Treatments for Asthma: Controller Meds and Rescue Meds

What are the two types of asthma medications? Asthma medications can be divided into two basic categories:

• Controller medication. These are taken every day for people with persistent asthma. This means asthma symptoms that last more than two days a week or two nights a month
• Rescue medication. These work quickly and are taken to stop an asthma attack when symptoms appear

What are the controller medications?

Once asthma has been diagnosed, many people start on controller medicines. These are also called long-term preventive or maintenance medications. They are taken daily on an ongoing basis. They calm the airways and control symptoms by reducing inflammation, opening the airways and improving breathing ability.

Types of long-term control medications include:

• Inhaled corticosteroids. These are the most potent and effective long-term control medicines for asthma. They are a type of steroid medication that blocks the chemicals in your body that cause inflammation. Inhaled corticosteroids are considered safe for long-term use because they are targeted directly at the lungs. Absorption by the body is limited. Examples include fluticasone (Flovent) and budesonide (Aerobid).
• Cromolyn sodium and nedocromil sodium. These medicines reduce inflammation and also help to prevent asthma attacks. They are less effective than inhaled steroids. These drugs are typically used as daily controller medications, but they can also be used before exercise or exposure to an allergic asthma trigger. Examples include nedocromil (Tilade) or sodium cromoglycate (Intal).
• Long-acting beta-agonists (LABAs). These medications relax the bronchial tubes and prevent them from tightening up and causing symptoms. They are not used alone to treat asthma. Instead they are used combined with another controller medication, such as an inhaled corticosteroid, as daily medicine for moderate or severe persistent asthma when a controller medication alone is not enough. In combination, these medicines may help prevent symptoms for those with nighttime symptoms and/or exercise-induced asthma. They work for up to 12 hours. They are not for use as quick-relief medication. Long-acting beta agonists are sometimes linked with severe asthma episodes, so you should discuss with your doctor the risks and benefits of using them. Your doctor may decide to stop the LABA, if possible, once control is achieved. Examples include formoterol (Foradil) and salmeterol (Serevent), which contain only the LABA. Advair and Symbicort are medications that contain both a LABA and a steroid controller medication.
• Methylxanthines. Theophylline is the main drug in this class. It is a pill that acts as a bronchodilator. It's rarely used in asthma treatment today and is noted for significant side effects. These include nervousness, hyperactivity, upset stomach and headaches. Tell your doctor if you are taking any other medicine with theophylline, because there may be a drug interaction.
• Leukotriene modifiers. Antileukotrienes, also known as leukotriene inhibitors or modifiers, block leukotrienes, which contribute to inflammation of the airways. These drugs are used for mild persistent asthma if other medications can't be taken or are not effective. They can also be add-on therapy with moderate or severe persistent asthma. Side effects may include headache and nausea. Examples include montelukast (Singulair) or zafirlukast (Accolate).
• Immunomodulators. The main drug in this class is omalizumab (Xolair). It is taken by injection and works by blocking the antibody IgE, which is what leads to allergic reactions. This drug can be used in moderate to severe persistent allergic asthma when inhaled corticosteroids do not control symptoms.
• Combination therapy. Sometimes a long-acting beta-agonist is added to a low-to-medium dose of inhaled corticosteroids to control symptoms. Advair and Symbicort are medications that contain both a LABA and a steroid controller medication. Adding a leukotriene modifier or theophylline to inhaled corticosteroids may also improve asthma control. The evidence for this is not as strong, though.

What are the rescue medications?

These are also called quick-relief or rescue medicine. This type of medication works quickly to relieve flare-ups of asthma symptoms. They can "rescue" you and keep symptoms from getting worse. Most of these drugs come in a canister and are inhaled. Relievers work by quickly opening airways and increasing airflow.

Quick-relief medicine is not meant to be used daily. Relievers are used at the moment you are having a flare-up of symptoms. Some are used before exercise in those who have exercise-induced asthma. No matter how light or severe your asthma is, your doctor will make sure that you have a reliever medication available.

NOTE: If you are using your rescue inhaler more than twice a week, then your asthma may not be in good control. You may also need a long-term controller medicine if you don't already have one. Talk to your doctor about adjusting your medications.

• Short-acting beta-agonists. These are the most effective bronchodilators. When bronchial muscles tighten, the airway is narrowed and asthma symptoms occur. These drugs work rapidly (within three to five minutes) to open the airways and improve breathing. Possible side effects are shakiness, jitteriness or rapid heartbeat. These should wear off after several weeks as the body adjusts to the medicine. Examples include albuterol HFA (Proventil or Ventolin) and pirbuterol CFC (Maxair).
• Anticholinergics. This type of medicine relaxes muscles around the airways to reverse airway narrowing and stop spasms in the bronchial muscles. The only approved drug in this class is ipratropium bromide (Atrovent HFA). It is typically used along with a short-acting beta-agonist for people who have severe asthma episodes or as an alternative for those who can't tolerate short-acting beta-agonists.
• Oral corticosteroids. These are medications (usually prednisone) that may be used in moderate or severe asthma attacks. They are only used for a few days and then the dose is sometimes lowered slowly. If your doctor has you on prednisone for your asthma more than three times in a year, it probably means you need to change your asthma management.

Other Treatments

Allergy desensitization shots. Some people who have asthma symptoms triggered by allergies can't control their symptoms with medication. In these cases, immunotherapy (allergy shots) may offer relief and even help prevent the onset of airway inflammation.