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Asthma medicines

Published by Bupa's health information team, September 2009.

This factsheet is for people who are taking asthma medicines, or who would like information about them.

Asthma medicines are used to control or prevent the symptoms of asthma. They are normally taken as inhalers (also known as 'puffers').

Why would I take asthma medicines?
What are the main types of asthma medicine?
How do asthma medicines work?
How to take asthma medicines
Special care
Side-effects of asthma medicines
Interactions of asthma medicines with other medicines
Names of common asthma medicines
Questions and answers
Related topics
Further information
Sources

Why would I take asthma medicines?

Your doctor may prescribe these medicines if you have asthma or other respiratory problems such as chronic obstructive pulmonary disease (COPD). For more information on these conditions, please see Related topics.

What are the main types of asthma medicine?

There are two main types of asthma medicines. These are:

relievers, which treat your asthma symptoms - you take these when you feel asthma symptoms starting
preventers, which help to prevent asthma symptoms - if you need these, you will have to take them every day

If you have mild asthma symptoms that don't happen often, you will just need a reliever. You will need to have a preventer as well if:

you need to use your reliever inhaler three or more times a week
your asthma symptoms wake you up once a week or more
you have had an asthma attack in the last two years

Preventers are not used to treat an asthma attack, but they help prevent them. Regular use of preventers can stop some of the long-term changes to the lungs caused by repeated asthma attacks, and so help to reduce the number of asthma attacks you have.

How do asthma medicines work?

Relievers

The main type of reliever medicines are called short-acting selective beta2 adrenoreceptor agonists (or short-acting beta2 agonists for short).

These work by copying the effects of natural substances - adrenaline and noradrenaline - produced in the body. These substances are chemical messengers that the body produces as part of the 'fight or flight' reaction. They prepare the body for exercise or a stressful situation. One of their effects is to open up the airways (bronchodilation) so that more air can reach the lungs.

Short-acting beta2 agonists are used to relieve symptoms. They work within 30 minutes of taking them and the effects last for three to five hours. Long-acting beta2 agonists take longer to work but the effects can last up to 12 hours.

Preventers

The main preventer medicines are the inhaled corticosteroids (or steroids for short). These work by reducing the amount of inflammation in your airways. This eases the swelling and narrowing of the airways, and also reduces the amount of mucus produced in the lungs. Inhalers that contain a combination of a beta2 agonist and a steroid or another asthma medicine are also available.

You may need to have other preventer medicines if short-acting beta2 agonists in combination with inhaled steroids aren't completely controlling your asthma. These include long-acting beta2 agonists, leukotriene receptor antagonists and theophylline. Leukotriene receptor antagonists work by reducing the inflammation in your airways. They can be particularly helpful for people who also have allergic conditions. Theophylline helps to improve breathing, but side-effects are common and it is only used occasionally.

How to take asthma medicines

Most asthma medicines come as inhalers, also known as 'puffers'. They are also available as tablets, nebuliser solutions and injections for treating more severe asthma.

Beta₂ agonists and inhaled steroids are usually taken through an inhaler. Beta2 agonists usually come as blue inhalers and inhaled steroids usually as brown, orange or red inhalers. These come in different doses per puff, and with different mechanisms for releasing the dose. Normally you take one or two puffs at a time.

To get the full benefit of your asthma medicines, follow your doctor's advice carefully about how to use your inhaler(s). For example, you need to take inhaled steroids every day, even if you don't have symptoms, for them to work properly.

It can be tricky to co-ordinate breathing in and 'firing' your inhaler. Your doctor or specialist asthma nurse will show you how to use your inhaler(s) properly, and will also check your technique from time-to-time.

You can use a spacer device with an inhaler to make it easier to inhale the medicine. A spacer is a tube that clips onto the inhaler. At the other end of the tube is a mouthpiece to breathe in and out of. A spacer allows you to activate the inhaler, then inhale, in two separate steps, so you don't need to co-ordinate breathing and pressing the puffer. Using a spacer means more medicine reaches your lungs. This means you may be able to take a lower dose - reducing the risk of side-effects.

