A guide to asthma controller medications

Managing asthma requires a number of strategies, including controlling your exposure to triggers, monitoring your symptoms with a diary (and possibly a peak flow meter), recognizing when to use your quick-relief inhaler, and knowing the right technique for using that inhaler.

For many people, especially those who have difficult-to-control asthma or moderate-to-severe asthma, managing this respiratory condition also involves long-term controller medications.

Long-term asthma controller medications are taken to help control symptoms. There are a number of different long-term controller medications available, which work in different ways.

Inhaled corticosteroids

The steroids used to treat asthma are corticosteroids (or glucocorticoids), which are different than the type of steroids that are used to build muscle or enhance athletic performance.

Corticosteroids work by inhibiting inflammatory processes and chemicals. Inhaled corticosteroids are taken with an inhaler, delivering a dose of asthma medication directly into the tissues of the airways. Taken regularly, over time, this helps control the inflammation, mucus production, and narrowing of the airways that make it difficult for asthma patients to breathe. Inhaled corticosteroids do not provide immediate relief for symptoms and cannot be used in place of a rescue inhaler.

Oral and injectable corticosteroids

Corticosteroids can also be taken as oral medications or injections. Oral corticosteroids contain higher doses of medication and travel to the airways via the bloodstream.

While this means they are more powerful treatments, it also means they carry a greater risk of side effects, which is why they are only prescribed for short durations. For example, if a person experiences a severe asthma attack, a healthcare provider may prescribe a one- or two-week course of these high-dose steroids to get symptoms under control.

Long-acting bronchodilators

Bronchodilators (also called beta-2 antagonists) are drugs that relieve bronchoconstriction, the tightening of the muscles around the airways that occurs when asthma flares. In other words, they help open up narrow airways.

Short-acting bronchodilators are found in quick-relief inhalers, used for the immediate relief of asthma symptoms. There are also long-acting bronchodilators, which are prescribed to prevent asthma attacks. Doses for long-acting bronchodilators last for 12 or 24 hours, depending on the type. They're used in combination with inhaled corticosteroids, and there are several varieties of inhaled asthma medications that contain both corticosteroids and long-acting bronchodilators.

However, the most commonly prescribed inhalers are ICS-formoterol inhalers. Formoterol is a fast-acting, long-acting bronchodilator (LABA), which makes it useable for both quick relief and prevention. This kind of treatment is often called single maintenance and reliever therapy (SMART).

Leukotriene modifiers

Leukotriene modifiers are another anti-inflammatory therapy. These drugs work by interfering with the activity of natural inflammatory chemicals called leukotrienes, which are released during asthma flares and are the primary cause of bronchoconstriction. These drugs help prevent inflammation, bronchoconstriction, and mucus production. Leukotriene modifiers are taken as pills, either once or twice a day depending on the specific brand prescribed.

Mast cell stabilizers

Mast cells release a variety of pro-inflammatory chemicals (leukotrienes are one example). Mast cells are important to normal immune system function, but mast cell activity is also linked to a number of health conditions, including asthma. Mast cell stabilizers are inhaled (with a nebulizer) asthma medications that prevent mast cells from releasing pro-inflammatory chemicals.

Immunoglobulin E (IgE) blockers

This medication blocks the activity of an antibody called IgE to prevent it from causing an asthma attack. This treatment is typically used for people with severe allergic asthma, and is given by injection.

Anti-Interleukin (anti-IL) agents

Interleukins (ILs) are a group of proteins that help regulate immune responses and reduce disease activity. Some ILs are related to asthma, particularly a type of asthma called eosinophilic asthma, which is often severe and related to high levels of eosinophils, a type of white blood cell. There are several anti-IL agents that work by targeting specific types of ILs. These therapies are given by injection and are typically only prescribed to people who have severe asthma.

Anticholinergics

Anticholinergics are a type of medication used to treat chronic-obstructive pulmonary disease (COPD), but some are used as asthma controller medications.

Choosing an asthma controller medication

Many of these medications are used in combination with one another. Choosing the right controller medication or combination of controller medications that works best for you is a decision that you will make with the guidance of your healthcare provider. Whichever medication you are using to treat asthma, it is important to follow your healthcare provider’s instructions and adhere to the dosing schedule, even when you are not experiencing symptoms.