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Medicine is a vital part of asthma management.
The aim of asthma medicine is to control your symptoms, prevent asthma attacks and improve your lung function.
There’s no cure for asthma, but with the right medicine and support you can get on with living without symptoms.
Your doctor will try to find the best asthma treatment for you. Keeping your asthma well controlled while using the least amount of medicine. Everyone has different needs and as a result your asthma plan will likely be different to someone else’s.
Finding out what medicine works best for you can be trial and error. So be sure to track your symptoms and have regular asthma reviews with your doctor. Ask for an update of your asthma action plan as needed.
You can get the most out of your medicine by using the right device and technique.
Using your asthma medicines and devices the right way has many benefits such as:
- medicines work better
- lowering your chance of side effects
- may reduce the number of puffs you need
- may save you money.
Learn how to use asthma devices and techniques here.
Asthma medicines are divided into around 3 main groups:
- Preventers – This medicine treats your asthma to help keep you symptom free. This includes preventers, combination preventers, non-steroidal preventers
- Relievers – This medicine treats symptoms caused by your asthma triggers. This includes relievers and dual-purpose relievers.
- Add-On Medicines – Help manage on-going asthma symptoms or severe asthma. This includes long-acting bronchodilators, oral corticosteroids, and monoclonal antibodies.
For generic names of asthma medicines see list of Active Ingredients Guide for Asthma Medication.
If you still have questions after reading this page you can book a free call with an Asthma Educator today.
Preventers
Other names: inhaled corticosteroids (ICS) or single preventer inhalers.
They contain just one corticosteroid medicine.
Includes medicines such as Alvesco, Arnuity, Flixotide, Fluticasone Cipla, Pulmicort, Qvar. (See list of Active Ingredients Guide for Asthma Medication).
HOW DO PREVENTERS HELP ASTHMA?
Preventers play a vital part in your asthma treatment. Preventers contain a corticosteroid which makes the airways less sensitive, reduces redness and swelling and helps to dry up mucus.
When you are prescribed a corticosteroid for asthma, your doctor is trying to copy the action of steroids that your body produces naturally to help reduce injury or inflammation.
Preventers:
- help to treat the underlying cause of the symptoms and
- work by treating the inside of airways to help keep them clear.
Most adults and some kids with asthma should be prescribed a preventer. Ask your doctor about preventers if you don’t have one. Some clear signs you need one are if you have:
- experienced asthma symptoms at least once per week
- symptoms that cause regular trouble with activities
- woken at night due to asthma symptoms once or more during the past month
- had a flare-up requiring an urgent visit to a GP or emergency department
- needed a course of oral corticosteroids.
If taken properly a preventer can:
- prevent symptoms
- reduce the likelihood of asthma attacks and
- improve asthma related quality of life.
If you have been prescribed a preventer medicine, you should take it every day as directed, even if you no longer have asthma symptoms and feel well.
Don’t stop taking it once you feel better, this is a sign that it is working!
It may take two to four weeks of regular use before your preventer medicine reaches its full effect.
Combination Preventers
Other names: Inhaled corticosteroids (ICS) plus long-acting bronchodilator or combination therapy inhalers.
Includes medicines such as Atectura, Breo, DuoResp, Enerzair, Fluticasone and Salmeterol Cipla, Flutiform, Fostair, Seretide, Symbicort, Trelegy, Trimbow. See generic names here: Active Ingredients Guide for Asthma Medication.
HOW DO COMBINATION PREVENTERS HELP ASTHMA?
Combination preventers contain two or three asthma medicines in combination: an inhaled corticosteroids (ICS) plus one or two long-acting bronchodilator medicines.
- Corticosteroid helps make the airways less sensitive, reduces redness and swelling and helps to dry up excess mucus.
- Long-acting bronchodilators relax tight airway muscles for up to 12 hours (some up to 24 hours).
When combination preventers are taken regularly they will reduce asthma symptoms or flare-ups. It may take a few weeks of consistent use to see signs of improvement.
Some combination preventers work within a few minutes and others take up to 30 minutes. Make sure you know which one you have been prescribed.
If your asthma is not being well controlled by your preventer treatment (ICS only), your doctor might ‘step up’ treatment by prescribing a combination preventer.
Combination preventers may be prescribed for people who have frequent asthma symptoms despite using their regular single preventer. If you use a combination preventer regularly and correctly, and still experience asthma symptoms, speak to your doctor. You might benefit from add-on medicines.
