Medicines used to manage asthma
There are many different types of asthma medicines and sometimes you have to take more than one. They fall into the main categories of:
- preventers – inhalers or tablets taken every day to prevent asthma symptoms from developing
- relievers – inhalers taken when needed to ease asthma symptoms
- steroid tablets – used for a short time when symptoms are severe
- montelukast – an alternative tablet medicine for asthma symptom prevention.
Asthma medicines are generally available in 2 main types of inhaler devices: metered dose inhalers (MDI) or puffers, and dry powder inhalers such as Turbuhalers, Accuhalers and Handihalers. Metered dose inhalers (puffers) can be used with a spacer. Read more about inhalers and spacers.
Preventers are used over the long term to prevent asthma symptoms from coming on.
- Preventers are usually taken every day, even when you are not having symptoms.
- Preventers take days or weeks to work, compared to relievers, which take minutes.
- The main types of preventers commonly used are:
- steroid preventers
- long-acting bronchodilator preventers.
|Examples of steroid preventers
What do steroid preventers do?
- Steroid preventers work by reducing swelling of your airways and preventing mucus build-up, which narrows your airways.
- Your asthma can get worse if you miss doses.
- Talk to your doctor about reducing your dose if you think you are better.
- Steroid preventers are safe when used for a long time.
- There are some side effects that can be reduced by using a spacer (see below) and rinsing your mouth after taking your preventer.
Long-acting bronchodilator preventers
| Examples of long-acting bronchodilators
Long-acting bronchodilators include:
These long-acting bronchodilators should be used only if you regularly use a steroid preventer as well.
Combination inhalers: steroid + long-acting bronchodilator
Some brands of inhalers contain a steroid preventer plus a long-acting bronchodilator in a single inhaler, for convenience, such as:
These are described as combination inhalers.
- If your asthma symptoms are not well controlled by the steroid preventer alone your doctor may add a long-acting bronchodilator preventer.
- A bronchodilator widens your airways by relaxing the muscle that surrounds your airways.
- Long-acting bronchodilators work in a similar way to relievers, but work for up to 24 hours.
Preventer and a reliever (SMART therapy)
- Symbicort and DuoResp Max are the only combination inhalers that are used as both a preventer and a reliever.
- When you use them, there is no need for an extra reliever inhaler.
- This is called a SMART therapy (which stands for Single Maintenance and Reliever Therapy). Read more about SMART.
Montelukast is a type of anti-inflammatory medicine that comes in tablet form. It is used for asthma symptom prevention. It is generally less effective than steroid inhalers for most people with asthma.
People respond quite differently to this medicine, some very well, while others not at all. Montelukast may be useful if you have exercise-induced and viral-induced symptoms. It may also be useful if you can’t tolerate inhalers or don’t respond to inhaled preventers. Montelukast can be used in addition to steroid inhalers.
Montelukast is generally well tolerated. It has a rare risk of causing stomach pain, agitation and mood changes.
| Examples of relievers
Budesonide plus formoterol
- The combination of budesonide/formoterol as Symbicort or DuoResp Max is the preferred reliever.
- If you have mild asthma, you can use budesonide/formoterol as a reliever, without needing to use it regularly as a preventer as well.
- This is called AIR therapy (anti-inflammatory reliever therapy).
Salbutamol or terbutaline
- If you are using these inhalers, they should only be used occasionally.
- Using them too often (more than 2 times a week) means that your asthma is not well controlled.
- Tell your doctor if this is happening. You need your asthma medicine to be reviewed.
Prednisone (steroid tablets)
Prednisone is a tablet form of steroid that works very well to reduce inflammation (swelling) in your airways. If your asthma symptoms become severe or if you have an asthma attack, your GP or asthma nurse may give you a short course of prednisone tablets for a few days to help your asthma settle.
Short courses of prednisone are safe and have no lasting side effects. If you need prednisone more than 2 times a year then your asthma is not well controlled and you need to review your self-management plan with your doctor.
Important information about prednisone
- Good asthma care reduces the need for steroid tablets.
- If you need steroid tablets, your doctor should supervise this treatment and you should see them regularly.
- A medic-alert bracelet for steroids is only needed if you take steroid tablets for months or years.
- It's dangerous to suddenly stop taking steroid tablets if you have been taking them for months or years.
- Long-term treatment with steroid tablets is only needed in a small number of people with asthma.
What is an inhaler?
An inhaler is a device used to send medicine to your airways. By getting medicine directly to your lungs, smaller doses of medicine are needed and it can start working more quickly. The main types of inhaler devices are metered dose inhalers (MDI) and dry powder inhalers such as Turbuhalers, Accuhalers and Handihalers.
