Medicine doesn't cure asthma. But it is an important part of managing it. Medicines for asthma treatment are used to:

• Prevent and control airway inflammation so you have fewer asthma symptoms.
• Decrease how often you have asthma attacks, how long they last, and how severe they are.
• Treat the attacks as they occur.

Asthma medicines are divided into two groups: those for prevention and long-term control of inflammation and those that provide quick relief for asthma attacks.

• Long-term (controller) medicines are used daily for persistent asthma.
• Quick-relief medicines are used as needed and provide rapid relief of symptoms during asthma attacks.

How to take asthma medicine

Most medicines for asthma are inhaled. Inhaled medicines are used because a specific dose can be given directly to the airways .

Delivery systems include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler (MDI) is used most often.

Sometimes doctors recommend attaching a spacer to an MDI to better deliver the medicine to the lungs. For many people, a spacer makes an MDI easier to use.

Asthma: Using a Metered-Dose Inhaler

Asthma: Using a Dry Powder Inhaler

Medicine choices

The most important asthma medicines are:

• Inhaled corticosteroids. These are the preferred controller medicines for long-term treatment of asthma. They reduce inflammation of your airways. You take them every day to keep asthma under control and to prevent sudden and severe symptoms (asthma attacks). They include mometasone, triamcinolone, fluticasone, budesonide, and ciclesonide.
• Oral or injected corticosteroids (systemic corticosteroids). They get your asthma under control before you start taking daily medicine. You may also need these medicines to treat asthma attacks. Oral corticosteroids are used much more than injected corticosteroids. They include prednisone and methylprednisolone.
• Short-acting beta2-agonists for asthma attacks. They relax the airways, allowing you to breathe easier. These quick-relief medicines include albuterol and pirbuterol.

There are other long-term medicines for daily treatment. They include:

• Leukotriene pathway modifiers (such as zafirlukast, zileuton, or montelukast).
• Long-acting beta2-agonists (such as salmeterol and formoterol). They are always used with an inhaled corticosteroid as a single medicine.
• Less commonly, mast cell stabilizers (such as cromolyn) or theophylline.

Other medicines may be given in some cases.

• Anticholinergics (such as ipratropium) are usually used for severe asthma attacks.
• Omalizumab may be used if asthma doesn't improve with treatment. An asthma specialist typically prescribes this medicine.

The right medicine for you

Medicine treatment for asthma depends on your age and type of asthma, and how well the treatment is controlling your asthma symptoms.

• The least amount of medicine that controls the asthma symptoms is used.
• The amount of medicine and number of medicines are increased in steps. So if asthma isn't controlled at a low dose of one controller medicine, the dose may be increased. Or another medicine may be added.
• If the asthma has been under control for several months at a certain dose of medicine, the dose may be reduced. This can help find the least amount of medicine that will control the asthma.
• Quick-relief medicine is used to treat asthma attacks. But if you need to use quick-relief medicine a lot, the amount and number of controller medicines may be changed.

Your doctor will work with you to help find the number and dose of medicines that work best.

What to think about

One of the best tools for managing asthma is a daily controller medicine that has a corticosteroid ("steroid"). But some people worry about taking steroid medicines because of myths they've heard about them. If you're making a decision about a steroid inhaler, it helps to know the facts.

At the start of asthma treatment, the number and dosage of medicines are chosen to get the asthma under control. Your doctor may start you at a higher dose within your asthma classification so that the inflammation is controlled right away. After the asthma has been controlled for several months, the dose of the last medicine added is reduced to the lowest possible dose that prevents symptoms. This is known as step-down care. Step-down care is believed to be a better way to control inflammation in the airways than starting at lower doses of medicine and increasing the dose if it is not enough.¹⁸

Because quick-relief medicine quickly reduces symptoms, people sometimes overuse these medicines instead of using the slower-acting long-term medicines. But overuse of quick-relief medicines may have harmful effects, such as reducing how well these medicines will work for you in the future.¹⁹

You may have to take more than one medicine each day to manage your asthma. Help yourself remember when to take each medicine, such as taping a note to your refrigerator to remind yourself.

Tell your doctor about all the medicines you are taking, so he or she can choose asthma medicines that won't interfere with other medicines.

Some people only have symptoms during certain times of the year (seasonal asthma). If you know when you will most likely have symptoms, start using a medicine to decrease inflammation before the symptoms start.