The Top 10 Asthma Medicines

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Given the prevalence of asthma and the different types of medications that a person may need to understand and use, it’s important to cover the top ten asthma medications and their role in asthma care.

Anti-inflammatory drugs (mast cell mediators)

Cromolyn and Tilade, were more popular years ago, as asthma management drugs but the are no longer used. Newer medicines offer better asthma control.

Long-acting beta-adrenoceptor agonists (LABAs)

These help asthmatics control bronchospasm long term. In some studies LABAs have been linked to life-threatening asthma attacks. Risk is greatest when LABAs are used without an inhaled corticosteroid. If used with the inhaled steroid, it can be an effective treatment for many asthmatics. Salmeterol (Serevent Diskus), Formoterol (Perforomist) and Artformoterol (Brovana) should be used in conjunction with an inhaled steroid – Fluticasone, Budesonide, Mometasone, Flunisolide, or Beclomethasone. We’ll discuss “combo options” of these two drug types next.

Combination inhalers

The combination of Fluticasone and Salmeterol (Advair Diskus or Advair HFA) in one inhaler offers the patient a “best option” for asthma control. Symbicort, Dulera and Breo ellipta are other combo options. These drugs may not be covered by some insurance providers, but some of the companies offer discount coupons.

Oral steroids

Prednisone and Medrol hit homeruns in those desperate situations when you need to gain control of inflammation in your lungs. Yet, due to side effects, these meds are best avoided unless you really need them. The best way to limit the need of these drugs is by maintaining good asthma control, which is best achieved by being compliant with your prescribed regimen.

Oral bronchodilators

Fifteen years ago Theophylline was one of the drugs in this group commonly prescribed that lead many asthmatics to improved asthma control. Yet now its usefulness has pretty much run out, and this old veteran was forced to retire. It was a great bronchodilator in its day, but the risks and side effects are far greater than newer medicines used to control asthma.

Immunomodulators

Here we have the latest trend in asthma medicines with Xolair an IgE inhibitors. This is an expensive and once or twice a month subcutaneous injection that works to prevent asthma symptoms when you're exposed to your asthma triggers. This is basically only used for those with severe, persistent allergic asthma not controlled with other meds on this list. To qualify for the drug, you have to meet certain IgE levels. Not to be used in the pediatric community under age six.

Xopenex (levabuterol)

This medication is used to treat wheezing and shortness of breath (SOB) that commonly occurs in asthma, COPD and some other lung diseases. It’s a “quick-relief” drug. It’s a beta-2 receptor agonist that helps to open breathing passages. It’s inhaled using a nebulizer, usually three times a day. It’s also dispensed as a metered-dose inhaler (MDI).

Albuterol

This emergency medication has helped many an asthmatic breathe better on the spot. However, if you need this medicine often, chances are your asthma is not under control. Every asthmatic should have this medicine on hand, although it should seldom be needed.

Inhaled corticosteroids

This group of medications includes Flovent, QVAR, Asmanex and Pulmicort as the big boys hitting in the middle of the lineup (using a baseball analogy), Use of one of these inhalers helps to treat chronic inflammation in your airways. Unlike oral corticosteroids, there are limited side effects and no systemic drawbacks.

Leukotriene modifiers

This group includes Singulair, Zyflo, and Accolate. These drugs help by blocking the allergic response and controlling inflammation. Only Singulair is approved for management of allergic rhinitis. Until I started taking this medicine spring hay fever season was miserable. Not anymore. For this reason alone, I have to rank this near the top of my personal asthma management team.

Given the prevalence of asthma among adults and children, there are efforts to continue to find medications with fewer side effects, as well as medications that help to limit exacerbations and specifically ones that target severe asthma. Fevipiprand is one such drug currently undergoing clinical trials.