Medicines used to manage asthma

Key points about asthma medication

  • There are many different types of asthma medicines. Sometimes you have to take more than one.
  • It is important that you understand how your asthma medicines work, and then take them as prescribed.
  • Find out how to take asthma medicines safely and possible side effects.
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Budesonide/formoterol is a combination of 2 medicines, budesonide and formoterol, in a single inhaler. Examples include Symbicort TurbuhalerVannair Inhaler and DuoResp Spiromax.

Depending on the severity of your asthma symptoms, budesonide/formoterol can be used as a reliever only OR as a preventer and a reliever.

  • Mild symptoms: Use budesonide/formoterol when required for relief of asthma symptoms. Also called anti-inflammatory reliever (AIR) therapy.
  • Moderate to severe symptoms: Use budesonide/formoterol every day PLUS when required for relief of asthma symptoms. Also called single-inhaler maintenance and reliever therapy (SMART).

Steroid inhalers are used as preventers, to prevent asthma symptoms from developing. They are usually used every day, even when you are not having symptoms. Preventers take days or weeks to work, so they must not be used for the immediate relief of asthma symptoms.

What do steroid preventers do?

  • Steroid preventers work by reducing swelling of your airways and preventing mucus build-up, which narrows your airways.
  • Your asthma can get worse if you miss doses.
  • Talk to your doctor about reducing your dose if you think you are better.
  • Steroid preventers are safe when used for a long time.
  • There are some side effects that can be reduced by using a spacer (see below) and rinsing your mouth after taking your preventer.

  • Long-acting bronchodilators should be used only if you regularly use a steroid preventer as well. 
  • If your asthma symptoms are not well controlled by the steroid preventer alone, your doctor may add a long-acting bronchodilator preventer. 
  • A bronchodilator widens your airways by relaxing the muscle that surrounds your airways. 
  • Long-acting bronchodilators work in a similar way to relievers, but work for up to 24 hours.

Long-acting bronchodilators include: 

Some brands of inhalers contain a steroid preventer plus a long-acting bronchodilator in a single inhaler, for convenience, such as:

These are described as combination inhalers.

  • Salbutamol and terbutaline are called relievers. They are used for quick relief when you are experiencing difficulty breathing. They are used to relieve asthma symptoms once they have started. 
  • Relievers are fast-acting so they improve your breathing immediately.
  • They should only be used occasionally or now and again.
  • Using them too often (more than 2 times a week) means that your asthma is not well controlled.
  • Tell your doctor if this is happening. You will need your asthma medicine to be reviewed. 

If you are using your salbutamol or terbutaline inhaler more than two times a week, tell your doctor. You need your asthma medicine to be reviewed.

Montelukast is a type of anti-inflammatory medicine that comes in tablet form. It is used for asthma symptom prevention. It is generally less effective than steroid inhalers for most people with asthma.

People respond quite differently to this medicine – some very well, while others not at all. Montelukast may be useful if you have exercise-induced and viral-induced symptoms. It may also be useful if you can’t tolerate inhalers or don’t respond to inhaled preventers. Montelukast can be used in addition to steroid inhalers. 

Montelukast is generally well tolerated. It has a rare risk of causing stomach pain, agitation and mood changes. Read more about montelukast.

Prednisone is a tablet form of steroid that works very well to reduce inflammation (swelling) in your airways. If your asthma symptoms become severe or if you have an asthma attack, your GP or asthma nurse may give you a short course of prednisone tablets for a few days to help your asthma settle.

Short courses of prednisone are safe and have no lasting side effects. If you need prednisone more than 2 times a year then your asthma is not well controlled and you need to review your self-management plan with your doctor.

Important information about prednisone

  • Good asthma care reduces the need for steroid tablets.
  • If you need steroid tablets, your doctor should supervise this treatment and you should see them regularly.
  • A medic-alert bracelet for steroids is only needed if you take steroid tablets for months or years.
  • It's dangerous to suddenly stop taking steroid tablets if you have been taking them for months or years.
  • Long-term treatment with steroid tablets is only needed in a small number of people with asthma.

An inhaler is a device used to send medicine to your airways. By getting medicine directly to your lungs, smaller doses of medicine are needed and it can start working more quickly. The main types of inhaler devices are metered dose inhalers (MDI) and dry powder inhalers such as Turbuhalers, Accuhalers and Handihalers.

Read more about the different inhaler devices and the points to consider when deciding on the right inhaler for you.

A spacer is a long plastic tube that your inhaler fits into. It makes using an MDI inhaler much easier. Your doctor or nurse can show you how to use a spacer properly. Spacers are not just for children, adults can use them too. You can often get a spacer for free from your doctor – just ask them for one. Read more about spacers

If you are an athlete and need to take medicine to keep your asthma under control, you need to know which inhalers and medicines are allowed.

Many asthma medicines contain Beta2-Agonists, which are not allowed in competitive sport. If you need to take one of these inhalers, you need to apply for a therapeutic use exemption(external link)(external link). Visit DrugFree Sports NZ(external link)(external link) for details. 

Asthma medicines(external link)(external link) Asthma & Respiratory Foundation, NZ
Asthma medications(external link)(external link) Asthma NZ and The Lung Association, NZ
How is asthma treated and controlled?(external link)(external link) National Heart Lung & Blood Institute, US

Resources

Inhaler chart(external link) Counties Manukau Health, NZ, 2021
Anaesthetics and asthma fact sheet(external link) Asthma + Respiratory Foundation NZ, 2010
Asthma – First aid poster(external link) Asthma and Respiratory Foundation NZ, 2021 English(external link), te reo Māori(external link)
GINA patient guide for asthma – you can control your asthma(external link) Asthma Respiratory Foundation NZ, 2020
NZ adolescent and adult asthma guidelines(external link) Asthma Respiratory Foundation NZ, 2020
Summer holiday asthma and allergies checklist(external link) Asthma Respiratory Foundation NZ
Asthma checklist(external link) Asthma Respiratory Foundation NZ

Reference

NZ adolescent and adult asthma guidelines 2020(external link) Asthma + Respiratory Foundation, NZ

Brochures

nz adolescent and adult asthma guidelines

NZ adolescent and adult asthma guidelines(external link)

Asthma Respiratory Foundation NZ, 2020

anaesthetic and asthma fact sheet

Anaesthetics and asthma fact sheet(external link)

Asthma + Respiratory Foundation NZ, 2010

inhaler chart brochure

Inhaler chart(external link)

Counties Manukau Health, NZ, 2021

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Credits: Sandra Ponen, Pharmacist, Healthify He Puna Waiora. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Angela Lambie, Pharmacist, Auckland and Dr Jeremy Steinberg, FRNZCGP, Auckland

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