There are many safe, effective medicines that can help you control your asthma. You will need a doctor's prescription to get these medicines. You will also need instructions on when and how to use each kind of medicine.
Work with your healthcare team to control your asthma
Because asthma symptoms are variable - they can get worse or better, depending on many things - you need to know how to adjust your medicines depending on your symptoms. Your doctor can create a personalised asthma action plan for you. Your asthma action plan tells you exactly how to treat your symptoms, and what to do when your symptoms get worse.This written plan will explain how to adjust your medicine depending on your symptoms.
Your doctor, pharmacist, or certified asthma educator can also:
- Explain how each of your asthma medicines works
- Answer your questions
- Show you how to use your medicine inhalation device
- Each you how to use a peak flow meter to monitor your breathing
If you know how to take care of your asthma every day, you can avoid getting asthma attacks.
People on your asthma healthcare team may include:
- Your doctor – you may have a family doctor and a respirologist (breathing specialist doctor)
- Your nurse
- Your pharmacist
- Your Certified Asthma Educator (CAE) or Certified Respiratory Educator (CRE): Certified asthma educators and certified respiratory cducators are respiratory therapists, nurses, pharmacist, or physiotherapists who have special training to teach people about asthma. They are experts at explaining how asthma affects you and what you can do about it. To find a certified asthma educator or certified respiratory educator, ask your local Lung Association or your doctor. Or look for an asthma education clinic near you - search our online database of asthma programs and clinics.
What to discuss with your healthcare team
- Your asthma action plan
- All your symptoms, especially if they are getting worse
- What you can do to prevent asthma attacks
- How you can get rid of asthma triggers
- If you are using more of your rescue medicine (blue puffer) than usual
- Questions about your treatment
- How how to use your puffers and inhalers
- Worries you may have about side effects
- What will happen if you don't take your medicine
- This medicine is also approved for use as a rescue medicine
Controller and reliever medicines work together
There are two main kinds of asthma medicines: preventer medicine and rescue medicine. Each medicine is important, and each medicine does a different thing for your lungs.
For most people with asthma, the doctor will prescribe both kinds of medicine:
- Asthma preventer (controller) medicine : You take your preventer medicine every day, even if you have no symptoms, to make sure your airways stay clear and to prevent redness, mucus and swelling.
- Asthma Rescue (reliever) medicine: Most people with asthma will be given a reliever inhaler. These are usually blue.
You use a reliever inhaler to treat your symptoms when they occur. They should relieve your symptoms within a few minutes.
Some people think they can skip the preventer medicine and only use the rescue medicine. This is dangerous. If you've been prescribed a preventer medicine, use it. The rescue medicine by itself will not control your asthma over the long term. To make sure you get all your medicine into your lungs, be sure you know how to use your inhalation device (metered-dose inhaler, spacing chamber, Diskus, etc.).
It's really important to take your preventer medicine as directed, even when you don't have symptoms. If you don't take the preventer medicine that your lungs need, your lungs will be weaker. Without your preventer medicine, you 'll be more sensitive to your asthma triggers and more vulnerable to an asthma attack.
There are different kinds of preventer medicines:
- Inhaled corticosteroids
- Long-acting bronchodiolators
- Combined inhaled corticosteroids and long-acting bronchodilators
- Leukotriene receptor antagonists
- Corticosteroid pills
Inhaled corticosteroid are the most common and effective type of asthma preventer. They are inhaled, not swallowed, so they go straight to your lungs and give you fewer side effects than pills. To get the most out of your medicine, it is important you know how to use your inhaler device.
Examples of inhaled corticosteroids: budesonide (Pulmicort®), fluticasone (Flovent®), ciclesonide (Alvesco®), fluticasone furoate (Arnuity®), mometasone (Asmanex®), beclomethasone (Qvar®).
What inhaled corticosteroids do: inhaled corticosteroids reduce the inflammation (swelling, redness, and mucus) in your airways.
Side effects of inhaled corticosteroids: For a full list of side effects, see your doctor or pharmacist. In most cases, inhaled corticosteroids have few side effects with the dose needed to control asthma.
Corticosteroids for asthma are NOT the same as the muscle-building steroids that some athletes use. Some athletes take anabolic steroids, which is a completely different kind of steroid. Corticosteroids used to treat asthma are not the same thing, and don't have the same risks or effects.
