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Asthma Treatment: Steroids And Other Anti-Inflammatory Drugs
The key treatments for asthma are steroids and other anti-inflammatory drugs. These asthma drugs both help to control asthma and prevent asthma attacks.
Steroids and other anti-inflammatory drugs work by reducing inflammation, swelling, and mucus production in the airways of a person with asthma. As a result, the airways are less inflamed and less likely to react to asthma triggers, allowing people with symptoms of asthma to have better control over their condition.
The key treatments for asthma are steroids and other anti-inflammatory drugs, which work by reducing inflammation, swelling, and mucus production in the airways of a person with asthma. Photo credit: Aaron Amat/Dreamstime
The main types of anti-inflammatory drugs for better asthma control are steroids or corticosteroids. Other anti-inflammatory treatments include leukotriene modifiers and immunomodulators.
Inhaled steroids are the mainstay treatment for controlling asthma. The use of inhaled steroids leads to:
Steroids may help with asthma symptoms during an attack but are slow-acting and can take several hours to take effect. Dosages of inhaled steroids in asthma inhalers vary.
Inhaled steroids need to be taken daily for best results. Some improvement in asthma symptoms can be seen in 1 to 3 weeks after starting inhaled steroids, with the best results seen after 3 months of daily use.
Inhaled steroid medications for better asthma control include:
Inhaled steroids come in three forms: the hydrofluoroalkane inhaler or HFA (formerly called a metered dose inhaler or MDI), dry powder inhaler (DPI), and soft mist inhalers.
Inhaled steroids have few side effects, especially at lower doses. Thrush (a yeast infection in the mouth) and hoarseness may occur, although this is rare. Rinsing the mouth, gargling after using the asthma inhaler, and using a spacer device with metered dose inhalers can help prevent these side effects. Thrush is easily treated with a prescription antifungal lozenge or rinse.
Inhaled steroids (asthma inhalers) are safe for adults and children. Side effects with these anti-inflammatory asthma inhalers are minimal. Your doctor will prescribe the lowest dose that effectively controls your child's or your asthma.
On a side note, many parents are concerned about giving their children "steroids." Inhaled steroids are not the same as anabolic steroids that some athletes take to build muscle. These steroids are anti-inflammatory drugs, the cornerstone of asthma therapy. There are many benefits of using anti-inflammatory asthma inhalers to manage asthma.
To learn more about using inhaled steroids in children, see WebMD's article on childhood asthma.
The benefits of inhaled steroids for better asthma control far exceed their risks, and include:
Using systemic steroids (steroids taken by mouth or by injection that can affect the entire body) such as methylprednisolone, prednisone, and prednisolone helps to treat severe asthma episodes, allowing people to gain better asthma control. Prednisone and other steroid drugs may be used to help control sudden and severe asthma attacks or, in rare cases, to treat long-term, hard-to-control asthma.
Most often, prednisone or another steroid is taken in high doses for a few days (called a steroid burst) for a more severe asthma attack.
Side effects of systemic steroids can include acne, mood or behavior changes, an upset stomach, thinning of the bones, and eye changes (glaucoma and cataracts). These side effects rarely occur with short-term use, such as for an acute asthma attack.
Steroids have many potential side effects, especially when given orally and for a long period of time. Side effects with short-term steroid use include:
Side effects with long-term steroid use include:
For in-depth information, see WebMD's article on prednisone and asthma.
Montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo) are called leukotriene modifiers. Leukotrienes are inflammatory chemicals that occur naturally in our bodies and cause tightening of airway muscles and production of mucus. Leukotriene modifier drugs help control asthma by blocking the actions of leukotrienes in the body. Studies show that these medications can help improve airflow and reduce asthma symptoms.
Leukotriene modifiers are taken as pills and have been shown to decrease the need for other asthma medications. These medications have also been shown to work well in people with allergic rhinitis (nasal allergies) and may work well in people with both allergic rhinitis and allergic asthma.
The most common side effects of leukotriene modifiers are headache, nausea, vomiting, insomnia, and crankiness. Leukotriene modifiers may interfere with other medications (for example, theophylline and the blood thinner warfarin). Make sure you inform your doctor of all the medications you are taking.
Mepolizumab (Nucala) is a biologic therapy that has been found to control the blood cells that often trigger asthma. Nucala targets interleukin-5 (IL-5) which regulates the levels of blood eosinophils (the type of white blood cells that helps trigger asthma). Genetically engineered, Nucala keeps IL-5 from binding to eosinophils and, thereby, lowers the risk of a severe asthma attack.
