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Asthma medicines

Asthma medicines are used to control or prevent the symptoms of asthma. You usually take them as inhalers (also known as ‘puffers’).

Your GP may prescribe these medicines if you have asthma. He or she may also prescribe them if you have another respiratory problem, such as chronic obstructive pulmonary disease (COPD). 

How to use your metered-dose inhaler
Helping you use your puffer correctly

Details

  • Types What are the main types of asthma medicines?

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

    • relievers, which help treat your asthma symptoms – you take these when you feel asthma symptoms starting
    • preventers, which help to prevent asthma symptoms – if you need these, it’s likely you will have to take them every day

    If you get mild asthma symptoms that don’t happen often, you may only need a reliever. You may 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 and needed to take steroid tablets in the last two years

    Preventers are not used to treat an asthma attack, but they help prevent them. If you regularly use a preventer inhaler, it can help to reduce the number of asthma attacks you have.

  • How they work How do asthma medicines work?

    Relievers

    The main types of reliever medicines are called short-acting selective beta2 adrenoreceptor agonists (or short-acting beta2 agonists for short). Relievers are usually blue in colour.

    Relievers work by quickly relaxing the muscles that surround your narrowed airways. This allows your airways to open wider, making it easier for you to breathe. They often work within minutes and the effects last for three to five hours.

    Preventers

    The main preventer medicines usually contain a medicine called an inhaled corticosteroid (or steroid for short). Preventers are usually red, orange or brown in colour. These work by reducing the amount of inflammation in your airways. This eases the swelling and narrowing of your airways, and also reduces the amount of mucus that your lungs produce. There are also combination inhalers available that contain both a long-acting reliever and a preventer.

    You may need to take other preventer medicines if beta2 agonists in combination with inhaled steroids don’t completely control your asthma. These may include long-acting beta2 agonists, leukotriene receptor antagonists and theophylline.

    Long-acting beta2 agonists work in a similar way to relievers. However, they take longer to work and the effects can last up to 12 hours. You must use these with a preventer inhaler and not on their own.

    Leukotriene receptor antagonists are preventer tablets that work by reducing the inflammation in your airways. They can be particularly helpful if your asthma is triggered by an allergy, or exercise makes your asthma worse.

    Theophylline comes as tablets that help to relax the muscles around your airways to improve your breathing. However, side-effects are more common with this medicine so it's used by fewer people.

  • Taking the medicine How to take asthma medicines

    Most asthma medicines come as inhalers, also known as ‘puffers’. There are also tablets and nebuliser solutions (a mist of medicine that you breathe in) if you have severe asthma.

    You usually take asthma medicines through an inhaler. These often come in different doses per puff, and with different mechanisms for releasing the dose.

    There are a variety of inhaler devices available. Some examples are listed below.

    • Metered dose inhalers deliver a specific amount of medicine into your lungs when you press down on the inhaler and inhale through the mouthpiece.
    • Breath-actuated metered dose inhalers deliver a specific amount of medicine into your lungs automatically when you inhale through the mouthpiece.
    • Dry powder inhalers work in a similar way to breath-actuated metered dose inhalers. However, they deliver the medicine in the form of dry powder as you inhale through the mouthpiece.
    • Nebulisers create a mist of medicine that you breathe in through a face mask.

    Your GP or asthma nurse will advise you on what type of inhaler you need and how many puffs a day you need to take. Even if you don’t have symptoms, you may need to take preventers every day for them to work properly. Your GP or asthma nurse will also show you how to use your inhaler(s) properly and check that your technique is effective. He or she may also give you an asthma action plan. This will explain when to increase or decrease your inhaler use and when to seek medical help.

    You can use a spacer device with metered dose inhalers to make it easier to inhale the medicine. A spacer is a tube that fits onto your 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 the medicine in two separate steps. This makes taking your inhaler easier as you don’t need to co-ordinate breathing and pressing the puffer at the same time.

    Using a spacer means more medicine reaches your lungs. This may result in you being able to take a lower dose and helps to reduce the risk of side-effects.

    Spacers are particularly useful for children, and there are spacers available with masks for babies. They’re also useful for people who get mouth infections, such as oral thrush, when inhaling medicines. Spacers can be useful for everyone, especially during an asthma attack, as they help to increase the amount of medicine that reaches your lungs.

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

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    Pregnancy and breastfeeding

    If you’re pregnant or breastfeeding, you can still take your asthma medicines as usual. It’s important to control your asthma symptoms so you don’t have a severe asthma attack, as this could harm you and your baby. The vast majority of asthma medicines are safe to take when you're pregnant. The risks of not using a medicine will generally outweigh any risks of the medicine itself.

