What’s the Best Medicine for Your Asthma?

Most recently updated July 7th, 2023

Estimated Reading Time: 17 minutes

If you or your children are asthmatic,  you’ve probably spent a lot of time looking for the best medicine for your asthma.

Or maybe looking for better asthma treatments, if you’ve already been prescribed something. 

If you’ve read some of my other posts, you know that I’ve had asthma and have been fighting it my whole life, with both medical and non-medical tools.

In the U.S., asthma affects more than 25 million people.

There is no cure, but some people do “grow out” of it (meaning you don’t have obvious symptoms), and medical drugs are available that treat the symptoms for those that have them.  

I didn’t grow out of it, and from childhood through young adulthood, my parents tried all available medical options to make my illness better.

But in spite of allergy shots and prescribed inhalers and pills, my asthma got worse every year. 

Finally, as a young adult, I had an epic attack that led to complete respiratory failure and several days unconscious on a ventilator.

When I woke up, the doctors just told me to take more medicine and stay in a controlled environment.

That’s when I became very pro-active in my search for better treatments and lifestyle choices to reduce my asthma symptoms and prevent future severe attacks.

I’ve had some success 🙂

In this post I tell you about the prescribed medical options available now, and the ones I’ve used – and mostly still use – that appear to help my chronic asthma.

For inspiration I’m also sharing photos of beautiful places I’ve been able to hike, without any trouble breathing!

Some of my posts contain affiliate links.  If you make a purchase through an affiliate link, I will receive a small payment at no additional cost to you. As an Amazon Associate, and other marketing affiliations,  I earn from qualifying purchases.   See full Disclosure page here.

 The first step to getting some relief is figuring out what kind of asthma you or your kids have.

Asthma can affect the breathing of children or adults, and symptoms range from fairly mild to life-threatening.

NOTE:  I am not a medical practitioner, and speak only from my own personal experience and what I’ve found in research.   As always, consult your doctor before making substantial changes in your medications, exercise, or eating habits.

What Kind of Asthma Do You Have?

The easiest way to classify your asthma is to identify the things that cause an attack – i.e. your triggers.

 Some Common Asthma Triggers: 

• • • Smoke – cigarette and  fire smoke
    • Air Pollution – smog, car exhaust, other air pollution
    • Chemicals in food
    • Pet dander
    • Pollen, Mold and Dust
    • Food allergies
    • Insect bites and stings

Prior to the 1900’s, it was generally agreed that asthma was caused by either an allergy or a mental disturbance of some kind.

Then in 1916 Francis Rackemann found that not all non-psychosomatic asthma was as a result of allergies.

(The psychosomatic theory has been largely discounted, but sadly, is seeing some resurgence.   But that’s a story for another time….)

Allergic or Non-Allergic

He designated the two main categories of asthma as  “intrinsic” (non-allergic) and “extrinsic” (allergic).

• • • Extrinsic asthma is your body’s reaction to an air-borne or ingested allergen.
    • Intrinsic asthma is a reaction that does not include an external allergen.

You can have either kinds of asthma or both.   I’m lucky enough to have both kinds 🙂

If you have allergies, your immune system produces antibodies to attack substances that generally cause no harm, such as pollen, dust mites and pet dander.

For asthmatics, our allergic immune response includes tightening and inflammation of airways, plus secretion of thick mucous in the lungs – making it very hard to breathe.

It wasn’t until 1921 that doctors also realized that most asthmatics have allergic reactions to both indoor AND outdoor irritants.

The asthmatic over-achieving immune system responds to other non-allergic (intrinsic) events in the same way.

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World Asthma Day

World Asthma Day is held each May by the Global Initiative for Asthma, (GINA) (www.ginasthma.org), a World Health Organization (WHO) collaborative organization founded in 1993.   

According to WHO, or is that whom? :-),  it’s estimated that in 2016 alone more than 339 million people had asthma worldwide and there were 417,918 deaths due to asthma across the globe.   

This year’s World Asthma Day theme was “Uncovering Asthma Misconceptions”.  Learn more about World Asthma Day here.

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No matter what, asthmatics should try to avoid their known triggers whenever they can.

The types and doses of asthma medications you need depend on your symptoms, the severity of your asthma, and known medication side effects.

Asthma can change over time, so you should work closely with your doctor to track your symptoms and adjust your asthma medications, if needed.

NOTE:   This section is long, and packed full of information that (of necessity) requires lots of potentially tiresome reading.  I’ve tried to make it interesting with comments about my own experiences with each type of drug. 🙂

Long-term Control Medications

There are several types of long-term asthma control medications, including the following.

Inhaled corticosteroids

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.