Read more about the different inhaler devices and the points to consider when deciding on the right inhaler for you.
What is a spacer?
A spacer is a long plastic tube that your inhaler fits into. It makes using an MDI inhaler much easier. Your doctor or nurse can show you how to use a spacer properly. Spacers are not just for children, adults can use them too. You can often get a spacer for free from your doctor – just ask them for one. Read more about spacers
Asthma medicines and competitive sports
If you are an athlete and need to take medicine to keep your asthma under control, you need to know which inhalers and medicines are allowed.
Many asthma medicines contain Beta2-Agonists, which are not allowed in competitive sport. If you need to take one of these inhalers, you need to apply for a therapeutic use exemption. Visit DrugFree Sports NZ for details.
Asthma medicines Asthma & Respiratory Foundation, NZ
Asthma medications Asthma New Zealand and The Lung Association, NZ
How is asthma treated and controlled? National Heart Lung & Blood Institute, USA
- NZ adolescent and adult asthma guidelines 2020 Asthma + Respiratory Foundation, NZ
Medicines that may trigger asthma symptoms
Some medicines can trigger asthma symptoms or make them worse. Not everybody with asthma is sensitive to these medicines, but if you have asthma, it is important to talk with your doctor before taking them. Always read the information leaflet and any warning labels on all medicines. This includes medicines from the pharmacy, supermarket, health food shops and other places. Whenever talking to people about your health, make sure that you tell them you have asthma. Examples of medicines that may trigger asthma include:
- aspirin and non-steroidal anti-inflammatories (NSAIDs)
- beta blockers
- complementary or herbal products.
Aspirin and non-steroidal anti-inflammatories (NSAIDs)
|NSAIDs available in New Zealand
- ibuprofen (Ibugesic®, I-Profen®, Nurofen®)
- diclofenac (Voltaren®)
- naproxen (Noflam®, Naprosyn®)
- ketoprofen (Oruvail®)
- celecoxib (Celebrex®)
- mefenamic acid (Ponstan®)
- sulindac (Aclin®)
- tenoxicam (Tilcotil®)
- etoricoxib (Arcoxia®)
- Many NSAIDs can be bought from your pharmacy without a prescription.
- Some NSAIDs, such as ibuprofen, can be bought from the supermarket. NSAIDs are usually available as tablets or capsules, some are available as a syrup and some are available as gels or creams that can be massaged onto the painful area.
- Aspirin is also an NSAID, but it is mainly prescribed in low doses to help to keep the blood from clotting, such as for people who have had a heart attack in the past for example, Aspec®, Cartia®, Cardiprin®.
Beta blockers are mostly used to control high blood pressure and treat heart failure. They are also used to control heart rhythm disorders (atrial fibrillation), prevent chest pain (angina) reduce tremor and fast heart rate in anxiety, and prevent migraine headaches.
|Examples of beta blockers
- celiprolol (Celol®)
- propranolol (Cardinol®)
|Beta blockers that also come in eye drops to treat glaucoma can also trigger asthma symptoms in some people.
- betaxolol (Betoptic ®, Betoptic S®)
- levobunolol (Betagan®)
- timolol (Arrow-Timolol®, Timoptol-XE®)
- brimonidine + timolol (Combigan®)
- dorzolamide + timolol (Arrow-Dortim®, Dorzolatim®).
Complementary or herbal products
For example, echinacea and royal jelly are known to worsen asthma symptoms.
How do you know which medications triggers your asthma?
Are your symptoms worse after you started taking the medication? Sometimes it’s not easy to find out exactly what triggers your asthma. This is because some triggers are invisible (such as grass pollen); you may have more than one trigger; and sometimes you may have a delayed reaction to a trigger. A bit of extra detective work may be needed - try keeping a diary of activities and symptoms to help you spot any patterns.
What should you do if these medicines trigger your asthma
- Take your preventer medication every day.
- If your symptoms get worse, use your reliever and use your asthma action plan.
- If its medication or herbal supplements that you've bought from your pharmacy or supermarket, avoid these in the future.
- If its medication that has been prescribed, such as a beta blocker, let your doctor know. They may be able to prescribe a different medicine or increase the dose of your preventer medication. Do not suddenly stop taking your beta blocker without talking to your doctor first. This can be dangerous and make you feel unwell.
- Other medicines and asthma Asthma + Respiratory Foundation NZ
- Medications may trigger asthma symptoms American Academy of Allergy Asthma and Immunonology