Non-Steroidal Preventers
Other name: Preventer tablet.
Brand names include APO-Montelukast, Lukair, Montelair, Montelukast, Montelukast APOTEX, Montelukast GH, Montelukast Lupin, Montelukast Mylan, Montelukast Sandoz, Singulair.
Active ingredient name is montelukast.
HOW DOES A NON-STEROIDAL PREVENTER HELP ASTHMA?
Montelukast helps asthma by blocking substances in the lungs called leukotrienes . Leukotrienes cause narrowing and swelling of airways.
Blocking leukotrienes improves asthma symptoms and helps prevent asthma attacks, as well as reducing hay fever symptoms. It can also be prescribed as an add-on treatment for adults.
Montelukast starts to work within a day but can take days to weeks of consistent use to show improvement.
Montelukast comes in a chewable tablet and is a common option for children. They can be used to help exercise-related asthma symptoms or hay fever.
Montelukast is usually started as a treatment trial and should be reviewed after four to six weeks of starting.
POSSIBLE SIDE EFFECTS
Overall, montelukast is a useful first line treatment for mild to moderate asthma and is generally very well tolerated. A safety review in April 2018 showed there was an association between montelukast and psychiatric side effects. These might include agitation, sleep disturbances and depression, or in rare cases, suicidal thinking and behaviour.
We recommend parents watch for mood, behaviour or sleep changes in their children after starting this treatment. Usually, these will be seen in the first two weeks and if so, visit your doctor. If your child develops suicidal thoughts or self-harming behaviours, seek medical attention urgently.
We urge doctors to discuss with you or parents/carers about the possible side effects of montelukast if prescribed. We advise you and parents/carers to be aware of the potential side effects and to closely monitor for any changes while taking montelukast. If you notice a change in behaviour, seek medical attention.
We recommend discussing your concerns with your doctor at the point of prescription. You can also visit this website Therapeutic Goods Administration to get more information.
Relievers
Other names: Short Acting Beta Agonists (SABA), Short Acting Bronchodilators
Includes medicines such as Airomir, Asmol, Ventolin, Zempreon and Bricanyl. Generic names here: Active Ingredients Guide for Asthma Medication.
HOW DO RELIEVERS HELP ASTHMA?
Relievers are fast-acting medicine that quickly relieve asthma symptoms like coughing, wheezing, being short of breath and a tight chest. They help to relax the muscles that are squeezing tight around the outside of the airways.
It is your Asthma First Aid medicine.
Everyone with asthma should always have a reliever medicine handy.
They work within minutes and can last for up to four hours.
Relievers can sometimes be used 15 mins before an activity or sport to help prevent asthma symptoms. Ask your doctor to include this on your Asthma Action Plan if this is right for you.
HOW OFTEN ARE YOU USING YOUR RELIEVER?
Relievers are an important medicine used to relieve your asthma symptoms. However, it’s important to know if you are using it too much.
If you are using your reliever more than two days per week or finishing three or more reliever puffers in one year your asthma could be poorly controlled, increasing your risk of an asthma attack.
WHY CAN’T I JUST USE MY RELIEVER PUFFER?
If you only use a reliever to treat your asthma, you are treating the symptoms but not the cause. This means your airways are more likely to react to triggers and are not protected from the increased risk of an asthma attack. People who rely too much on their reliever have a higher chance of severe and even life-threatening asthma attacks.
If you can relate to any of this, talk to your doctor about the possibility of being prescribed an asthma preventer.
A preventer will treat your underlying inflammation and sensitivity. Most people with asthma can lower their reliever use and maintain good asthma
control by using a preventer.
DOSE COUNTERS ON RELIEVER PUFFERS
Relievers have dose counters allowing you to check how many puffs you have left. Writing the date on the canister helps you track how long your puffer lasts. Puffers (metered dose inhalers) with a dose counter are more sensitive to blockage, so it is important to clean your puffer weekly to keep it working.
View cleaning instructions here for Asmol, Ventolin, and Zempreon
Dual Purpose Relievers
Other names: As needed preventer, Anti-Inflammatory Reliever (AIR) (budesonide/formoterol)
Limited to these medicines: DuoResp Spiromax 200/6, Symbicort Rapihaler 100/3, Symbicort Turbuhaler 200/6. See generic names here: Active Ingredients Guide for Asthma Medication.
Dual purpose relievers are limited to specific strengths of already existing asthma medicines.