 Inhaled corticosteroids include: 

• • • • Fluticasone (Flovent HFA)
      • Budesonide (Pulmicort Flexhaler)
      • Mometasone (Asmanex Twisthaler)
      • Beclomethasone (Qvar RediHaler)
      • Ciclesonide (Alvesco)

Regular use of inhaled corticosteroids helps keep asthma attacks and other problems linked to poorly controlled asthma in check.

Leukotriene Modifiers

These medications block the effects of leukotrienes, immune system chemicals that cause asthma symptoms.

Leukotriene modifiers can help prevent asthma symptoms for up to 24 hours.

 Leukotrine Modifiers include: 

• • • • Montelukast (Singulair)
      • Zafirlukast (Accolate)
      • Zileuton (Zyflo)

In rare cases, montelukast can be linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thoughts.

Long-acting beta agonists (LABAs)

These bronchodilator medications open airways and reduce swelling for at least 12 hours.

LABAs are used on a regular schedule to control moderate to severe asthma and to prevent nighttime symptoms.

Though effective, they’ve also been linked to severe asthma attacks.  To combat this, LABAs are taken only in combination with an inhaled corticosteroid.

The most commonly used LABA for asthma is salmeterol (Serevent).

I have been using Serevent for years with success, both in diskus and inhaler form.

Theophylline

You take this bronchodilator daily in pill form to treat mild asthma. The active ingredient is derived from a compound found in coffee.

I was prescribed Theophylline pills as a child through young adulthood, but usually didn’t take them until I needed them, and when I did they made me jittery.

Then, when I was in my 20’s and having an especially bad season,  I started taking more of these pills and had to get frequent refills.

When the Pharmacist accused me of selling them (?!)  I decided to:

1. 1. 1. Get a new pharmacy and
      2. Investigate other treatment options.

It never occurred to me that anyone would take this stuff for fun.  I hated taking so many pills…

That said, Theophylline  relaxes the airways, decreases the lungs’ response to irritants and can be helpful for nighttime asthma symptoms.

If you need a quick home treatment for mild wheezing, try drinking some hot coffee – it will help ease your breathing 🙂

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Theobromine 

I recently found myself looking for a new bronchodilator medicine when I couldn’t get my regular prescription inhalers due to supply chain issues.

I found Theobromine, a mild bronchodilator related to Theophylline, sold as an over-the-counter supplement in capsule form.   

Theobromine is milder than Theophylline and is often found as one of the ingredients in so-called “fat burning” diet supplements.   But it’s also sold in capsules on it’s own as a dietary supplement.

Theobromine, related to both caffeine and theophylline,  is a natural stimulant found in some foods, such as cocoa and chocolate (made with cocoa). 

So, what does it do?

Theobromine Benefits

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Corticosteroids and LABA Combos

Some inhaled asthma medications are a combination of both a corticosteroid and a bronchodilator:

• • • Fluticasone and salmeterol (Advair Diskus)
    • Budesonide and formoterol (Symbicort)
    • Mometasone and formoterol (Dulera)
    • Fluticasone and vilanterol (Breo)

Quick-relief Medications

Often called rescue medications, they can ease worsening symptoms or stop an asthma attack in progress by relaxing airway muscles.

They begin working within minutes and are effective for four to six hours.

Though not intended for daily use, some people use a quick-relief inhaler before exercise to help prevent asthma symptoms.

 Quick-relief medications include: 

• • • Albuterol (ProAir HFA, Ventolin HFA, others)
    • Levalbuterol (Xopenex HFA)

If your symptoms are infrequent or you only have exercise-induced asthma, you might manage just using a rescue inhaler.

I have used both ProAir and Ventolin and found them equally effective, so to me that’s a choice to make based on cost.

Most people with persistent asthma also need an inhaled corticosteroid or other long-term control medication to go along with the rescue inhaler.

Ipratropium

Ipratropium (Atrovent HFA) is a short-acting bronchodilator usually prescribed for emphysema or chronic bronchitis, but sometimes used to treat asthma attacks, too.  It may be used either with or instead of short-acting beta agonists.

Oral Corticosteroids (Pills)

These medications may be taken, usually in pill form,  to treat severe asthma attacks.

Though inhaled steroids have few side-effects, these pills are a stronger dose and can cause annoying short-term side effects, and more-serious side effects if they’re taken for a long period.

 Examples of these medicines include: 

• • • • Prednisone
      • Methylprednisolone

Whether inhaled or taken in pill form,  cortico-steroids are prescribed specifically to treat inflammation in the lungs.

I’ve only ever taken Prednisone following a hospitalization, and I hated them.  Apparently my body did, too, because I would start throwing them up within 3 days of being discharged.

That said, sometimes you have to take strong medicine until you can breathe real-world air again. 😉

Steroid Side Effects

Because inhaled corticosteroids are used over the long term, side effects can be a concern.

