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The Latest Asthma Treatments

Explore your options from inhalers to biologics for asthma.

The Latest Asthma Treatments

For anyone who has lived with asthma for a while, one of the top questions has got to be: "Is this the best treatment out there?" With scientists always on the hunt for better drug therapies with fewer side effects, it's possible that the drug you're on now isn't the best option for you.

To make a smart decision with your doctor, it helps to know about the latest stuff available. For that, we talked with Stephen Wasserman, MD, professor of medicine in the division of Rheumatology, Allergy & Immunology at UCSD.

Are there new quick-relief medicines?
Turns out, there are still two main options for when you need immediate help—beta-agonists and anticholinergics. These drugs temporarily relax the muscles around the airways to relieve asthma symptoms quickly. Anticholinergics don't work as quickly as beta-agonists, so some doctors don't consider them true relief medications. Also, Dr. Wasserman says most people seem to find beta-agonists, such as albuterol, to work the best for them, but that studies show the two drugs to be about the same in terms of effectiveness.

Are there new controller medicines?
First, some inhalers combine a long-acting beta agonist (LABA) with a steroid in a single device. LABAs help open up the small airways inside the lungs. If someone's asthma isn't well controlled on an inhaled steroid alone, they usually step up to this type of inhaler. Once controlled, you can try to step back down under your doctor's guidance.

Examples include Advair (salmeterol and fluticasone), Breo Ellipta (vilanterol and fluticasone), Dulera (formoterol and mometasone) and Symbicort (formoterol and budesonide).

Wasserman doesn't recommend one brand over another, but says some people like the convenience of the once-a-day options. He notes, though, that the FDA has put a "black box" warning on LABA drugs because of early studies that showed an increased risk of death in patients with asthma. That's why LABA drugs are recommended only as "add-on therapy" to be used with a steroid.

Second, several studies show that long-acting anticholinergics work for asthma, too. Originally developed for chronic obstructive pulmonary disease (COPD), these drugs stop the muscles from tightening around the larger airways, which happens when the lungs are irritated.

There's only one long-acting anticholinergic drug approved for asthma, called Spiriva Respimat (tiotropium). There's no black box warning for anticholinergics, but it doesn't necessarily mean they're better or safer, says Wasserman. Some doctors prefer to start their patients on this type of combo inhaler.

And there are a few oldies but goodies worth noting. Singulair (montelukast) is a pill that works well for some people, but it's not as likely to help as other long-acting drugs. Theophylline is another "old-fashioned" asthma pill that's related to caffeine and may cause the same jitters, says Wasserman. It fell out of favor because it can be toxic at high doses, but he says it's still a reasonable drug to consider if you're having trouble controlling your asthma, especially if you're one of the 25-30% of severe asthmatics who smoke.

What are biologics for asthma?
The above treatments usually work for people with mild to moderate asthma, but they may not be enough to fully control more severe asthma. This gap has led scientists to test a new type of drug, called biologics. These drugs act similar to natural antibodies in your body.

The first biologic approved for allergic asthma is Xolair (omalizumab). Wasserman says this drug is very effective for asthma, probably even in people who don't have allergic asthma. The success of this medicine for difficult-to-treat asthma has sparked a lot of interest. More biologics that work in different ways are being tested, but it's not clear yet which patients will benefit most from which therapy.

Wasserman warns that biologics should be considered the final drug someone would add to their regimen. "Biologics are pricey, require injections and require monitoring," he adds.

How do I know I'm on the right drug?
If you're reading this, chances are you're not totally satisfied with your asthma drugs. If your doctor thinks you're already on the best medicine, they may increase the dose to see if that helps. They'll probably also ask you if you're truly taking it as prescribed, since 30-70% of people with asthma don't follow their doctor's orders exactly.

The real key is figuring out why you're not happy, Wasserman says. If you're not doing well, ask your doctor: What more could we do or what are we missing? If you don't like the drug delivery, try a dry powder inhaler, for example. If the drug tastes bad or makes you feel sick, tell your doctor. There's probably an alternative you can try. Talk over your concerns and goals with your doctor to come up with the right treatment plan for you.

Medically reviewed in April 2018.

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