Which Asthma Medication Is Best?

One of the most common questions we get here on the site is some variation on, "Which asthma medicine is best?" So, I thought it might be helpful to write a post that addresses this issue for asthma. (A similar post on the Allergy site continues to be one of the most viewed posts I've ever written.)

There are many different types of asthma medicines on the market, with more being added regularly, so I know it can get confusing. There is no one right answer to the question of the best asthma medicine, but I will try to shed some light on your choices.

First, it's important to understand that the official Asthma Treatment Guidelines recommend that the first line of defense against asthma should always be an inhaled steroid. The reason for this is that asthma is an inflammatory disease of the airways. And steroids are the best medicine for controlling inflammation.

Inhaled steroids are what is considered an asthma controller medicine, which means that you take them every day (often twice a day) in order to prevent asthma symptoms from occurring. Every asthmatic should be on some type of asthma controller medication.

Here are some examples of inhaled steroids:

• Pulmicort (budesonide)
• Qvar (beclamethasone)
• Asmanex (mometasone)
• Flovent (fluticasone)

There are also steroid pills. Being on long-term steroids in pill form can have a number of bothersome or even serious side effects. The good news, though, is that inhaled steroids have very few of the same side effects, because they are mostly limited to acting in your airways, where they are most needed.

Unfortunately, inhaled steroids are not always successful in controlling asthma for every person. They do work great for most of us, but people with severe asthma may need to try something additional or something different altogether. Let's look at the choices:

• Leukotriene modifiers or blockers. This type of controller medicine can be used alone or in combination with inhaled steroids. Leukotrienes are a type of chemical in the body that contribute to airway inflammation in asthma. Leukotriene modifiers block the action of leukotrienes in your body. That, in turn, helps to reduce and prevent swelling and tightening inside your airways. It also stops mucus from forming. Singulair is one of the most popular leukotriene modifiers; others include Accolate and Zyflow.

• Combination asthma inhalers. When Singulair or an inhaled steroid alone don't adequately control asthma symptoms, a combination inhaler may be needed. A combination inhaler contains two different types of asthma controller medications in one device -- an inhaled steroid AND a long-acting bronchodilator. The two most common combination inhalers in the United States are Symbicort and Advair. These medicines have helped a lot of severe asthmatics finally achieve control.

Most people will be helped with one of more of the above options.

Less Common Asthma Medications

There are a few other types of medicines that have either fallen out of favor or been replaced by more effective medicines, but they can still have a role in asthma treatment for some people. They include: