Medications for Persistent and Severe Asthma

Page content


Your doctor has a long list of different asthma medications to prescribe for treating and controlling your asthma. While asthma is not curable, you can learn to treat and control your symptoms, enabling you to live your life more normally.

The list of medication classifications includes oral corticosteroids, inhaled corticosteroids, short-acting rescue inhalers, long-acting bronchodilators, theophylline bronchodilators, nonsteroidal antiallergics, leukotriene modifiers, short-acting bronchodilators and anticholinergic bronchodilators.

Short-Acting Rescue Inhalers

Also called short-acting beta2 bronchodilators, these medications quickly relax your airways during an asthma attack, enabling you to begin breathing. Because their therapeutic effect is cleared out of your body quickly, their effects last only three to four hours, according to eHealthMD. These medications include albuterol (Ventolin and Proventil), terbutaline (Brethaire and Bricanyl), pirbuterol (Maxair) and bitolterol (Tornalate).

Side effects of these medications include appetite changes, nausea, vomiting, diarrhea, heartburn, stomach pain, belching, gas, dry mouth, gastrointestinal distress, indigestion, constipation, oral fungal infections, and throat or mouth irritation. Nervous system side effects can include dizziness, vertigo, headache, lightheadedness, anxiety, drowsiness, tension, tremors, fatigue, weakness, nervousness, unstable emotions, restlessness, aggression, hyperactivity, excitement, sleeplessness, agitation, irritability, shakiness and nightmares. Respiratory side effects can include bronchospasm, breathing difficulty, nasal congestion, respiratory infections, bronchitis, lower respiratory infections, increased mucous discharge, wheezing, coughing, sinus headache, nosebleeds, hoarseness, particularly in pediatric use, chest discomfort, runny nose, viral infection, sneezing and a worsening of asthma symptoms. Circulatory system side effects can include blood pressure changes, changes in heart rhythm, pounding heartbeat, irregular pulse and chest pain. Skin side effects may include hives, flushing or pallor, sweating, eczema, skin inflammation and pain at the injection site, according to Health Care Tips. Other side effects can include unusual taste in the mouth, stiffness, muscle cramps, painful menstruation, tooth discoloration or pain, flu-like symptoms, general body discomfort, back, joint, arm, neck, shoulder or chest pain, low potassium levels, localized achiness, urinary tract infections, allergic reactions, fever, accidental injury, decreased sensitivity to stimulation, leg cramps, chills, migraine, fainting, abnormal lab tests, abnormal skin sensations, itchy eyes, eye inflammation and sweating.

Contraindications: No well-controlled, adequate studies exist for pregnant women. These medications should only be used when needed and the benefits to the mother outweigh any potential risks to the fetus. Researchers do not know if these medications are present in breast milk. Talk to your doctor about using these medications before you start breast feeding your infant. In children younger than 12 years of age, the safety of albuterol, pirbuterol, bitolterol and terbutaline have not been established. For Ventolin, the safety of this medication has not been established for children less than 4 years old, according to Health Care Tips.

Some of these medications contain sulfites, which can cause allergic reactions in sensitive individuals.

Long-Acting Bronchodilators

These medications are prescribed for persistent asthma symptoms, according to Pulmonology Channel. Asthma patients taking this class of medication should also include an anti-inflammatory medication. Medications in this class include fomoterol (Foradil) and salmetrol (Serevent). These medications’ effects last longer in the body, meaning they should be used twice a day, or every 12 hours as prescribed by your doctor.

Serevent and Foradil work to relax the muscle fibers that surround your airways, helping these airways to open up for easier breathing, according to eHealthMD.

Side effects for these medications can include trouble sleeping, shaky feeling, faster heart rate, overexcitement, upset stomach, and muscle aches or cramping, according to WebMD. These medications have been linked to “severe” asthma attacks, according to the Mayo Clinic. For this reason, they should only be used in combination with an inhaled corticosteroid.

Inhaled Corticosteroids

The inhaled corticosteroids prevent the release and production of inflammatory chemicals in your body. Because the medications are poorly absorbed, they produce few side effects, according to eMedicine and eHealthMD. Their most concentrated action takes place in your lungs, helping to reduce inflammation.

