Many people with asthma need to take long-term control medications daily, even when they don't have symptoms. There are several types of long-term control medications, including the following. These anti-inflammatory drugs are the most effective and commonly used long-term control medications for asthma.
They reduce swelling and tightening in your airways. You may need to use these medications for several months before you get their maximum benefit. In children, long-term use of inhaled corticosteroids can delay growth slightly, but the benefits of using these medications to maintain good asthma control generally outweigh the risks.
Regular use of inhaled corticosteroids helps keep asthma attacks and other problems linked to poorly controlled asthma in check. Inhaled corticosteroids don't generally cause serious side effects. When side effects occur, they can include mouth and throat irritation and oral yeast infections.
If you're using a metered dose inhaler, use a spacer and rinse your mouth with water after each use to reduce the amount of drug remaining in your mouth. These medications block the effects of leukotrienes, immune system chemicals that cause asthma symptoms. Leukotriene modifiers can help prevent symptoms for up to 24 hours. Examples include:.
In rare cases, montelukast is linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. See your doctor right away if you have any unusual reactions. These bronchodilator brong-koh-DIE-lay-tur medications open airways and reduce swelling for at least 12 hours. They're used on a regular schedule to control moderate to severe asthma and to prevent nighttime symptoms.
Although they're effective, they've been linked to severe asthma attacks. For this reason, LABAs are taken only in combination with an inhaled corticosteroid. You take this bronchodilator daily in pill form to treat mild asthma. Theophylline Theo, others relaxes the airways and decreases the lungs' response to irritants. It can be helpful for nighttime asthma symptoms.
You might need regular blood tests to make sure you're getting the correct dose. Potential side effects of theophylline include insomnia and gastroesophageal reflux. These asthma medications open the lungs by relaxing airway muscles. Often called rescue medications, they can ease worsening symptoms or stop an asthma attack in progress. They begin working within minutes and are effective for four to six hours. They're not for daily use. Some people use a quick-relief inhaler before exercise to help prevent shortness of breath and other asthma symptoms.
Possible side effects include jitteriness and palpitations. If your symptoms are minor and infrequent or if you have exercise-induced asthma, you might manage your symptoms with one of these medications alone. However, most people with persistent asthma also need an inhaled corticosteroid or other long-term control medication. If you need to use your inhaler more often than your doctor recommends, your asthma is not under control — and you may be increasing your risk of a serious asthma attack.
Ipratropium Atrovent HFA is a short-acting bronchodilator that's usually prescribed for emphysema or chronic bronchitis, but is sometimes used to treat asthma attacks. It may be used either with or as an alternative to short-acting beta agonists. These medications may be taken to treat severe asthma attacks.
They can cause bothersome short-term side effects and more-serious side effects if they're taken for a long period. Long-term use of these medications can cause side effects including cataracts, thinning bones osteoporosis , muscle weakness, decreased resistance to infection, high blood pressure and reduced growth in children.
Allergy shots. Allergy shots immunotherapy may be an option if you have allergic asthma that can't be controlled by avoiding triggers. You'll begin with skin tests to determine which allergens trigger your asthma symptoms. Then you'll get a series of injections containing small doses of those allergens.
You generally receive injections once a week for a few months, and then once a month for three to five years. In some cases, immunotherapy can be done more quickly. Over time, you should lose your sensitivity to the allergens. Allergy medications. These include oral and nasal spray antihistamines and decongestants, as well as corticosteroid and cromolyn nasal sprays.
Allergy medications are available over-the-counter and in prescription form. They can help with allergic rhinitis but aren't substitutes for asthma medications. Corticosteroid nasal spray helps reduce inflammation without causing the rebound effect sometimes caused by nonprescription sprays.
Because it has few, if any, side effects, cromolyn is safe to use over long periods of time. Your doctor may recommend treatment with biologics if you have severe asthma with symptoms not easily managed by control medications. Omalizumab Xolair is sometimes used to treat asthma triggered by airborne allergens. If you have allergies, your immune system produces allergy-causing antibodies to attack substances that generally cause no harm, such as pollen, dust mites and pet dander.
Omalizumab blocks the action of these antibodies, reducing the immune system reaction that causes allergy and asthma symptoms. Omalizumab is given by injection every two to four weeks. It isn't generally recommended for children under In rare cases, this medication has triggered a life-threatening allergic reaction anaphylaxis. In addition, the FDA has issued a warning about a slightly increased risk of heart and brain blood vessel problems while taking this drug.
Anyone who gets an injection of this drug should be monitored closely by health professionals in case of a severe reaction. A newer class of biologic drugs has been developed to target specific substances secreted by certain immune system cells.
It is important to rinse with water and spit after each dose of inhaled steroids. Bronchodilators are non-steroid medications that help open up your airways by relaxing small muscles that tighten them. Some bronchodilators are rapid-acting, and some are long-acting. The rapid-acting bronchodilators are used as "rescue" or quick — relief medications to immediately relieve your asthma symptoms, and include albuterol, levalbuterol, terbutaline and ipratropium.