Possible side effects include:

• • • Fungal infections,
    • Hoarseness,
    • Bruising, and
    • Weight gain.

Long-term use of steroid asthma treatments in pill form can cause more serious side effects,  including cataracts, thinning bones (osteoporosis), muscle weakness, decreased resistance to infection, high blood pressure, mood swings, and reduced growth in children.

In my case, I’m more sensitive than usual to even the relatively small doses of steroids in inhalers, so I opted not to take them as a preventive medicine.

When I was young, there were no other medical options for long-term treatment of  asthmatic inflammation, but today we have more choices 🙂

Medication for Allergic Asthma

For most people, allergies are annoying and inconvenient, but for asthmatics an uncontrolled allergy can put us in the hospital.

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 see which allergens trigger your asthma symptoms, then get a series of injections containing small doses of those allergens to create an immunity to it.

When I had these tests done, they drew a grid on my back, and then pricked the skin inside each box with a different type of allergen.

They measured the skin reaction of each applied allergen to see which things caused me the most trouble.

There were several clear winners, including grain dust, mold and pet dander.

I took allergy shots for several years, but I’m not sure they did any good.

But I’m not sure they didn’t  either 😉

At the very least, the tests identified my triggers so I could take steps to avoid them.

Allergy Medications

Another thing you can do is take regular OTC allergy medications to help relieve your asthma.

These kinds of meds 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.

I regularly take Benadryl pills in addition to my asthma meds to keep my lungs clear during allergy season.

Epinephrine Auto-Injectors

Also known by the trademark name “Epi-Pen”, these are syringes full of epinephrine (adrenaline) which is a powerful fast-acting bronchodilator.

You need a prescription to get one of these.  They can be quite pricey, and expire within a year, so only get one if you really think you might need it.

This kind of treatment is recommended for people who have previously experienced and survived acute asthma attacks or non-asthmatic allergic anaphylaxis.

To use the syringe, you inject yourself in the thigh, and the correct dosage is administered automatically.  I have one, and always carry it in my purse.

NOTE:  You would only use this treatment if you have a known serious reaction.  For wheezing alone, you would use your fast-acting inhaler.   Talk to your Doc about whether or not you need one.

Be sure to hang on to the empty syringe and give it to the doctors at the hospital so they know how much medication you’ve taken.

Breathing Bad Air

How to Avoid Bad Ozone

The best way to avoid breathing ground level ozone is to live in a place where it doesn’t occur very often – someplace with lower population and industry, cooler temperatures, and lots of air movement (not in a valley).

If you can’t do that, keep an eye on the Air Quality Index (AQI) reports for your area, and plan accordingly.

 Other things you can do: 

• • • Stay indoors as much as possible when ozone/pollution levels are high.
    • Keep windows closed.
    • Use the circulate setting on your home thermostat to keep polluted air out.
    • Exercise or be outside in the morning when ozone levels are lowest.

NOTE:  Facemasks mandated for COVID-19 provide no protection against ozone.

If you do become exposed to bad ozone, just keep taking your prescribed asthma medications, but contact your doctor if problems persist.

Your lungs will usually recover within a few days after exposure to elevated concentrations of ozone.

Newest Treatments

Newer treatments, called Biologics, have been developed that make severe asthma easier to control.

Biologics

An estimated ~ 46,000 people with severe asthma may benefit from biologics, a new type of treatment some asthmatics call a “game-changer”.

Biologics are genetically engineered proteins that target the specific parts of the immune system that cause inflammation.

Clinical trials found that for those with severe asthma, using biologics can reduce asthma attacks by up to 50%.  Your doctor may recommend treatment with biologics if you have severe asthma with symptoms not easily managed by other control medications.

If you start taking biologics, keep taking all of your other long-term or quick-relief asthma medications unless your doctor tells you to stop. 

Biologic drugs work with your immune system to block the  immune system chemicals that make your airways swell up.

Omalizumab

Omalizumab (Xolair)  blocks the action of the immune system reaction that causes allergy and asthma symptoms.

Omalizumab is given by injection every 2-4 weeks. It isn’t generally recommended for children under 12.

In rare cases, this medication has triggered a life-threatening allergic reaction (anaphylaxis).

NOTE:  Anyone who gets an injection of this drug should be monitored closely by health professionals in case of a severe reaction.

Eosinophils and Cytokines

A newer class of biologic drugs has been developed to target specific substances secreted by certain immune system cells.

These drugs target eosinophils and cytokines, reducing their numbers within the body and lowering inflammation.

