What are medicines for asthma?

Asthma is a chronic (long-term) inflammatory lung condition that can cause:

• chest tightness
• wheeze
• cough
• breathing problems.

Taking medicines can help you control your asthma and avoid acute (sudden) symptoms.

You may need to use one or more medicines for asthma. Asthma medicines come as inhalers (puffers), tablets or injections.

The main reasons to take medicines for asthma are to:

• stop inflammation (swelling) in your airways (small tubes in your lungs)
• prevent symptoms
• control symptoms when they happen
• improve your lung function

Current guidelines say all adults and young people aged over 12 years with asthma should use inhaled corticosteroids. Many children with asthma need low doses of inhaled corticosteroids too.

If you have been relying on a short-acting reliever containing salbutamol (also known as Ventolin) or terbutaline, see your doctor about how best to manage your asthma.

Your doctor will adjust your asthma medicines based on how often you have symptoms and how serious they are.

If you have asthma you should have a written asthma action plan from your doctor. An asthma plan lists which medicines to use and when to use them. It can also help you notice when your symptoms get worse. You might need to change how you take your asthma medicines during a flare-up.

It's very important to follow advice from your doctor or pharmacist when using asthma medicines.

What types of medicines might I be prescribed for asthma?

Asthma medicines are usually grouped into:

• preventers that you use regularly to treat asthma
• relievers that you use when needed to relieve symptoms
• other add-on treatments

Asthma preventers include:

• inhaled corticosteroids, also called ICS
• combination preventers
• triple therapy preventers
• montelukast tablets
• biologic injections

Asthma relievers can be:

• short-acting
• anti-inflammatory (lessen swelling)

Asthma preventers have low doses of inhaled corticosteroids. Your inhaler might contain a single medicine or more than one medicine. Your ICS preventer puffer is usually brown or orange.

Short-acting asthma reliever inhalers contain salbutamol or terbutaline. These blue or grey puffers are no longer recommended as the main way to ease symptoms in people aged 12 or over.

If you use a preventer that contains a corticosteroid on its own, you should have a reliever to use when needed. Reliever puffers are also used for first aid for acute (sudden) asthma symptoms.

Anti-inflammatory reliever (AIR) inhalers contain a corticosteroid such as budesonide combined with formoterol. These inhalers can be used as both a reliever and a preventer by people aged 12 or over. They are usually purple or pink.

Treatment of asthma in children under 12 can be different. Read about asthma in children under 6.

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How do asthma medicines work?

The most common way to take medicines for asthma is by using a handheld inhaler (also known as a 'puffer'). Sometimes, your asthma medicine can be given as a vapour (mist) through a machine called a nebuliser.

Inhalers and nebulisers deliver your asthma medicine to your lungs, where they help to:

• open your airways
• reduce inflammation

Asthma puffers often contain more than one medicine that work together.

If you are using a puffer, you may benefit from using a spacer. This is a plastic container with a mouthpiece or mask at one end. You can get a spacer from your pharmacy. Using a puffer with a spacer helps more of your asthma medicine reach your lungs.

Some asthma preventers come as tablets.

If you have severe asthma that is difficult to control your doctor might recommend an injection.

During an asthma flare-up, your doctor may prescribe an oral corticosteroid tablet such as prednisolone. You can take this for a few days as a 'rescue' treatment for severe symptoms. Oral corticosteroids can have serious side effects and should be used only when other treatments do not help.

How do asthma relievers work?

There are two types of relievers:

• anti-inflammatory reliever (AIR)
• short-acting reliever — the blue or grey inhaler

Anti-inflammatory reliever (AIR)

Anti-inflammatory relievers contain two medicines in one inhaler. These are budesonide and formoterol. They work together to reduce inflammation and to open your airways. Formoterol is a 'rapid-onset beta-2-agonist'. You can use an anti-inflammatory reliever as needed to control mild asthma. You won't need a blue inhaler as well.

Short-acting relievers

Short-acting relievers (also called 'bronchodilators') are fast-acting asthma medicines. The most common short-acting bronchodilator is salbutamol. They provide quick relief from the symptoms of asthma, such as:

• wheeze
• chest tightness
• cough
• shortness of breath

Relievers relax your airway muscles and open up your airways, making it easier to breathe.

Learn more about how to use an asthma inhaler.

When do I need to bring my asthma reliever?

If you have asthma, you should always carry a reliever with you.

They can work as soon as one to three minutes after use.

If you have exercise-induced asthma, you can use your reliever before exercising.

What are the side effects or risks of asthma relievers?

For some people, short-acting relievers can cause side effects such as:

• palpitations (a fast heartbeat)
• shaking hands
• feelings of anxiety or nervousness

These feelings should pass quickly. Speak to your doctor or pharmacist if you are concerned about the side effects of using your inhaler.

