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What asthma medication will I be prescribed?
When discussing what medication is best for you, your healthcare provider will consider things like your symptoms and how often you experience them, your risk of exacerbation and your ability to use a specific type of inhaler correctly.
Most asthma medications come as sprays or powders in inhaled delivery devices, also called inhalers or puffers. Inhalers are the best way to deliver medication directly to the lungs where it is are needed. Knowing how to use your inhaler correctly is important to make sure the medication is working as it should.
Most people are familiar with metered dose inhalers (MDIs), the classic “puffer”. There are many other forms of inhalers. It is very important to use your inhaler properly. Talk to your healthcare team if you are not sure how to use your inhaler, or if you have any questions about how your asthma medication works. There are also videos that can help.
Your healthcare team will want to check in with you when any change is made to your medications. Changes include increasing or decreasing a strength or dose of inhaler.
There are two main types of asthma medications: controllers and relievers.
Everyone with asthma should have access to a reliever medication to use as needed to treat acute asthma symptoms.
Short-acting bronchodilators (short acting beta2-agonists or SABAs) work quickly to relax your airways and make it easier for you to breathe. You take these medications if you are having symptoms.
Although they work quickly so that you get relief from symptoms fast, these medications wear off in a few hours.
The following reliever inhalers are available in Canada:
- Teva-salbutamol MDI (salbutamol)
- Ventolin Diskus (salbutamol)
- Ventolin MDI (salbutamol)
- Bricanyl Turbuhaler (terbutaline)
Some people who are at low risk for exacerbations can achieve good control over their asthma symptoms using a SABA as needed. If you are at higher risk of exacerbations, even if your symptoms are well managed using SABA as needed, your healthcare provider will likely prescribe you a controller medication.
It is important to note that repeated use of SABAs can result in becoming tolerant to their effect. This means the medication won’t work as well. It is important to follow your action plan if you find yourself using your SABA more than two times per week.
Anti-inflammatory medications
Controller medications are usually used on a daily basis to control and prevent asthma symptoms. Inhaled corticosteroids (ICS) are the most effective anti-inflammatory medication for asthma. They reduce symptoms, make the airways less sensitive to triggers. They reduce the risk of flareups (asthma attacks), hospitalization and death.
The following ICS inhalers are available in Canada:
- Aeromony Respiclick (fluticasone propinate)
- Alvesco MDI (ciclesonide)
- Asmanex Twisthaler (mometasone furoate)
- Ellipta Arnuity (fluticasone furoate)
- Flovent MDI (fluticasone propionate)
- Flovent Diskus (fluticasone propionate)
- Pulmicort Turbuhaler (budesonide)
- Qvar MDI (beclomethasone propionate)
If you have had a recent severe exacerbation and don’t respond to inhaled SABA as outlined in your action plan, your provider may increase your dose of ICS by prescribing a 1- or 2-week course of oral corticosteroids.
Dual therapy: Combination ICS+LABA
If an ICS alone does not provide adequate control of your asthma, your provider will likely add a long-acting inhaler medication to the ICS. Long-acting beta2-agonists (LABAs) are a type of medication called bronchodilators. They control asthma symptoms by keeping the small muscles that wrap around the airways relaxed
The following combination ICS+LABA inhalers are available in Canada:
- Advair Diskus (fluticasone propionate + salmeterol)
- Advair MDI (fluticasone propionate + salmeterol)
- Breo Ellipta (luticasone furoate + vilanterol)
- Symbicort Turbhaler (budesonide + formoterol)
- Wixela Inhub (fluticasone propionate + salmeterol)
- Zenhale MDI (mometasone + formoterol fumarate)
Triple therapy: Combination ICS+LABA+LAMA
If your asthma is not sufficiently controlled with ICS+LABA, your provider may add a long-acting muscarinic antagonist (LAMA). LAMAs is also a bronchodilator. It works by preventing the muscles around your airways from tightening and helping clear mucus from your lungs. This allows you to cough up mucus more easily.
The following triple combination ICS+LABA+LAMA inhalers are available in Canada:
- Enerzair Breezhaler (indacaterol + glycopyrronium + mometasone)
- Trellegy Ellipta (futicasone furoate + umeclidinium + vilanterol)
Biologic medications work to block specific allergy-related antibodies, molecules or cells (eosinophils) that cause airway inflammation and asthma symptoms. Typically, biologics are used as add-ons to treatment for those with severe eosinophilic (allergic) asthma, whose asthma is not controlled with their current asthma medicines. Most biologics (except Cinqair) are given by injection, approximately every 2 to 4 weeks. With proper training and support, these injections can be give at home. Cinqair is given by IV infusion by a qualified healthcare professional, approximately every 4 weeks.
- Tezspire (tezepelumab)
- Nucala (mepolizumab)
- Cinqair (reslizumab)
- Fasenra (benralizumab)
- Dupixent (dupilumab)
- Xolair (omalizumab)
Using a spacer with your inhaler
For inhaled asthma medicines to work properly, they need to reach your lungs. But sometimes using an MDI alone can mean some of the medication only reaches the back of your throat, which can cause irritation or infection. If you use an MDI, you should also use a spacer to help more of the medication reach your lungs.
Valved holding chambers are spacers with a one-way valve. The valve keeps the medication inside the tube until you inhale it. Infants, young children and anyone who has trouble fitting their mouth around a mouthpiece should use a spacer with a mask.
Spacers and masks come in various sizes depending on age and can be purchased at your local pharmacy.