Dual purpose relievers are a different way of using an asthma medicine for people with mild asthma. Dual purpose relievers might be another option for people with mild asthma who use a daily low-dose preventer and an as-needed reliever.
You can read more about dual purpose relievers in our guide
HOW DO DUAL PURPOSE RELIEVERS HELP ASTHMA?
Dual purpose relievers relax tight airway muscles and treat inflammation in the airways.
The combination of budesonide/formoterol in the dual purpose reliever, when used as needed, can relieve symptoms and reduces your chance of having more serious asthma flare-ups.
Dual purpose relievers are a treatment option for mild asthma only. Mild asthma is when you:
- only experience few symptoms
- don’t wake at night due to symptoms and
- have not experienced a flare-up in the past year.
It is important to recognise and treat your asthma symptoms, even mild symptoms.
WHEN DO I USE A DUAL PURPOSE RELIEVER?
Use your dual purpose reliever inhaler for the same reasons as using a blue/grey reliever inhaler. You should use it as needed to relieve your asthma symptoms. You can also use it before exercise or when you know you are going to have contact with or experience a known trigger (e.g. allergen, dust, vacuuming).
You do not need to rinse and spit after using a dual-purpose reliever.
If you are finding your symptoms continue over two or three days despite using your dual purpose reliever see your doctor for an asthma review.
If your asthma symptoms increase, you can take more doses to relieve the symptoms to the maximum doses below (or as directed by your doctor). If you need more doses than shown below, see your doctor, or seek medical attention as soon as possible, as you may be having an asthma flare up.
DuoResp Spiromax 200/6
Do not use more than 6 inhalations on a single occasion or more than 12 inhalations in any day.
Symbicort Rapihaler 100/3
Do not use more than 12 puffs on a single occasion or more than 24 puffs in any day.
Symbicort Turbuhaler 200/6
Do not use more than 6 inhalations on a single occasion or more than 12 inhalations in any day.
USING YOUR DUAL PURPOSE RELIEVER FOR ASTHMA FIRST AID
When using a dual purpose reliever, you no longer need to have a separate blue/grey reliever.
If you do have a flare up, you will use your dual purpose reliever for asthma first aid.
You can download and print the steps for Asthma First Aid using your dual purpose reliever here.
Add-On Inhaled Medicines
LONG-ACTING BRONCHODILATORS
Other names: long-acting relievers, long-acting beta agonist (LABA).
Includes medicines such as Oxis, Serevent, Spiriva. See generic names here: Active Ingredients Guide for Asthma Medication.
HOW DO LONG-ACTING BRONCHODILATORS HELP ASTHMA?
Long-acting bronchodilators work to relax the muscles around the airways. They are called ‘add-ons’ because they should only ‘add on’ to your asthma treatment, not be used alone or as the first option. They are not a preventer treatment, as they do not reduce swelling in your airways.
Long-acting bronchodilators last longer to help keep your airway muscles relaxed and open and most don’t work as fast as your reliever. They should NOT be used in place of your prescribed reliever or dual purpose reliever.
Long-acting bronchodilators may be found in a separate inhaler (to be used as an add-on together with a preventer inhaler) or are included as part of a combination preventer inhaler.
Atrovent
Other names: Short-acting muscarinic antagonist/anticholinergic bronchodilator.
The active ingredient is ipratropium.
HOW DOES ATROVENT HELP ASTHMA?
This add-on medicine helps in treating asthma attacks. It works by opening the narrowed tight airways to help with breathing, using a different pathway to relievers. It is usually used together with your blue/grey reliever.
It begins to act quickly after use but may take up to 2 hours to give most benefit.
It is only used when you have asthma symptoms. Ask your doctor how long you should use Atrovent after your flare-up.
Oral Corticosteroids
Commonly called rescue medicine, steroid tablets, pred, prednisolone, oral or systemic corticosteroids.
Includes medicines such as Panafcortelone, Predmix, Predsolone, Redipred, Solone, Panafcort or Sone. The active ingredient is prednisolone or prednisone.
HOW DO ORAL CORTICOSTEROIDS WORK?
Oral corticosteroids (OCS) are a powerful medicine that act in the body to help reduce inflammation. It quickly reduces the swelling in your lungs, helping you to breathe more easily.
They are much stronger than the inhaled corticosteroid in preventer inhalers. Because it is a much stronger dose, it can also have an effect on other parts of your body, not just your lungs.
OCS usually take up to 1-2 hours to start working.
WHY MIGHT YOU NEED ORAL CORTICOSTEROIDS?