If you use a short-acting reliever, you also need inhaled corticosteroids to treat the underlying problem.

If you have asthma you can benefit from using an inhaled corticosteroid, even if you have mild symptoms.

How do asthma preventers work?

Preventers help control asthma symptoms and prevent attacks. These medicines reduce the inflammation (redness and swelling) in the airways that cause asthma.

Combination inhalers

Some preventers contain 'long-acting bronchodilators' with a corticosteroid. These are combination inhalers.

The long-acting bronchodilator helps to relax your tightened airway muscles. They allow your airways to open so more air can reach your lungs. Some names of long-acting bronchodilators are:

• formoterol
• salmeterol

Your doctor will probably suggest using your combination inhaler every day if you:

• have had asthma symptoms 2 times or more in the last month
• sometimes wake up from sleep at night because of your asthma symptoms
• have had a flare-up in the past year that resulted in an urgent visit to a doctor or emergency department

If you are aged 12 or over and have just been diagnosed with asthma, Australian guidelines say you should start with an inhaler containing a low dose of budesonide and formoterol.

Triple combination inhalers containing three medicines are available for more severe asthma.

Inhaled corticosteroids (ICS)

Many people who get asthma symptoms use an inhaler containing a corticosteroid medicine such as:

• beclometasone
• budesonide
• ciclesonide
• fluticasone

Preventers that contain a corticosteroid on its own take several days or even weeks to work, so they're not useful for the fast relief of symptoms. To work properly, your ICS puffer needs to be used every day, even when you have no symptoms.

If you use a preventer containing an ICS on its own, you should have a second inhaler to use as a reliever.

Montelukast

You may be prescribed a preventer called montelukast, which is a tablet. This can be used alone or together with an inhaled preventer.

If you or your child experience changes to your mood, sleep or behaviour while taking montelukast, tell your pharmacist or doctor.

Biologic injectable therapy

If you have severe asthma that is difficult to control, your doctor can refer you to a respiratory specialist (lung doctor).

The specialist might recommend trying an injection that helps reduce inflammation in your lungs.

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What are the side effects or risks of asthma preventers?

Inhaled corticosteroids

Inhaled corticosteroid preventers can have side effects such as:

• a sore throat
• hoarse voice
• oral thrush

You can reduce the chance of getting these side effects by using a spacer with your puffer. Rinsing your mouth out with water or gargling after using it is also helpful.

Inhaled corticosteroids deliver a small dose direct to your lungs. This makes them safer than prednisolone tablets.

If you are using a biologic injection for hard to control asthma, ask your doctor about the benefits and risks.

Montelukast safety

If you take montelukast you can get side effects which can be serious such as:

• agitation or aggressive behaviour
• depression, anxiety or suicidal thinking
• difficulty concentrating or feeling lost
• tremor, irritability or restlessness
• sleep disturbance or nightmares
• hallucinations (seeing, feeling or hearing things that are not there)

For more information, read the Therapeutic Goods Administration's safety alert or the Consumer Medicine Information (CMI) for montelukast.

How long will I need to take asthma medicines?

Everyone's asthma is different. The type and dose of medicines you need will vary depending on your circumstances and asthma triggers.

Asthma is a long-term (chronic) condition, so you are likely to need to take medicines for months or years.

Your doctor may need to adjust your asthma medicines so that your symptoms stay well controlled. They will aim to use the lowest dose of medicine that works to control your asthma.

When should I see my doctor?

It's important to see your doctor regularly to review your asthma medicines and your asthma action plan.

If you only have a blue puffer for your asthma, talk to your doctor to find out what other treatment options you could benefit from.

Adults should see their doctor for a review at least every 6 to 12 months, and children should be reviewed every 3 to 6 months. You should see your doctor for a review even if your asthma is well controlled.

You should also see your doctor:

• after a flare-up
• about a month after starting a new medicine or having a dose change

See your doctor for a review any time your asthma is not well controlled. Signs that you may need your asthma treatment adjusted include:

• needing to use reliever medicines more than 2 times a week
• needing to limit your activities due to asthma symptoms
• nighttime symptoms of asthma, such as cough or waking up from sleep feeling breathless
• daytime asthma symptoms on more than 2 days a week

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Resources and support

For more information and support, try these resources.

Asthma Australia has up to date information on the treatment of asthma. Fill out their Asthma Review worksheet.

Call Asthma Australia on 1800 278 462 to connect with an asthma educator and ask for advice.

Watch National Asthma Council's how-to videos to learn how to use your inhaler, spacer or nasal spray.

Use National Asthma Council's My Asthma Guide for practical strategies to help you understand and manage your asthma.

Health Translations provides information in languages other than English. Watch a video about Asthma Action Plans in your language.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.