Asthma Medication: Chronic Management & Asthma Attacks

Updated in January 2023

Asthma medications are typically prescribed by a doctor. The types that are prescribed depend on the treatment goals. Some may be used for long-term management of symptoms and to prevent asthma attacks (e.g. inhaled corticosteroids and long-acting bronchodilators). Other medications may be used for the treatment of acute asthma attacks (e.g. systemic corticosteroids or short-acting bronchodilators).

These medications work by reducing lung inflammation, opening up the airways, and facilitating airflow for optimal breathing. They can help to relieve symptoms of asthma and asthma attacks. 

Asthma treatment should be directed by a doctor, and should be adapted based on each individual patient. The doctor should consider symptoms, age, health history, asthma type, illness severity, and asthma attack intensity when selecting appropriate treatment. 

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Asthma medication

Medications to manage asthma are generally used on a long term basis. They help to manage and prevent asthma attacks, and should be taken every day. 

The main medications prescribed to manage asthma include: 

1. Corticosteroid inhalers 

Corticosteroid inhalers, like beclomethasone, fluticasone, budesonide or mometasone have a potent anti-inflammatory action on the respiratory airways. They help to reduce chronic inflammation in the lungs and are considered to be one of the most efficient asthma treatments. These inhalers help to reduce symptpoms and prevent asthma attacks by improving lung function and overall quality of life. 

These medications, also known as puffers, can be purchased at the pharmacy with a prescription. In some cases, the doctor may prescribe corticosteroid inhalers together with bronchodilator inhalers to help treat and manage asthma. 

Corticosteroid inhalers should be used on a daily basis as prescribed by a doctor. Be sure to rinse your mouth or wash your teeth immediately after use. You should also clean your puffer with a sift brush to remove and medication residue. 

2. Long-acting bronchodilator inhalers 

Long-acting (LA) bronchodilators, like salmeterol and formoterol, help to open up the bronchi in the lungs. They help to facilitate optimal airflow in and out of the lung, and usually act for up to 12 hours. They are most recommended for chronic asthma treatment. 

Generally, these medications are used in combination with corticosteroids. Combination puffers can be purchased at the pharmacy with a prescription, with some examples including formoterol + budesonide (Symbicort) and salmeterol + fluticasone (Advair).

LA bronchodiltors should used only as prescribed by a doctor, and are contraindicated for use during an asthma attack (as they take longer to work). 

3. Antileukotrienes 

Antileukotrienes, like montelukast or zafirlukast act by decreasing the action of chemical substances called leukotrienes. Leukotrienes are responsible for lung inflammation, and this medication helps to prevent narrowing and swelling of the respiratory airways. 

Antileukotrienes are indicated for the long-term management of asthma in those with moderate persistent asthma. They help to prevent asthma attacks and are particularly recommended for those who are unable to tolerate treatment of corticosteroid inhalers. They can also be used as a complement to corticosteroid and bronchodilator puffers. Antuileukotrienes have a maximum affected after 14 to 30 days of consistent use, and therefore are not indicated for use during an asthma attack. 

This medication can be found as coated pills or chewable pills, as well as in powder form. They are not recommended for use during pregnancy or breastfeeding, unless cleared by a doctor. 

4. Immunossupressants 

Immunosuppressants, like omalizumab or dupilumab, are indicated for the treatment of allergic asthma when treatment with corticosteroid inhalers are ineffective. These medications act by reducing immune system action and relieve lung inflammation. 

Immunosuppressants can be purchased at pharmacies as Xolair or Dupixent in injectable form. They are dispensed as outlined in the doctor’s prescription. 

5. Xanthine derivatives 

Xanthines, like theophylline, contain bronchodilating actions, although they are not as commonly prescribed today. They may be indicated as a maintenance therapy for asthma, as they help to relax respiratory airway muscles. 

Asthma attack medications 

Medications for asthma attacks should only be used when experiencing an asthma attack or when you suspect one is about to start. The doctor will usually give specific instructions about when to use these medications (ie. when your respiratory rate and work of breath increases).

The main medications prescribed to treat asthma attacks: 

1. Short-acting bronchodilator inhalers

Short-acting (SA) bronchodiltors, like salbutamol and fenoterol, are medications recommended for asthma attacks. They act within a few minutes and effects can last for up to 4 to 6 hours. 

These medications dilate the bronchi rapidly, which facilitate air entry and relieve asthma attack symptoms. 

Salbutamol can be obtained at the pharmacy with a prescription as a puffer or nebulizer solution. 

2. Systemic corticosteroids 

Systemic corticosteroids, like prednisone, prednisolone and methylprenisolone, are prescribed to decrease pulmonary inflammation during serious asthma attacks. They are usually used for just one or two weeks, as long-term use can lead to side effects in comparison to inhaled corticosteroids. Some risks of long-term use include obesity, osteoporosis or diabetes. 

These medications can be prescribed as oral pills, although the doctor may advise IV administration in the hospital setting for more severe asthma attacks. 

Prednosione and prednisolone, in pill or oral solution form, can be obtained at the pharmacy with a prescription. 

3. Antimuscarinics 

Antimuscarinic agents, like ipratropium bromide, act quickly to dilate the bronchi. Doctors will typically prescribe them to treat intense and uncontrolled asthma attacks. Some doctors may also opt to prescribe these medications to complement treatment with corticosteroid or bronchodilator puffers. 

Ipratropium bromide can be purchased at the pharmacy with a prescription, under the brand name Atrovent. It can be obtained as a nebulizer solution or puffer. 

Asthma medication during pregnancy

Asthma medication during pregnancy is usually advised for women who already used these medications prior to expecting. Before continuing treatment, however, they should report their medication to their doctor to ensure that continued use is safe. 

Excessive use of asthma medication should be avoided during pregnancy. Women are advised to avoid factors that may trigger asthma attacks and worsen symptoms, like contact with pollen, dust, cats, dogs, perfumes and intense smells. 

It is important to follow guidelines as outlined by the doctor, as uncontrolled and untreated asthma during pregnancy can lead to complications, like preeclampsia, gestational diabetes and premature labor. Other complications that can impact the baby include premature birth and low birth weight, which can be life-threatening to the baby. 

Considerations for asthma treatment 

Some factors to keep in mind when treating asthma include: 

  • Taking medications as advised by the doctor 
  • Maintaining flu and pneumonia vaccines up-to-date, as recommended to your doctor, to prevent lung infections that can cause asthma attacks 
  • Identifying substances that can trigger asthma attacks, like pollen, air pollution, and mold 
  • Keeping your home clean, without grime or dust 
  • Smoking cessation 
  • Maintaining a healthy weight
  • Partaking in physical activity, within your doctor’s guidelines 
  • Avoiding alcohol 
  • Avoiding dusty places, cleaning products with strong odors, hair spray or perfumes (as these can irritate the lungs and lead to inflammation and asthma attacks) 
  • Avoid taking medications on your own, especially anti-inflammatories, as these can also trigger asthma attacks. 

If you experience an asthma attack, you should seek immediate medical attention or proceed to the closest hospital. Learn more about what to do if you or someone you know experience an asthma attack