You might be prescribed a short course of oral corticosteroid to help regain asthma control during a flare-up or after an asthma attack.
If you have used oral corticosteroids more than twice in a year or for long periods, it is important to discuss other options with your doctor for improving your asthma control.
This might include:
- checking your inhaler technique to make sure you are getting the most from your preventer
- exploring any issues with taking your preventer consistently
- discussing the possibility of add-on therapies for your asthma
- exploring other health conditions impacting your breathing.
HOW DO YOU USE ORAL CORTICOSTEROIDS?
Oral corticosteroids are usually prescribed as a tablet that you swallow for adults, or a liquid for children. You will usually take this medicine for 5-10 days for adults and 3-5 days for children.
Weaning down doses of oral corticosteroids is usually only needed when taken longer term (more than 14 days).
Your doctor may include oral corticosteroid medicine on your written Asthma Action Plan as a step to take if your asthma worsens.
WHY MIGHT YOU NEED LONG TERM ORAL CORTICOSTEROIDS?
If you have severe asthma, you might be prescribed oral corticosteroids long term. This could be months or even years. Your doctor or specialist will only prescribe this if it is necessary to prevent you from having regular flare-ups.
If you are prescribed long term oral corticosteroids, ask your doctor or specialist if any monoclonal antibodies are suitable for you – they could reduce or eliminate your need for long term oral corticosteroids.
MONOCLONAL ANTIBODIES
Also known as biologics, biologic therapies or injectables.
Includes medicines such as Dupixent, Fasenra, Nucala, Xolair. See generic names here: Active Ingredients Guide for Asthma Medication.
WHY MIGHT YOU NEED MONOCLONAL ANTIBODIES
Monoclonal antibodies are for specific types of severe asthma. Severe asthma is asthma that remains uncontrolled despite high-dose combination preventer or maintenance oral corticosteroids, or asthma that requires such treatment to prevent it becoming uncontrolled. Less than 4% of adults with asthma have severe asthma. Severe asthma is sometimes also called ‘severe refractory asthma’ or ‘severe treatment-resistant asthma’.
Your asthma specialist will conduct tests to figure out which monoclonal antibody will target your specific type of asthma. These might include:
- blood tests
- breathing tests
- scans and investigations of the chest and lungs
- skin prick testing
- sputum testing.
HOW DO MONOCLONAL ANTIBODIES HELP SEVERE ASTHMA?
This medicine is for severe eosinophilic asthma and severe allergic asthma. Monoclonal antibodies target pathways in the immune system that cause the airway inflammation seen in asthma. You will only respond to a particular treatment if that specific pathway is the cause of your severe asthma.
Professor Peter Gibson says that “biologics therapies make a big difference, for example, a 50 per cent reduction in the rate of severe attacks. We expect to see reduced presentations for asthma attacks in severe asthma patients.”
ELIGIBILITY FOR MONOCLONAL ANTIBODIES
You will need a diagnosis for severe asthma to have monoclonal antibodies prescribed. Often people mistake uncontrolled asthma for severe asthma.
- Monoclonal antibodies can only be prescribed and obtained from a specialist.
- These medicines are subsidised for use by the PBS provided certain strict criteria are met.
- To be eligible to start subsidised monoclonal antibody therapy under the PBS, you must be under the care of the same specialist for at least a six-month period. (This can be less if you have received a diagnosis by a multidisciplinary asthma clinic team.)
- Reviews must be carried out by the specialist at set times for continuing PBS-funded treatment.
HOW DO YOU TAKE MONOCLONAL ANTIBODIES?
Monoclonal antibodies are delivered by injection every two to eight weeks.
After treatment is started by a specialist, your ongoing doses can be given by your doctor. Some monoclonal antibodies are available as a pre-filled syringe for you to give yourself at home.
Do you know how to use your asthma medicines and devices?
Using your asthma medicine inhaler and device properly is vital to make sure the medicine gets to your lungs where it is needed. This is true no matter what type of inhaler or device you are using.
Make sure you are using your inhaler correctly here.
It is extra important to use a spacer if you use a metered-dose inhaler device (puffer), as this will also reduce the chance of any side-effects.
All medicines have possible side effects, but not everybody will experience them. When you are recommended a medicine, it’s important to ask questions about side effects and what they mean for you.
While most side effects are mild, some medicines do pose the chance of more serious reactions. Tell your doctor or pharmacist if you notice any of the following or if they worry you. Possible side effects from the above medicines are uncommon but may include:
