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:
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:
- Inhaled, long-acting bronchodilators (also known as beta agonists). This type of medicine used to be prescribed quite often for people with asthma, until studies found that the risk of death from asthma actually increased when people took these drugs. Eventually, experts concluded that the reason for this was that this type of drug just wasn't adequate in controlling asthma by itself. But in combination with an inhaled steroid in a combination inhaler, long-acting bronchodilators do have a place in asthma treatment. Examples are Serevent and Foradil.
- Oral bronchodilators. In days past, medicines like Theophylline were commonly prescribed for asthma and other lung conditions and could be useful. They may still be used in some cases, but newer asthma medicines are more effective and have fewer and less severe side effects.
- Oral steroids. Prednisone is the most common in this class and is effective in controlling airway inflammation and helping asthmatics to recover from severe asthma attacks. Unfortunately, taking oral steroids for a long time can come with many side effects. So, they are usually only used in an emergency situation to get fast control over asthma symptoms or to prevent relapses after acute attacks.
- Non-steroidal anti-inflammatory drugs (NSAIDS). This type of asthma medicine blocks the action of mast cells in the body that release certain chemicals that trigger inflammation in your airways. As a result, they block the airway swelling and tightening and mucus typical of asthma. Examples include cromolyn sodium and nedocromil.
The Newest Hope for Severe Asthmatics
Sometimes, even the combination inhalers aren't enough to fully control asthma in people with extremely severe asthma. For the past few years, there has been another option, which is called an immunomodulator. Immunomodulators are asthma medicines that change how your immune system reacts to the asthma triggers you come into contact with.
This type of medicine blocks the action of Immunoglobulin E, also known as IgE. IgE is one of the major factors in allergic asthma. Your body normally produces small amounts of IgE, but in allergic people, IgE is produced in large amounts that cause asthma symptoms when you come into contact with your asthma triggers.
An example of an immunomodulator is Xolair. Xolair is an injectable medicine that must be given in a doctor's office, so it's not for everyone.
So, which of these asthma medicines are best for you?
Unfortunately, the only really correct answer to this question is, "It depends..." Every pharmaceutical company will try to convince you that their drug is best. And if you talk with other asthmatics, chances are they'll tell you whatever they take is best. But the truth is, we are each of us different, with slightly different things going on in our bodies.
So, how you will react to a specific asthma medication is not entirely predictable. Asthma treatment is very much a case of trial and error. Your doctor will prescribe something for you and wait to see how well it works.
My advice is to talk with your doctor about what asthma medication will be most right for you. Be willing to endure the trial and error process and give each a good 1 to 2 weeks to reach full effectiveness in your body. And, if necessary, you may want to consult with an asthma expert on your treatment plan. This includes both allergists and pulmonolgists.
Of course, the best way to prevent asthma symptoms is to avoid your asthma triggers, but that's not always an easy task. Another option, if you have allergic asthma, is to take allergy shots, which slowly desensitize you to your allergens over a period of months or years.