Asthma medicines fall into two categories:

• reliever medicines, taken during flare-ups (exacerbations) or for quick relief of symptoms, and
• maintenance medicines (preventers), taken every day to help make breathing easier over the long term. A preventer should be used even if a person isn’t experiencing any asthma symptoms.

A person with asthma will be prescribed reliever medicine whether their symptoms are mild, moderate or severe.

People who experience moderate or severe asthma symptoms are also likely to be prescribed a preventer, alongside their reliever medication. This is for everyday use. Some people with mild asthma may also need to use a preventer.

For adults with asthma, some inhalers can contain both a reliever and preventer. This means that you can use the same inhaler during a flare-up to help with symptoms, and also daily to reduce airway inflammation even if you are not experiencing symptoms.

People with asthma will use inhalers to take both relievers and preventers. If their asthma symptoms persist, a doctor may recommend taking tablets as well.

Inhalers

Inhalers are devices that let a person breathe in medication, so that the medicine is delivered directly into their lungs. There are many different types of inhalers for asthma medicine. Not all inhalers are used the same way.

A doctor, nurse or pharmacist can teach you or your child how and when to use an inhaler.

Find out more about inhalers

Watch the National Asthma Council of Australia's videos about using inhalers

Most reliever medicines for asthma belong to a group of medicine called short-acting beta₂ agonists (SABAs). They include these active ingredients:

• salbutamol (brands include Airomir, Asmol, Ventolin)
• terbutaline (Bricanyl).

Reliever medicines help relax the muscles around narrowed airways and quickly reduce asthma symptoms. They usually work within 4 minutes and can keep airways open for around 4–6 hours.

Inhaler devices for these medicines are usually blue or grey, so they are sometimes called 'blue reliever puffers'.

A person with asthma should carry a reliever with them at all times. A doctor, nurse or pharmacist can demonstrate how and when to use a reliever.

It’s recommended to see a doctor if reliever medicine is being used for more than two days a week , or if someone is having asthma symptoms more than twice a week. This is a sign that their asthma is not well controlled or may be getting worse.

Preventers contain anti-inflammatory medicines called corticosteroids which reduce inflammation of the airways. Preventers make the airways less sensitive and irritated. They also help dry out the mucus in the lining of the airways that can lead to breathing difficulty.

By reducing inflammation, these medicines can help keep asthma symptoms under control and reduce the chance of having an asthma flare-up. For children aged 6 years or older, a low dose of an inhaled corticosteroid can be used as a preventer.

The effect of a preventer medicine on the airways lasts for 12–24 hours. It should be taken once or twice a day, as directed by your doctor.

Preventer medicines can have the following active ingredients:

• beclometasone (eg, Qvar Autohaler)
• budenoside (eg, Pulmicort Turbuhaler)
• ciclesonide (eg, Alvesco 160)
• fluticasone (eg, Flixotide Accuhaler).

The inhaler devices that contain these medicines are usually brown, orange, rust or yellow.

Different types of inhaler will suit different people. Important factors may include:

• the person’s hand strength and coordination (eg, some inhalers may be harder for people with weak hands or arthritis to use)
• the type of active ingredient, as some medicines can only be delivered by certain types of devices.

Combination medicines are usually made up of both long-acting beta₂ agonists and inhaled corticosteroids packaged together in one inhaler. These medicines can help manage asthma in the long term. They may be a good option if asthma symptoms are not controlled with a single-ingredient preventer medicine.

If children who are 6 years or younger are experiencing difficulty in controlling asthma symptoms, they need to see a specialist. The specialist will decide if they need a combination medicine.

The combination of medicines will be:

• a long-acting beta₂ agonist (to relieve shortness of breath, coughing and wheezing) and
• an inhaled corticosteroid (a preventer medicine, to reduce swelling of the airways)

These should be taken daily, either once or twice depending on the medicine.