  • Side-effects Side-effects of asthma medicines

    Side-effects are the unwanted effects of taking medicine. If you have side-effects, it’s important to talk to your GP or the healthcare professional who prescribed your medicine before you stop taking it.

    Side-effects of relievers

    Most people who take relievers don’t have any problems. Possible side-effects may include:

    • slight shakiness of your hands
    • nervousness
    • headache
    • muscle cramps

    Rare, but more serious, side-effects may include:

    • fast or irregular heart rate
    • sleep and behaviour disturbances
    • allergic reactions

    Side-effects of preventers

    You’re unlikely to get serious side-effects from taking preventers because the medicine is delivered directly to your lungs. Only small amounts of the medicine get into your bloodstream. However, side-effects may include a:

    • husky or hoarse voice
    • sore throat or tongue
    • mouth yeast infection (oral thrush)

    You can reduce these side-effects by using a spacer to reduce the amount of the medicine that stays in your mouth and throat. Also rinse your mouth with water or brush your teeth after using your inhaler as this can help too.

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

    Preventers contain inhaled steroids but they don’t seem to slow down children’s growth in the same way as oral steroids do. However, if your child takes inhaled steroids for a long time, your doctor or nurse may monitor their height and weight once a year.

    If you need to take high doses of inhaled steroid medicines, you may be more at risk of osteoporosis (thinning of the bones). You may need to carry a steroid card that gives details the steroids and dose you take for asthma. In the case of an emergency, it's important for doctors to have this information.

    Side-effects of leukotriene receptor antagonists

    The side-effects of leukotriene receptor antagonists may include:

    • digestive problems, such as stomach pain, sickness and diarrhoea
    • dry mouth and feeling thirsty
    • sleep disturbances
    • painful muscles or joints
    • headache

    Side-effects of theophylline

    The side-effects of theophylline may include:

    • fast or irregular heart beat
    • feeling sick or vomiting
    • headache
    • difficulty sleeping
    • fits

    This section does not include every possible side-effect of asthma medicines. Please read the patient information leaflet that comes with your medicine for more information.

  • Interactions Interactions of asthma medicines with other medicines

    Check with your GP or pharmacist before you take any other medicines or complementary therapies at the same as your asthma medicine.

    Some medicines, such as aspirin and beta blockers, can make asthma worse.

  • Common names 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 name Examples of common brand names
    Short-acting beta2 agonists
    bambuterol hydrochloride Bambec
    salbutamol Airomir, Asmasal Clickhaler, Salamol Easi-Breathe, Salbulin Novolizer, Ventmax SR, Ventolin
    salmeterol Serevent Accuhaler, Serevent Diskhaler
    terbutaline sulphate Bricanyl
    Long-acting beta2 agonists
    formoterol fumarate Atimos Modulite, Foradil, Fostair (a combination of beclometasone and formoterol), Oxis
    salmeterol Serevent Accuhaler, Serevent Diskhaler, Serevent Evohaler
    Inhaled steroids
    beclometasone Asmabec Clickhaler, Becodisks, Clenil Modulite, Qvar, Fostair (a combination of beclometasone and formoterol)
    budesonide Budelin Novolizer, Pulmicort, Symbicort (a combination of budesonide and formoterol)
    ciclesonide Alvesco
    fluticasone propionate Flixotide, Seretide (a combination of fluticasone and salmeterol)
    mometasone furoate Asmanex
    Leukotriene receptor antagonists
    montelukast Singulair
    zafirlukast Accolate

    theophylline

    Nuelin SA, Slo-Phyllin, Uniphyllin Continus
    Xanthines
    theophylline Nuelin SA, Slo-Phyllin, Uniphyllin Continus
  • FAQs FAQs

    Are there any complementary therapies I can try to control my asthma?

    Answer

    There is little or no evidence to show that complementary therapies help control symptoms of asthma. Some can be harmful and others are just not effective. The only therapy that has been found to be of any benefit is the Buteyko breathing technique.

    Explanation

    Research into complementary therapies has found no evidence that they are helpful in controlling asthma symptoms. These studies have looked at herbal and traditional Chinese medicine, acupuncture, homeopathy, hypnosis, manual therapy, dietary supplements and many others.

