What Asthma Controller Medicine Works Best for You?

John Bottrell Health Pro
  • There are so many asthma controller medicines on the market that the choices can be overwhelming.  A common question I get is: which one is best for me? To answer this, you must first understand the basic components of asthma.


    Chronic:  All asthmatics always have some degree of inflammation in their air passages.


    Acute:  When this chronic inflammation is not controlled, exposure to asthma triggers may worsen the inflammation, resulting in increased mucus production and spasming of the air passages, both of which make it hard to breathe.


    Based on this knowledge, physicians now know that the best way to treat asthma is:

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    Control:  Control underlying inflammation.


    Prevention:  Prevent asthma symptoms.   


    Treat Flare-ups:  Treat acute symptoms when they occur.


    Learn about the different levels of asthma severity, asthma control, and how to gain control of your asthma.  


    This post is to help those of you who have come to the point where you and your doctor have determined that the best way of gaining control of your asthma is with asthma controller medications. Once you’ve come to this level of asthma treatment, you are committing yourself to a lifetime of taking asthma medicines. 


    It usually takes about two to three weeks for the medicine to start working. In order for the medicine to work, you have to take it every single day of your life even when -- especially when -- you are feeling well.  So, just because you are feeling good today means you will still have to take your controller medicines.  


    The wonderful thing about all the modern asthma controller medicines on the market is they all only have to be taken once or twice a day.  This makes it very easy to be compliant.  All you have to do is take your inhaler before you brush your teeth in the morning, and again in the evening.  If you have a once-daily medicine, you only need to do this once.  


    Another thing that is important regarding taking asthma controller medicines is to learn how to properly take the medicine.  Since there are so many inhalers on the market, and each one has a unique delivery device, I will provide a link with each medicine listed below so you can learn how to properly use that medicine.  Learning how to properly use your asthma controller medicine is essential to good asthma control.


    Also, as I list the various types of asthma controller medicines, I am going to note whether they are inhalers or solutions taken by nebulizer route.  I want it to be noted here that most asthmatics do very well using inhalers.  However, some asthmatics benefit from taking a nebulizer instead of an inhaler.  These would include:

    • Small children and infants who cannot coordinate an inhaler

    • Adults who cannot coordinate an inhaler, such as mentally challenged and elderly

    • Severe asthmatics who have trouble generating enough flow to actuate inhalers

    That said, what asthma controller medicine is best for you basically depends on the severity of your asthma.  Usually your physician will start with a simple inhaled steroid, and if one of these works no further treatment is necessary. Common inhaled steroids are:


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    Inhaled Steroid


    Qvar (beclomethasone)

    2 puffs twice a day/ inhaler

    Flovent( fluticasone)

    1-2 puffs twice a day/, inhaler

    Pulmicort (budesonide)

    twice a day/ solution taken by nebulizer


    If one of those medicines work, great!  You are good to go.  However, if you take one of them for a month or two and your asthma is still considered to be poorly controlled, then your physician might recommend a long acting beta adrenergic combined with an inhaled steroid.  


    Combination inhaler

    inhaled steroid



    Advair Discus



    1 puff twice daily/ inhaler

    Symbicort Turbohalert

    or inhaler



    2 puffs twice daily/ inhaler




    2 puffs twice daily/ inhaler

    Breo Ellipta



    1 puff once daily/ inhaler

    Brovana/ Pulmicort



    twice daily/ solution taken in nebulizer

    For the most part, most asthmatics (about 90 percent) should be able to obtain good asthma control with either an inhaled steroid alone, or with one of these combination inhalers.  However, when necessary, there are other medicines available for trial to help you gain control.  Some of these include:




    Combivent Respimat

    2 puffs four times daily

    Spiriva Handihaler

    One puff once daily


    1-2 doses per day/ pill taken orally


    Ideally, asthma control is determined by two things:

    • Use of rescue medicine less than 2-3 times in a two-week period, or...
    • You are comfortable with your present standard of living.

    Usually, finding the asthma controller medicine that works best to control your asthma is a matter of trial and error.  You will have to visit your physician regularly; you will have to heed his advice and instructions; you will have to take your controller medicine every day; and you will have to use proper technique when taking it.  


    It should be noted that just because you have obtained good control today, doesn't mean you will never have flare-ups. However, with good control, flare-ups should be less severe and less frequent.  


    When flare-ups occur, you may still use your asthma rescue medicine as prescribed.  However, please note that if you require your rescue medicine more frequently than 2-3 times in a two-week period, or you are using it more often than normal, this can be a sign of worsening asthma, and you should seek medical attention to regain control.  


    The great news is, there are plenty of medicinal options to help you control your asthma.  Finding out what one works best for you is usually accomplished by a matter of trial and error.  Once you obtain good control, you should be able to live a normal life with this disease.

    Never begin an asthma medication without first consulting with your doctor. If you experience adverse side effects, stop the medication and contact your doctor.

Published On: July 13, 2014