If your asthma is not controlled using only inhaled corticosteroids, your doctor may add on another controller medication. Other controller also need to be taken regularly. These include:
Combined inhalers: corticosteroids and Long-Acting Beta2-Agonists (LABAs)
Doctors usually prescribe an inhaler that has a combined medicine of Long-Acting Beta2-Agonists (LABAs) and corticosteroid and is for people whose asthma is not controlled by their usual medicine. Long-Acting Beta2-Agonists (LABAs) are inhaled medicines help the airways relax, allowing more air to pass through. They have to be used in combination with an corticosteroid. A combined inhaler ensures you get both.
Examples of combination asthma medicines:
- Advair®: Made of a corticosteroid (fluticasone / Flovent®) plus a Long-Acting Beta2-Agonists (salmeterol / Serevent®)
- Breo®: Made of corticosteroid (fluticasone) plus a Long-Acting Beta2-Agonists (vilanterol)
- Symbicort®: Made of a corticosteroid (budesonide / Pulmicort®) plus a Long-Acting Beta2-Agonists (formoterol / Oxeze)
- Zenhale®: Made of a corticosteroid (mometasone) plus a Long-Acting Beta2-Agonists (formoterol)
Long-Acting Muscarinic Antagonist (LAMA)
LAMA are sometimes prescribed if your asthma is not under control when you use a combination inhaler. When used with a combination inhaler LAMA have also been shown to reduce the amount of mucus produced in your airways.
Leukotriene receptor antagonists (LTRA)
Leukotriene receptor antagonists come in the form of a pill you take every day. Leukotriene receptor antagonists act against one of the inflammatory components of asthma and provide protection against bronchoconstriction (airways muscles squeezing tightly).
For people with mild asthma, doctors may prescribe leukotriene receptor antagonists alone.
Doctors may also prescribe leukotriene receptor antagonists to people who are already taking inhaled corticosteroids, with the idea that the relief they get from leukotriene receptor antagonists will allow them to (slowly) reduce their dose of corticosteroids and still keep their asthma under control.
Examples of leukotriene receptor antagonists: zafirlukast (Accolate®), montelukast (Singulair®)
Side effects of leukotriene receptor antagonists: For a full list of side effects, see your doctor or pharmacist. In general, side effects with are very rare. Occasionally, people notice these side effects from leukotriene receptor antagonists:
- Upset stomach
Sometimes, the swelling in people's airways is severe - this may be because they have a chest infection or for some other reason. In cases of severe airway swelling, the doctor may prescribe corticosteroid pills. Corticosteroid pills basically do the same thing as inhaled corticosteroids, but they are more powerful. Doctors often prescribe these pills for a short time, to get the swelling under control.
Examples of corticosteroid pills: Prednisone, Prednisolone (PediaPred®), and Dexamethasone (Decadron®)
What corticosteroid pills do: Corticosteroid pills reduce the swelling, redness, and mucus in the airways.
Side effects of corticosteroid pills: For a full list of side effects, see your doctor or pharmacist.
Basic information about asthma reliever medicine:
- Reliever medicine helps during asthma attacks– take it right away.
- Reliever medicine is usually in a blue-coloured device.
- Reliever medicine acts quickly.
- Reliever medicine reduces the effects of asthma triggers like exercise and cold air.
- Reliever medicine lasts a short time.
- Reliever medicine makes your tight airway muscles relax.
- Usually, you take rescue medicine when you need them – only when you have symptoms.
It is important you keep your rescue medicine close by, so it is there when you need it.
If your asthma is under control, you won't need to take rescue medicine more than three times a week. If you use your rescue medicine more than three times a week, tell you doctor. Find out what you can do to get your asthma under control.
You take fast-acting bronchodilators as needed, for quick relief of asthma symptoms.
When to use short-acting bronchodilators:
- For quick relief during an asthma attack
- To relieve the symptoms of cough, chest tightness, wheezing and shortness of breath
- Fifteen minutes before exercising, as prescribed by your doctor
Examples of short-acting bronchodilators:
- Salbutamol (Ventolin®, Airomir®)
- Terbutaline sulfate (Bricanyl® inhaler)
Side effects of short-acting bronchodilators: For a full list of side effects, ask your doctor or pharmacist
If you are using your short-acting bronchodilators too much (more than three times a week besides with exercise), it may mean your asthma is not under good control. It may mean that you have lots of inflammation (swelling and redness) in your airways that need to be treated. Use your asthma action plan and follow the instructions. You may need to increase your asthma preventer medicine until your asthma is under good control.
During a serious asthma attack, while you wait for ambulance to arrive, it is safe keep taking puffs of your rescue inhaler every few minutes. If your asthma keeps getting worse and you are on your way to the hospital keep taking your rescue inhaler.