Nucala is given as a shot once every 4 weeks and is meant to be used along with other asthma treatments as a maintenance medication. By using Nucala, patients have been found to not only have fewer asthma incidents, but they are able to reduce the amount of their other asthma medications. Side effects include headaches and a reaction that can cause swelling of the face and tongue, dizziness, hives, and breathing problems.
Omalizumab (Xolair), an immunomodulator, works differently from other anti-inflammatory medications for asthma. Xolair blocks the activity of IgE (a protein that is overproduced in people with allergies) before it can lead to asthma attacks. Immunomodulator treatment has been shown to help reduce the number of asthma attacks in people with moderate to severe allergic asthma whose symptoms are not controlled with inhaled steroids.
Xolair, a prescription maintenance medication, is given as a shot every 2 to 4 weeks. It's recommended for people with moderate to severe allergic asthma. Side effects may include redness, pain, swelling, bruising or itching at the injection site, joint pain, and tiredness. There is a slight increase in risk for problems with the heart and circulation to the brain in people using Xolair. It also carries a boxed warning about a severe, potentially life-threatening allergic reaction (anaphylaxis).
Reslizumab (Cinqair) is also a maintenance medication. It is used along with regular asthma medicines when those medicines cannot fully control your asthma. This medicine is given every 4 weeks as an IV over a period of about an hour. This drug works by reducing the number of a specific type of white blood cells called eosinophils that play a role in causing asthma symptoms. It can reduce severe asthma attacks. Side effects include anaphylaxis (a severe allergic reaction), muscle pain, and cancer.
Tiotropium bromide (Spiriva Respimat) is a long-acting anticholinergic medication. Anticholinergics relax and enlarge (dilate) the airways in the lungs, making breathing easier (bronchodilators). Tiotropium bromide is a maintenance medication used once a day along with other maintenance drugs when tighter control is needed for symptom relief. It is not a rescue inhaler. This drug may be used by people ages 6 and older who have asthma.
The most common side effects are pharyngitis (a sore throat), a headache, bronchitis, and sinusitis. Other reactions include dizziness, diarrhea, coughing, allergic rhinitis, urinary tract infections and urinary retention, yeast infections in the mouth or throat, and high blood pressure (hypertension).
10 Surprising Asthma Mistakes Even Long-term Patients Make
Managing asthma effectively requires more than just keeping an inhaler nearby. This chronic respiratory condition affects approximately 25 million Americans, yet despite medical advances and improved treatment options, many continue experiencing unnecessary symptoms and flare-ups due to subtle but significant management mistakes.
Asthma involves complex interactions between airway inflammation, bronchoconstriction, and mucus production that create the familiar symptoms of wheezing, coughing, chest tightness, and shortness of breath. While medication forms the cornerstone of control, numerous factors influence asthma stability beyond prescriptions alone.
Understanding these common missteps can transform asthma management from a reactive emergency-focused approach to proactive prevention. Many of these mistakes occur without patients realizing their impact on respiratory health, creating cumulative effects that undermine even the best treatment plans.
The following errors represent the most frequent yet overlooked aspects of asthma control—issues that affect patients across all severity levels, from mild intermittent to severe persistent asthma. Addressing these mistakes often provides the missing pieces for achieving better breathing and improved quality of life.
Incorrect inhaler technique compromises medication deliveryPerhaps the most pervasive and significant mistake in asthma management involves improper inhaler technique. Research consistently shows that 70-90% of patients make at least one critical error when using their inhalers, dramatically reducing medication effectiveness regardless of how faithfully they follow their treatment schedule.
Common technique errors include:
Inadequate exhaling before inhalation, preventing full lung expansion for medication delivery Improper inhaler positioning, allowing medication to hit the back of the throat rather than reaching the airways Breathing too quickly or forcefully with metered-dose inhalers, causing turbulence that deposits medication in the upper airway Poor coordination between canister depression and inhalation, causing medication release before or after the breathing cycle Insufficient breath-holding after inhalation, reducing medication deposition in the small airways
These errors occur with all inhaler types but vary in frequency and impact depending on the specific device. Metered-dose inhalers (MDIs) typically show the highest error rates, particularly when used without spacers. Dry powder inhalers (DPIs) eliminate some coordination issues but introduce different technique requirements, including sufficient inspiratory force to activate the medication.
Even experienced asthma patients make technique errors, as habits change over time and periodic reinforcement rarely occurs after initial device training. Additionally, many patients receive minimal initial instruction, with some studies showing less than two minutes of technique education during medical visits.
The solution involves requesting technique evaluation at every asthma-related appointment, using device-specific checklists for each inhaler type, and considering video recording your technique for self-assessment between visits. Spacer devices dramatically improve MDI effectiveness for many patients by eliminating coordination challenges and reducing oropharyngeal medication deposition.
Confusing controller and rescue medications leads to undertreatmentAsthma typically requires two fundamental medication types: controllers (taken regularly to reduce inflammation and prevent symptoms) and rescue medications (used as needed for quick relief during symptoms or flares). Confusing these medication roles represents a dangerous and common mistake that undermines long-term lung health.
The distinction matters critically because:
Controller medications work by gradually reducing underlying airway inflammation but provide no immediate symptom relief Rescue medications quickly open constricted airways during symptoms but don't address the underlying inflammation Overreliance on rescue medications while underusing controllers allows ongoing inflammation to damage airways permanently Trying to use controllers during acute symptoms provides no immediate relief and potentially delays necessary emergency treatment
This confusion frequently manifests as patients using rescue inhalers daily while leaving controller medications untouched or used sporadically. This pattern creates a dangerous cycle where immediate relief takes precedence over addressing the underlying condition, allowing inflammation to progress unchecked.
Controller medications typically include inhaled corticosteroids (ICS), combination ICS/long-acting bronchodilators, leukotriene modifiers, and biologics. These medications require consistent use over weeks to achieve full effectiveness. Rescue medications include short-acting beta-agonists like albuterol and combination quick-relief inhalers.
Visual cues can help maintain clarity—keeping controller medications in the bathroom with other daily routine items while carrying rescue inhalers in purses, backpacks, or pockets helps reinforce their different purposes. Color-coding or labeling inhalers with their specific purpose ("daily use" versus "emergency only") provides additional distinction.
Missing early warning signs of worsening controlAsthma rarely deteriorates from well-controlled to severe exacerbation without warning signs. However, many patients miss these subtle control changes, losing valuable intervention opportunities before significant flares develop. This oversight often stems from becoming accustomed to mild symptoms or misattributing them to other causes.
Early warning signs that frequently go unrecognized include:
Increasing nighttime awakenings due to coughing or chest tightness Needing rescue medication more than twice weekly Mild exercise intolerance or needing to stop activities earlier than usual Morning symptoms that linger longer than previously Increased mucus production or throat clearing Subtle changes in peak flow measurements before noticeable symptom changes
Many patients normalize these gradual changes, considering them part of living with asthma rather than indicators of slipping control. This normalization allows inflammation to intensify and airways to become more reactive before intervention occurs.
Structured monitoring tools provide objective measures that can identify control changes before they become obvious. Daily or weekly symptom tracking apps, peak flow monitoring with documented personal best values, and asthma control questionnaires like the Asthma Control Test (ACT) help quantify subtle shifts that might otherwise go unnoticed.
The goal involves identifying control changes when minor medication adjustments can prevent major exacerbations, hospital visits, and oral steroid requirements. Established action plans should define specific thresholds for increasing controller medications or contacting healthcare providers based on these monitoring parameters.
Ignoring environmental trigger managementWhile medication addresses the physiological aspects of asthma, environmental trigger management represents an equally important but often neglected component of comprehensive control. Many patients focus exclusively on pharmaceutical interventions while continuing exposure to preventable triggers that directly stimulate airway inflammation and constriction.
Common environmental triggers include:
Indoor allergens like dust mites, pet dander, cockroaches, and mold Outdoor allergens including pollen and environmental mold Irritants such as tobacco smoke, wood smoke, strong odors, and air pollution Weather changes, particularly cold air, humidity shifts, and barometric pressure changes Workplace exposures to chemicals, dusts, or fumes
Effective environmental management requires first identifying personal triggers through careful symptom tracking and potentially allergy testing for uncertain triggers. Once identified, specific avoidance or mitigation strategies for each trigger can dramatically reduce symptom frequency and medication requirements.
Home modifications often provide the most significant impact, as indoor air quality affects daily exposure levels. High-efficiency particulate air (HEPA) filters, dust mite-proof bedding encasements, humidity control to prevent mold growth, and removal of carpet in bedrooms can transform home environments from trigger-rich to respiratory-friendly spaces.
Even patients with severe asthma often find their medication needs decrease with comprehensive environmental control. This synergistic relationship between trigger avoidance and medication creates a positive cycle where each component enhances the other's effectiveness.
Failing to adjust treatment for exercise and seasonal changesAsthma requires dynamic management that responds to predictable variables like exercise, seasonal allergen changes, and weather shifts. Many patients maintain static medication regimens throughout the year despite these known challenges, leading to preventable symptom flares and activity limitations.
Exercise-induced bronchoconstriction affects approximately 80-90% of asthma patients but responds well to preventive strategies including:
Pre-medication with rescue inhalers 15-20 minutes before activity Extended warm-up periods allowing gradual respiratory adaptation Cold-weather modifications like face masks to warm inspired air Adjusted exercise intensity or duration during vulnerable periods Appropriate activity selection favoring swimming, walking, or other lower respiratory demand activities during vulnerable periods
Seasonal adjustments similarly prevent predictable exacerbations during high-risk periods like spring pollen season, fall leaf mold increases, or winter viral illness peaks. These adjustments might include temporarily increasing controller medication doses, adding additional control medications, or implementing more stringent environmental measures during high-risk periods.
Working with healthcare providers to develop season-specific and exercise-specific medication protocols empowers patients to maintain activity levels and outdoor engagement while preventing symptoms. This proactive approach replaces the common reactive pattern of waiting for symptoms to occur before seeking help.
Overlooking the impact of comorbid conditionsAsthma rarely exists in isolation. Multiple related conditions significantly influence asthma control yet often receive inadequate attention in comprehensive management plans. Failing to address these comorbidities creates a ceiling effect where asthma control plateaus despite optimal asthma-specific treatment.
Conditions frequently coexisting with asthma include:
Chronic rhinosinusitis and allergic rhinitis, which share inflammatory pathways with asthma and directly influence lower airway inflammation through post-nasal drainage Gastroesophageal reflux disease (GERD), where stomach acid microaspiration irritates airways and triggers bronchospasm Obesity, which increases inflammatory cytokines, reduces lung volumes, and decreases response to standard medications Obstructive sleep apnea, creating oxidative stress and systemic inflammation that worsen asthma control Anxiety and depression, which influence symptom perception, medication adherence, and stress-induced bronchospasm
These conditions create a bidirectional relationship with asthma—they worsen respiratory symptoms while asthma exacerbates their manifestations. This interaction creates a challenging cycle requiring coordinated treatment approaches.
Comprehensive asthma care includes screening for and addressing these common comorbidities. Treating rhinitis with intranasal corticosteroids often improves asthma control. Managing GERD through dietary changes, elevation of the head during sleep, and appropriate medications reduces nocturnal asthma symptoms. Weight management programs show significant asthma improvement alongside general health benefits.
Inconsistent medication adherence undermines controlThe most effective asthma medications only work when taken as prescribed. Yet adherence rates for controller medications typically hover around 30-50% in real-world settings, creating a substantial gap between potential and actual disease control. This adherence challenge often occurs silently, as patients rarely volunteer information about missed doses.
Common adherence barriers include:
Complicated medication regimens with multiple inhalers taken at different times Medication costs and insurance coverage limitations Concerns about long-term medication side effects, particularly with corticosteroids Symptom-based usage patterns where medications are only taken during noticeable symptoms Difficulty integrating medication use into daily routines, particularly with morning and evening doses
The solution involves addressing both practical and perceptual barriers to consistent use. Simplified regimens using once-daily medications or combination inhalers reduce complexity. Medication reminder apps, dose counters, and linking administration to established daily habits (like brushing teeth) enhance routine development.
Equally important is addressing perceptual concerns about medications. Many patients harbor unspoken fears about controller medications, particularly inhaled steroids, based on misconceptions about systemic steroids. Educational approaches emphasizing the safety profile of modern asthma medications, their local rather than systemic effects, and the greater risk of uncontrolled asthma compared to treatment side effects can transform adherence patterns.
Improper management during respiratory infectionsRespiratory infections represent the most common asthma exacerbation trigger, yet many patients lack clear protocols for adjusting management during these high-risk periods. This gap leaves them vulnerable to significant deterioration when viruses or bacteria inflame already sensitive airways.
Effective infection-period management includes:
Early intervention at the first signs of respiratory infection, rather than waiting for asthma symptoms to worsen Temporary increases in controller medication dosing according to pre-established action plans More frequent monitoring of lung function using peak flow measurements to detect early deterioration Maintaining adequate hydration to thin mucus secretions and facilitate clearance Seeking medical attention promptly if symptoms worsen despite initial management steps
Many patients make the mistake of relying solely on rescue medications during infections without adjusting controller medications. This approach addresses symptoms but not the intensified underlying inflammation, creating vulnerability for prolonged or severe exacerbations requiring emergency intervention.
Developing specific infection-management protocols as part of written asthma action plans provides clear guidance during these challenging periods. These plans typically use a zone system (green, yellow, red) with specific medication adjustments and monitoring requirements for each zone, removing uncertainty during periods when decision-making capacity may be compromised by illness.
Delaying action plan implementation during exacerbationsWritten asthma action plans provide personalized roadmaps for managing changing symptoms, but they only work when implemented promptly and correctly. Many patients delay following these plans during worsening symptoms, hoping for spontaneous improvement or waiting until symptoms become severe before taking action.
Common action plan implementation delays include:
Underestimating symptom severity due to gradual onset or habituation to limited breathing Inconvenient timing of symptoms interfering with work, school, or social obligations Reluctance to use oral steroids despite their inclusion in moderate or severe symptom protocols Medication access issues including empty inhalers or expired prescriptions discovered during exacerbations Confusion about plan details during the stress of breathing difficulty
These delays allow mild or moderate symptoms to progress to severe exacerbations requiring emergency care, precisely the outcome action plans aim to prevent. Research shows that patients who follow action plans promptly experience fewer emergency visits, hospitalizations, and missed work or school days compared to those who delay implementation.
Successful action plan utilization requires regular review during stable periods to ensure familiarity with the steps before they're needed urgently. Simplifying plans to focus on the most essential actions, using visual cues and straightforward language, and ensuring all medications in the plan remain readily available and unexpired enhances implementation likelihood during stressful symptom periods.
Overlooking the psychological dimensions of asthmaAsthma doesn't just affect the airways—it creates complex psychological interactions that influence both perception of and response to symptoms. Many management approaches focus exclusively on physiological aspects while neglecting the significant psychological components of effective disease control.
Key psychological factors affecting asthma include:
Anxiety-breathing cycle interactions, where shortness of breath creates anxiety that further compromises breathing patterns Symptom vigilance variations, with some patients overly attuned to minor changes while others dangerously underperceive significant symptoms Illness-related stress creating direct physiological effects through stress hormones that influence airway reactivity Disease self-efficacy—the confidence in one's ability to manage asthma effectively—directly influencing adherence and outcomes Depression affecting motivation for self-care behaviors and potentially altering inflammation through neuroendocrine pathways
Incorporating psychological support into asthma management transforms outcomes for many patients. Simple breathing retraining techniques help break the anxiety-breathing cycle. Mindfulness practices reduce stress-induced bronchospasm. Cognitive-behavioral approaches address catastrophic thinking patterns that intensify symptom perception and fear.
For patients with significant psychological components to their asthma experience, collaboration between respiratory specialists and mental health providers offers comprehensive support addressing both physiological and psychological dimensions simultaneously.
Creating a comprehensive control strategyAddressing these common mistakes requires an integrated approach where each component supports the others. Rather than viewing asthma management as simply "taking inhalers," effective control demands attention to medication use, environmental factors, comorbid conditions, psychological influences, and proactive planning for high-risk periods.
A comprehensive strategy includes:
Regular technique evaluation for all inhaler devices with specific checklists for each type Clear visual distinction between controller and rescue medications with proper education about their roles Structured monitoring using symptom tracking, peak flows, or validated questionnaires to identify control changes early Personalized environmental management addressing specific identified triggers Dynamic treatment adjustment for exercise, seasons, infections, and other predictable challenges Screening and management for common comorbidities that influence respiratory health Adherence support addressing both practical barriers and perceptual concerns Written action plans with clear instructions for recognition and management of changing symptoms Attention to psychological components including anxiety management and breathing retraining Regular medical review with spirometry to assess control objectively and adjust treatment appropriately
This multifaceted approach addresses the common mistakes undermining asthma control while providing redundancy where one system supports others. For example, improved inhaler technique enhances medication effectiveness, reducing the impact if occasional doses are missed. Environmental control decreases trigger exposure, creating greater resilience during high-risk periods like respiratory infections.
The path to better breathingUnderstanding these common asthma control mistakes provides a roadmap for improved management. Many patients discover that addressing these often-overlooked factors transforms their asthma experience, reducing both daily symptoms and exacerbation frequency even without changing their primary medications.
This transformation typically occurs gradually as each component receives attention, creating cumulative benefits that build over time. The goal isn't perfection in all areas simultaneously but rather progressive improvement across multiple dimensions of asthma care.
For the millions living with asthma, this broader perspective offers hope beyond simply accepting limitations or increasing medication doses. By addressing these common mistakes, many find a new level of respiratory health that allows fuller participation in life's activities with confidence and control.
Don't Skip The Asthma Inhaler Just Because You Feel Fine
A patient of mine is a 53-year-old educator with a history of asthma since early adulthood. Despite being prescribed a preventer inhaler to be used daily to control her airway inflammation, she seldom used it.
She assumed her asthma was under control, as she considered her symptoms to be mild and infrequent. She relied instead on using her other inhaler, a reliever inhaler, whenever her asthma symptoms came on.
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