Asthma medications

Everyone with asthma should have access to a reliever inhaler to use as needed to treat asthma symptoms when they occur. 

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)

It is very important that you use your inhaler(s) properly to make sure the medication you need is reaching your airways and lungs. Speak to your healthcare provider, a certified respiratory educator (CRE) or your pharmacist if you have any questions.

Even if you think you’re using your inhaler properly, it can’t hurt to check. You’ll find helpful instructions and videos for a wide range of inhaler types on our How to use your inhaler page. You’ll also find instructions on cleaning your inhaler.

Spacers

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 (metered-dose inhaler or puffer), 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.

The image below shows a child using a spacer (purple) and a mask with their inhaler (blue).