) antibodies to protect against this allergen. These antibodies signal your immune system to release chemicals into your bloodstream, causing a reaction that leads to allergy and asthma symptoms. Omalizumab blocks the action of these antibodies, reducing the immune system reaction.

Omalizumab is given as an injection every 2 to 4 weeks. It isn't generally recommended for children under 12 years of age. In rare cases, this medication has triggered a life-threatening allergic reaction (anaphylaxis). In addition, the U.S. Food and Drug Administration (FDA) has issued a warning about a slightly increased risk of heart and brain blood vessel problems while taking this drug.

Anyone who gets an injection of this drug should be monitored closely by health care professionals in case of a severe reaction.

Biologics for eosinophilic asthma

A newer class of biologic drugs has been developed to target specific substances produced by certain immune system cells. For some people, certain white blood cells, called eosinophils, build up within body tissues. Eosinophils release substances, called cytokines, which cause inflammation. These biological drugs target eosinophils and cytokines, reducing their numbers within the body and lowering inflammation.

These medications include:

• Benralizumab (Fasenra)
• Dupilumab (Dupixent)
• Mepolizumab (Nucala)
• Reslizumab (Cinqair)

Biologic for either eosinophilic asthma or allergic asthma

Tezepelumab-ekko (Tezspire) is a recently FDA-approved biologic for people with severe asthma. This medication can be used to treat eosinophilic asthma or allergic asthma by reducing certain kinds of cytokines that cause inflammation.

Tracking symptoms and side effects and adjusting your treatment based on changes is key to keeping your asthma symptoms under control. With your health care provider, create a written detailed plan for taking long-term control medications and for managing an asthma attack. Then follow your plan.

Know when to adjust your medications, when to see your provider and how to recognize an asthma emergency. If your provider has prescribed a peak flow meter to measure how well your lungs are working, use it according to your plan. Even if you feel well, take your medications as prescribed and track your symptoms until you talk to your provider.

July 02, 2024

Original article: https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma-medications/art-20045557