For adults with mild asthma, they may also be prescribed a combination inhaler containing both a reliever and preventer, to use as-needed for symptom relief, rather than on a daily basis.

These medicines include Symbicort (taken with a Turbuhaler or Rapihaler), DuoResp (taken with a Spiromax), Seretide (taken with an Accuhaler or MDI) and Breo.

Sometimes other preventer medicines, different to the inhaled corticosteroids discussed previously, may be used to reduce ongoing asthma symptoms.

One of these medicines is called montelukast (Singulair), which comes as a tablet (including a chewable tablet).

Montelukast may be used if asthma symptoms haven’t been controlled with the use of a reliever and a preventer together.

Some side effects of montelukast include headache, stomach pains and diarrhoea.

Some rare but more serious side effects include feeling agitated, not sleeping well, depression and in some cases, suicidal thoughts and behaviour. Even though they are rare, it is important to be aware of these side effects. If you or your child take montelukast and are having suicidal thoughts seek urgent medical help.

Find out more about montelukast

A person experiencing moderate or severe asthma symptoms may be prescribed an anticholinergic medicine in addition to combination medicine.

This is a medicine called tiotropium bromide (Spiriva Respimat) which relaxes the airways. It comes in an inhaler that delivers a mist of medication into the lungs.

A specialist may prescribe an anticholinergic to children 6 years or older if their asthma symptoms are severe and unable to be controlled by combination medicine alone.

If after taking tiotropium bromide you, or your child, experiences a fast or irregular heartbeat, shortness of breath, swelling on any part of the body, a rash, hives or itchy skin, then talk to your doctor immediately or go to the nearest emergency department.

Find out more about tiotropium bromide

Like all medicines, asthma medicines can have side effects.

• Side effects from long-acting beta₂ agonists include shaky hands (tremors) and a fast heartbeat.
• Inhaled corticosteroid medicines have side effects such as a sore throat, hoarse voice, and sore raised patches in the mouth (a fungal infection called thrush).
• Tiotropium bromide side effects include a dry mouth, cough, dry skin, or dizziness, or trouble sleeping. Some more serious side effects of tiotropium bromide can include blurred vision, high pressure in the eye, difficulty in swallowing, heartburn, difficulty or pain when passing urine, constipation and worsening of breathing problems. It’s important to tell a doctor if these occur.

It’s important to rinse the mouth out with water immediately after using an inhaler that contains a corticosteroid, as leftover medicine in the mouth can cause thrush.

If someone is experiencing side effects from their asthma medicine, they should not stop taking it. Stopping asthma medicine can cause more problems than side effects and can lead to an asthma attack. If the side effects are of concern or causing problems speak with a health professional as soon as possible.

A person is less likely to experience side effects if they take these medicines as directed by their health professional.

Everyone with asthma should have a written asthma action plan from a doctor. This will help to manage asthma symptoms and recognise signs of worsening asthma.

An asthma action plan will give instructions on how and when to use medicines and which medicine to use from the ones you have been prescribed. It will also instruct you on what to do in the event of an asthma flare-up.

It’s important to update the asthma action plan if there are any changes to your asthma treatment.

Find out more about asthma diagnosis and management

• For more information on asthma medications, see the Consumer Medicine Information for your brand of medicine, available on our Medicine Finder page or from your pharmacist or doctor.
• If you have any questions about medicines, you can speak to one of our pharmacists at Medicines Line by calling 1300 633 424 Monday to Friday, 9 am to 5 pm AET (excluding NSW public holidays).
• For non-medicine products, such as inhaler devices, further information may also be available from the manufacturer.
• For more about living well with asthma, managing asthma in school children and community-level education and support visit Asthma Australia

MedicineWise app

The MedicineWise smartphone app has been developed by NPS MedicineWise. It can help you keep an up-to-date list of all the medicines you take and get reminders on how and when to take your medicines.

Find out more about the MedicineWise app and how it can help you.