    There may be risks associated with using certain complementary medicines. Asthma can be potentially life threatening if it isn't treated with effective treatments. Other risks can include potentially harmful interactions with your prescribed asthma medicines or a risk of side-effects. Some traditional Chinese medicines have been found to contain potentially harmful substances. If you're thinking of trying a complementary therapy, speak to your GP or nurse first.

    Some people find the Buteyko breathing technique helps to control their asthma symptoms. This is a breathing technique that focuses on controlling hyperventilation (when you start breathing abnormally fast or deeply).

    Talk to your GP or asthma nurse if you have any questions or concerns about your asthma or complementary therapies.

    What is a nebuliser and do I need one for my asthma?

    Answer

    A nebuliser is a machine that makes a mist of medicine that you breathe in through a mask or mouthpiece. Most people with asthma won’t need to use a nebuliser but they may be used to treat severe asthma attacks.

    Explanation

    Nebulisers are usually only used in emergency situations when someone is having a severe asthma attack. They are often used in GP surgeries or in an accident and emergency department.

    Nebulisers can deliver high doses of reliever medicine quickly through a mouthpiece or mask. People who have severe asthma or have attacks that come on very quickly may need to have a nebuliser at home. However, very few people do actually need home nebulisers. Most people with asthma will only ever need an inhaler or a spacer to deliver their asthma medicine. These methods are usually just as effective and more convenient than using a nebuliser.

    Ask your GP if you think a home nebuliser would be useful for you. It’s important that you learn how to use a nebuliser properly and make sure it’s in good working order at all times. Your GP or asthma nurse will teach you how to use it.

    What should I do if I forget my asthma inhaler when I'm away from home?

    Answer

    Forgetting or losing your asthma inhaler when you’re away from home can be extremely dangerous. There are several places you can contact in an emergency to arrange asthma treatment.

    Explanation

    If you lose or forget your inhalers, there are several places you can contact to get emergency treatment and prescriptions, including:

    • GP surgeries
    • out-of-hours services
    • walk-in centres/urgent care centres
    • hospital emergency departments
    • ambulance services

    You may also buy emergency asthma inhalers from a pharmacy.

    It’s useful to keep spare inhalers in your car or at work in case you forget your asthma medicine. If you have a child with asthma, give spare inhalers to their school or carers. Remember to check the expiry dates on your spare inhalers regularly to make sure they don’t go out of date.

    If you have any questions or concerns about your asthma medicine, talk to your GP or asthma nurse.

  • Resources Resources

    Further information

    Sources

    • Asthma. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2011
    • Asthma treatment and management. Medscape. www.emedicine.medscape.com, published 10 June 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 16 September 2013
    • British guideline on the management of asthma. Scottish Intercollegiate Guidelines Network (SIGN), January 2012. www.sign.ac.uk
    • Preventer inhalers. Asthma UK. www.asthma.org.uk, accessed 16 September 2013
    • Reliever inhaler. Asthma UK. www.asthma.org.uk, accessed 16 September 2013
    • AAAAI allergy and asthma medication guide. American Academy of Allergy Asthma and Immunology. www.aaaai.org, published December 2011
    • Other treatments and 'add-on therapies'. Asthma UK. www.asthma.org.uk, accessed 16 September 2013
    • Management of chronic asthma in adults. Map of Medicine. www.mapofmedicine.com, published 1 July 2013
    • Nebulisers. Asthma UK. www.asthma.org.uk, accessed 16 September 2013
    • Spacers. Asthma UK. www.asthma.org.uk, accessed 16 September 2013
    • All about spacers. Asthma New Zealand the Lung Association. www.asthma-nz.org.nz, accessed 16 September 2013
    • Side effects of asthma medicines. Asthma UK. www.asthma.org.uk, accessed 16 September 2013
    • Steroid medicines – Q&A. Medicines and Healthcare Products Regulatory Agency. www.mhra.gov.uk, published 21 July 2007
    • Medications may trigger asthma symptoms. American Academy of Allergy Asthma and Immunology. www.aaaai.org, accessed 1 November 2013
    • Do ambulances carry nebulisers and steroids to administer to asthma attack patients on way to hospital? Asthma UK. www.asthma.org.uk, published 7 April 2013
    • Nebuliser factfile. Asthma UK. www.asthma.org.uk, accessed 16 September 2013
    • Advice for consumers on using traditional Chinese medicines (TCMS). Medicines and Healthcare Products Regulatory Agency. www.mhra.gov.uk, published 1 February 2013
    • Complementary therapies. British Lung Foundation. www.blf.org.uk, accessed 16 September 2013
  • Related information Related information

  • Author information Author information

    Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, November 2013.

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