Fact sheet: Medication for people with chronic asthma

Shortness of breath, wheezing, coughing, chest tightness: these are all typical asthma symptoms, commonly experienced by most people with chronic asthma. But even if they do not have any symptoms, the disease is active. Left untreated, chronic asthma can lead to frequent asthma attacks as well as impaired physical fitness and lower quality of life.

But it is absolutely possible to keep even severe asthma under control with the help of certain medications and other non-drug strategies. Here it is important that people with chronic asthma understand their disease and treatment well. Many people have asthma: about 5 to 10 out of 100 children and 5 out of 100 adults have asthma symptoms. You can read more about asthma here.

Drugs called reliever or rescue medication are used to treat asthma attacks or other acute symptoms. However, treating attacks alone is not enough to feel good and live well with chronic asthma in the long term. Controller medication (also called preventer medication), which is taken regularly and independently of symptoms, can help against the disease processes.

How do medications for chronic asthma work?

People with chronic asthma typically take certain medication on a daily basis and other medication only when needed. The dose and how it is taken usually depend on the severity of their asthma. Doctors usually use the frequency and severity of the symptoms as a guideline. There is a range from occasional mild symptoms, for which regular medication is not necessary, to severe persistent asthma, requiring continuous drug treatment. Medication can be inhaled using metered-dose inhalers (liquid sprays) or dry powder inhalers, commonly known as “puffers”, or swallowed as tablets. Injections may sometimes be necessary. Depending on the intensity of asthma therapy, different combinations of medication are used. The doses of some medications are fixed, whereas for others the dose can and should be adjusted according to the patient’s needs.

Medication that is taken before physical exertion, or when acute symptoms arise, is called reliever or rescue medication. Relievers only ease symptoms in the short term. These short-acting medications open the airways and make it easier to breathe. Many commonly used relievers contain beta2 agonists such as salbutamol (also known as albuterol). Beta2 agonists relax the cramped muscles of the airways. These relievers act quickly against the cramping and narrowing but do not fight the underlying inflammation.

Having to use a reliever several times a week is a sign that your asthma is poorly controlled. In this case it is important to try to keep the condition in check by taking medication for long-term therapy.

Long-term controller medication (preventer medication) is characterized by being taken on a daily basis, and not only when needed. Some controller medications reduce the inflammatory reaction in the airways and can considerably reduce the frequency of asthma attacks. If taken regularly, they can prevent persistent symptoms such as shortness of breath as well as possible permanent damage. Corticosteroids or glucocorticosteroids, also referred to as “corticoids”, “steroids” or “cortisone”, are important controller medications. Corticosteroids can reduce chronic inflammation and prevent constriction of the airways and shortness of breath.

If asthma is still poorly controlled despite inhaling corticosteroids, the therapy can be changed to achieve better control. This can be done by increasing the dose of medication, switching to stronger medication or using different combinations of medication.

One way of improving the long-term control of asthma is by regularly using a long-acting beta2 agonist such as salmeterol or formoterol. Both of these medications must be taken in combination with corticosteroids as they might be harmful otherwise. The beta2 agonist and corticosteroid can be inhaled separately using two different inhalers, but they can also be inhaled at the same time using one inhaler. This is known as a fixed combination. You can read more about research on fixed combinations here.

Apart from steroids and long-acting beta2 agonists, other medications are used for the long-term treatment of asthma. Leukotriene antagonists, for example, work by blocking the effect of leukotrienes. Leukotrienes are messenger substances that play a key role in the inflammatory reaction of the airways.

One such leukotriene antagonist, montelukast, is currently available in Germany under the brand name “Singulair”. You can find out more about this drug here on Informed Health Online. We will also information about other medications in the future.

During severe asthma attacks it is generally difficult to use inhaled medication due to the narrowing of the airways and production of thick mucus. In emergency situations medication has to be given directly in the form of an injection or an intravenous drip. One of the aims of regular controlled treatment is to prevent these severe attacks from occurring.

What long-term adverse effects can occur?

As with any other use of medications, it is important to weigh the benefits and adverse effects of asthma medication. The adverse effects depend on the type of medication, how large a dose you take and how you take it.

In general, asthma medication that is inhaled usually causes fewer adverse effects than medication swallowed as a tablet. In mild asthma, the adverse effects of some medications can outweigh their potential benefits, in which case it may be better not to take them. However, left untreated, moderate or severe asthma can lead to persistent symptoms and overall poor physical fitness.

Many people are particularly concerned about the adverse effects of using steroids for a long time. If medication is chosen and used correctly, long-term treatment will not necessarily have negative effects. Although it cannot be completely ruled out that long-term treatment with steroids may slightly impair growth in children, so far it has not been proven that this affects their final adult height. On the contrary, evidence suggests that children who have asthma and inhale corticosteroids grow to the same final adult height as other children with asthma who do not. Still, to be on the safe side, young patients are usually only prescribed the lowest possible doses of steroids and, if possible, only steroids which are inhaled.

The main advantage of steroid therapy is that it can greatly reduce the likelihood of severe or even life-threatening asthma attacks. For people with severe asthma, asthma attacks are a much greater risk than long-term adverse effects of drug therapy. Long-acting beta2 agonists should always be taken together with corticosteroids because they could be harmful otherwise. Research suggests that using long-acting beta2 agonists alone could lead to life-threatening asthma attacks.

What else can I do apart from taking medication?

Physical activity and sports, identifying and keeping a check on triggers, breathing exercises: the list of possible additional helpful options is long. You can read more about asthma here on Informed Health Online. Sign up for our newsletter if you would like to stay up-to-date, or visit our website every now and again.

© IQWiG (Institute for Quality and Efficiency in Health Care)