Although they make you feel better and breathe easier in the short — term, these drugs commonly do not solve the underlying problems that lead your asthma symptoms to appear. If you regularly need these rescue medications more than two times per week, your asthma isn't being properly controlled or there is something else going on that is causing your airways to be blocked.
See your allergist to change your treatment. Long-acting bronchodilators are used to provide asthma control instead of quick relief of asthma symptoms. They should only be used in conjunction with inhaled steroids for long-term control of asthma symptoms. These medications include salmeterol and formoterol.
Salmeterol and formoterol are long-acting beta 2-agonist bronchodilators with an anti-inflammatory medication on a regular daily , rather than as-needed, basis. Each of these long-acting bronchodilators is available in combination with a corticosteroid within one inhaler. Finally, tiotropium is an example of an inhaled long acting anticholinergic medication that is sometimes used as add-on therapy to improve asthma control and prevent asthma symptoms in both children and adults.
Types of Inhalation Devices - Asthma Inhalers There are three basic types of devices that deliver inhaled medications. The most common is the metered — dose inhaler MDI , which uses a chemical propellant to push the medication out of the inhaler.
Nebulizers deliver fine liquid mists of medication through a tube or a "mask" that fits over the nose and mouth, using air or oxygen under pressure. Dry powder inhalers DPIs deliver medication without using chemical propellants, but they require a strong and fast inhalation.
No matter which you use, getting the medication to your lower airways is essential for the medication to work. For all devices, education and training on how to correctly use them is very important. A device called a spacer may be prescribed if you're having trouble getting the medicine to your airways with an MDI. Spacers help you coordinate your inhaled breath with the release of the medication from the MDI canister. With many MDIs, the spacer also makes the medication droplets smaller, so they can more easily get into your lower airways where they are needed.
There are also MDIs with built-in spacers. Using a dry powder inhaler is very different than an MDI.
A calcium-rich diet paired with a daily calcium supplement 1, to 1, milligrams combine is recommended for those at the highest risk of bone fractures, including post-menopausal women or older adults. Weight-bearing exercises such as walking and an adjustment in the steroid dose may also help if the bone loss is severe. The long-term use of oral steroids is known to increase the risk of cataracts clouding of the eye lens and glaucoma optic nerve damage caused by increased inner eye pressure.
It is possible for inhaled steroids to do the same, especially in older adults already at high risk of cataracts and glaucoma. A study in the Digital Journal of Ophthalmology found that adults who used inhaled budesonide for no less than six months had significant increases in inner eye pressure.
Similarly, inhaled steroid users exposed to a lifetime dose of two million micrograms suggesting high-dose, long-term use were found to be at greater risk of cataracts than those who received lower doses. If you develop glaucoma or cataracts develop due to inhaled steroid use, the benefits and risks of your treatment need to be weighed on an individual basis and your treatment may need to be modified.
Surgical intervention may also be considered, including laser trabeculectomy for glaucoma or extracapsular surgery for cataracts. While some of the side effects of inhaled steroids are concerning, it is always important to weigh the effect on your respiratory function against the possible consequences of use. In most cases, inhaled steroids can be taken safely under the supervision and routine care of a doctor.
If you are experiencing side effects from a steroid drug, speak with your doctor about alternatives or adjustments that may help. But never stop treatment without your doctor's OK as this can lead to steroid withdrawal and a rebound of symptoms.
Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Practical considerations for dysphonia caused by inhaled corticosteroids. Mayo Clin Proc. Inhaled corticosteroids and systemic or topical antifungal therapy: A symmetry analysis.
Ann Am Thorac Soc. The frequency and risk factors for oropharyngeal candidiasis in adult asthma patients using inhaled corticosteroids. Turk Thorac J. Centers for Disease Control and Prevention. Candida infections of the mouth, throat, and esophagus. Updated November 13, Systemic effects of inhaled corticosteroids: An overview. Open Respir Med J. Inhaled corticosteroids and bone health.
The effect of inhaled steroids on the intraocular pressure. Digit J Ophthalmol. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. Table of Contents View All. Table of Contents. Oral Thrush. Vision Problems.
How Oral and Inhaled Steroids Differ. Combination Inhalers Used in the Treatment of Asthma. How to Get Relief for Oral Thrush. We reviewed the literature using the search terms "hypersensitivity to steroids, adverse effects of steroids, steroid allergy, allergic contact dermatitis, corticosteroid side effects, and type I hypersensitivity" to identify studies or clinical reports of steroid hypersensitivity.
We discuss the prevalence, mechanism, presentation, evaluation, and therapeutic options in corticosteroid hypersensitivity reactions. There is a paucity of literature on corticosteroid allergy, with most reports being case reports. Most reports involve non-systemic application of corticosteroids. Steroid hypersensitivity has been associated with type I IgE-mediated allergy including anaphylaxis. The overall prevalence of type I steroid hypersensitivity is estimated to be 0.
Allergic contact dermatitis ACD is the most commonly reported non-immediate hypersensitivity reaction and usually follows topical CS application. Atopic dermatitis and stasis dermatitis of the lower extremities are risk factors for the development of ACD from topical CS.
Patients can also develop hypersensitivity reactions to nasal, inhaled, oral, and parenteral CS.