Inhaled corticosteroid medications include flunisolide (AeroBid and Bronalide), triamcinolone (Azmacort), fluticasone and salmeterol (Advair), beclomethasone (Beclovent, QVar and Vanceril), fluticasone (Flovent–Diskus and HFA) and budesonide (Pulmicort–Flexhaler or Respules). Other medications include ciclesonide (Alvesco), according to eMedicine.

Side effects in children may include a slight delay in growth. Your doctor may decide the benefits of better asthma symptom control outweigh this risk. Other side effects may include oral yeast infections (thrush) and throat irritations, according to the Mayo Clinic. After administering this medication, rinse your mouth with water and spit the water out. The Mayo Clinic advises using a spacer with your corticosteroid inhaler as this reduces how much of the drug can be swallowed and absorbed into your body.

Oral Corticosteroids

Oral corticosteroids (steroid pills) help to block the production of inflammatory chemicals into your body. This treatment option should be used only for a short time as prolonged administration of this medication can lead to serious, unwanted side effects, according to eHealthMD.

Specific corticosteroids include prednisolone (Delta-Cortel), prednisone (Deltasone) and methylprednisone (Medrol and Solu-Medrol). The Mayo Clinic adds hydrocortisone to this list. These medications are prescribed by your doctor in short “steroid bursts,” beginning with the largest dose on the first day and decreasing by one pill each day until you finish with one pill on the last day.

Side effects include cataracts, thinning bones (osteoporosis), lowered resistance to infection, high blood pressure, muscle weakness and slowed growth in children, according to the Mayo Clinic.

Theophylline Bronchodilators

Theophylline bronchodilators help your constricted airways to relax, easing your ability to breathe. These medications block the action of chemicals in your body that cause the contraction of the muscles surrounding your airways.

This medication is available in a slow-release, oral formulation used in asthma maintenance therapy or as a faster-acting intravenous form, which is used for emergency room treatment of a severe asthma attack, according to eHealthMD. Theophylline is manufactured under the names Theo-Dur and Theolaire. The Mayo Clinic includes Theo-24 and Uniphil as well. This medication is helpful for treating nighttime asthma symptoms; your doctor may want to check for the right level of medication in your system with regular blood tests, according to the Mayo Clinic.

Nonsteroidal Antiallergics

This class of asthma medication helps block the release of inflammatory chemicals in your body, which reduces your symptoms of airway constriction, according to eHealthMD.

These medications include cromolyn sodium (Intal) and nedocromil (Tilade). Intal and Tilade are considered to be mast cell stabilizers, which help to stabilize the mast cell membrane, inhibiting acute responses to sulfur dioxide, cold air and exercise, according to eMedicine.

You should not stop taking these medications suddenly because they have to be taken continuously for the highest amount of protection.

Leukotriene Modifiers

The oral leukotriene modifiers block the release or the action of leukotrienes, which are inflammatory chemicals, in your body. These chemicals stimulate the allergic response that leads to asthma attacks in allergy-related asthma. As you take the medication, it helps to reduce mucous production and relax your airways.

The medications in this classification include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo). Your doctor will prescribe one tablet per day–the medication’s action lasts a full 24 hours, according to the Mayo Clinic.

Possible side effects can include suicidal thinking and other psychological reactions usch as agitation, hallucinations and depression, according to the Mayo Clinic. Call your doctor immediately if you notice any of these symptoms.

Anticholinergic Bronchodilators

The anticholinergic bronchodilator helps block the nerve response that signals your airways to narrow down. According to eHealthMD, this medication should be used in combination with a short-acting beta2 bronchodilator, such as albuterol or proventil.

This medication is ipratropium (Atrovent) and is also considered to be a short-acting bronchodilator that can be used to treat asthma attacks in progress, according to the Mayo Clinic.

The use of ipratropium is contraindicated in people with a known sensitivity to ipratropium bromide or atropine, according to

Side effects in sensitive patients can include angioedema of the lips, face and tongue, rash, laryngospasm, anaphylactic reaction, urticaria, bronchospasm and oropharyngeal edema (swelling of the throat).

Risks: Patients diagnosed with narrow angle glaucoma, prostatic hypertrophy or bladder neck obstruction should use the medication with caution, according to


Asthma Treatment

Your Asthma Medication Checklist

Uses of Sympathomimetics

WebMD: Asthma Guide

Asthma: Treatment & Medication

Medications to Prevent Asthma Attacks

Mayo Clinic: Asthma Medications: Know Your Options