 These medications include: 

• • • • Mepolizumab (Nucala)
      • Benralizumab (Fasenra)
      • Reslizumab (Cinqair)

These drugs treat severe asthma that’s caused by a type of white blood cell called an eosinophil (eosinophilic asthma). You take them by injection or through an IV into a vein.

Tiotropium (Spiriva)

This inhaled medication has been used to treat chronic obstructive pulmonary disease (COPD) for more than a decade.

In 2015, the FDA also approved Spiriva for the treatment of asthma.

Studies show that tiotropium improves asthma control when added to high doses of inhaled corticosteroids plus short-acting beta-agonists.

Leukotriene Modifiers

One group of asthma drugs works by blocking the action of leukotriene – the chemical that narrows your airways during an allergic asthma attack.

 Three leukotriene modifiers are approved to treat asthma: 

• • • • montelukast (Singulair)
      • zafirlukast (Accolate)
      • zileuton (Zyflo)

You take these medications by mouth to prevent or treat asthma attacks.

Bronchial Thermoplasty

Bronchial thermoplasty is a surgical technique used for severe asthma that hasn’t improved with other treatments.

During this technique, radiofrequency energy is applied to the airway.

The heat that’s generated destroys some of the smooth muscle lining the airway.

This treatment prevents the muscles of the airways from constricting and narrowing the opening.

Bronchial thermoplasty is delivered in three sessions, given three weeks apart.

Future Treatments

Researchers are still searching for new asthma drugs, and one that’s generated a lot of excitement is Fevipiprant (QAW039).  If Fevipiprant is approved, it would be the first new oral asthma drug to be introduced in 20 years.

There’s no set date for Fevipiprant to be ready to use, but it’s in its final stages of study.

Other studies are identifying more specific triggers that set off asthma symptoms.

This could one day enable researchers to stop those processes and prevent asthma before it starts.

When making a decision about what meds to take, be sure to ask about any side-effects or interactions with other drugs you may be taking.

For instance, some drugs work by suppressing a natural response of the immune system, which could help your asthma, but it could also make you more vulnerable to infection.

So, be sure to weigh all of the pros and cons and talk it through with your doctor before starting any new treatment.

Progress in Treatment

Asthma as a disease has not changed for two centuries.  But real progress has been made in identifying patients with asthma and  its treatment.

• • Doctors now know that allergic responses often substantially contribute to both chronic persistent asthma and acute asthma attacks.
  • Recognition that asthma runs in families has also become the basis for very sophisticated studies of the genetics of asthma.

But in spite of all the progress, we still don’t understand the fundamental causes of asthma –  there still is no cure.

How To Take Asthma Medications

Asthma Inhalers

Asthma inhalers are the most common and effective way to deliver asthma medicine to your lungs.

They’re available in several types that work in different ways. Your doctor might give you:

• • • A metered-dose inhaler, which uses a small aerosol canister to push out a short burst of medication through a plastic mouthpiece
    • A dry powder inhaler, which releases the medicine only when you take a deep breath

I’ve used dry powder (crushed-pill) inhalers, which made me feel like I had pill-shrapnel stuck in my tonsils.  I much prefer the aerosol (HFA) kind 🙂

Asthma Nebulizer

If you’re having trouble using small inhalers, your doctor may recommend a nebulizer.

A nebulizer converts liquid to a mist so the medicine is easier to get into your lungs.   I call mine my “hookah”  🙂

I find the medicine administered from the nebulizer to provide more relief than from a regular hand-held inhaler.

It also has a mouthpiece or mask that makes it a good option for infants, small children, or anyone who has trouble using inhalers.

Treatments take about 20 minutes per dose.   Nebulizers are portable, but must have access to an electrical outlet to run.

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Keep Your Asthma Medicine Handy

Once you and your doctor have found a treatment or combination of medicines that work well for you, you’ll want to be sure to always have some handy.

You might also want to keep some extra, just in case 🙂

How to “Stockpile” Medications

Whether the supply chain has been disrupted by a natural disaster like a hurricane, Government lockdowns, or the spread of an infectious disease like COVID-19, people want to be prepared so they can stay as healthy as possible in the aftermath of an emergency.

It’s human nature to want to protect yourself and your loved ones.

These are some the common ways to stockpile extra medication:

• • • • • Refilling prescriptions early
        • Paying for extra prescriptions
        • Rationing medications

When considering these options, keep in mind that medications have expiration dates.

I store my medicine by expiration date, with the soonest to expire as the next inhaler to use.

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I hope this information about available prescription medical asthma treatments helps you improve your breathing and your overall health! 

Eat to Breathe Easier – the Best Food for Asthma

Hiking With Asthma! A 3-Step Plan for Success

If you have a question, drop me an email and  I’ll reply as soon as I can.

Thanks for stopping by – see you next time!  LJ

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