Spacers are useful for children, and there are spacers available with masks for babies. There are also devices that make it easier to activate inhalers, which are useful for people who have sore hands and who find handling their inhaler difficult. However, spacers are useful for everyone, especially during an asthma attack.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Special care

Pregnancy and breastfeeding

Asthma medicines can be taken as normal if you are pregnant or breastfeeding. It's particularly important to control asthma symptoms during pregnancy so that you don't have a severe asthma attack, which can affect your pregnancy, the baby or the birth.

Side-effects of asthma medicines

Side-effects are the unwanted effects of taking a medicine. If you have side-effects, it's important to talk to your doctor or the healthcare professional who prescribed your medicine before you stop taking it. This section does not include every possible side-effect of asthma medicines. Read the patient information leaflet that comes with your medicine for more information.

Beta₂ agonists

Most people who take beta2 agonists don't have any problems. Possible side-effects include:

slight shakiness of the hands
restlessness
nervousness
headache
muscle cramps
flushing

Rare, but more serious, side-effects include:

fast or irregular heart rate
sleep and behaviour disturbances in children
allergic reactions

You can reduce the side-effects by rinsing your mouth out and gargling with water after using your inhaler. You should not swallow this water.

Inhaled steroids

Inhaled steroids are unlikely to cause serious side-effects because they are delivered directly to the lungs, with only small amounts getting into your bloodstream. However, they can give you a husky or hoarse voice. They can also give you a sore mouth or throat due to a fungal infection called candidiasis. You can help prevent this by using a spacer to help reduce the amount of the drug that stays in your mouth and throat, or by rinsing your mouth with water or cleaning your teeth after using your inhaler.

Other side-effects include a slightly increased risk of glaucoma, an eye condition caused by a build-up of pressure in the eye.

If you need inhaled steroids at high doses, you will be given a 'steroid card' to carry with you at all times saying what medicine you are taking.

Although inhaled steroids don't seem to slow down children's growth in the same way as oral steroids do, children taking inhaled steroids for a long time need to have their height monitored.

Leukotriene receptor antagonists

The side-effects of leukotrine receptor antagonists can include:

digestive problems such as stomach pain, sickness, indigestion and diarrhoea
an allergic reaction to the medicine
dry mouth and feeling thirsty
sleep disturbances
emotional changes, such as feeling agitated, aggressive or depressed
shakiness
pain in muscles or joints

Theophylline

The side-effects of theophylline can include:

fast or irregular hear beats
feeling sick
headache
difficulty sleeping
fits

Interactions of asthma medicines with other medicines

Check with your doctor or pharmacist before you take any other medicines or herbal remedies at the same time as your asthma medicine.

Names of common asthma medicines

Asthma medicines are shown in the table.

All medicines have a generic name. Many medicines also have one or more brand name. Generic names are written in lower case, whereas brand names start with a capital letter.

Generic names	Examples of common brand names
Short-acting Beta₂ agonists
bambuterol	Bambec
salbutamol	Airomir, Asmasal Clickhaler, Cyclohaler, Easyhaler, Pulvinal, Salamol Easi-Breathe, Salbulin Novolizer, Ventmax SR, Ventolin Accuhaler
salmeterol	Serevent Accuhaler, Serevent Diskhaler
terbutaline	Bricanyl Turbohaler
Long-acting Beta₂ agonists
formoterol	Atimos Modulite, Foradil, Fostair (a combination of beclometasone and formoterol), Oxis
Inhaled steroids
beclometasone	Asmabec Clickhaler, Beclazone Easi-Breathe, Becodisks, Clenil Modulite, Qvar, Fostair (a combination of beclometasone and formoterol)
budesonide	Novolizer, Pulmicort, Symbicort - a combination of budesonide and formoterol
ciclesonide	Alvesco
fluticasone	Flixotide, Seretide - a combination of fluticasone and salmeterol
mometasone furoate	Asmanex
leukotriene receptor antagonists
montelukast	Singulair
zafirlukast	Accolate
theophylline	Nuelin SA, Sio-Phyllin, Uniphyllin Continus