The main goal of most control drugs is to prevent symptoms from occurring
in the first place. In general, anyone with persistent asthma — whether mild,
moderate, or severe — should take a control drug every day. (Read more about children
under age 5.)
Beyond this, the National Asthma Education and Prevention Program recommends
that long-term control therapy should be considered in any infant or young
child who has had more than three episodes of wheezing in the last year that
lasted more than 1 day and affected sleep. They should also be given long-term
control therapy if they are at risk for developing asthma. Children are at
risk for asthma if they have a parent with asthma or eczema, or two of the
- Nasal allergies
- Wheezing apart from colds
- Evidence of allergies on a complete blood count test
This approach may prevent or delay the child developing asthma.
Some people who already have asthma use control drugs only during times when
they are likely to be exposed to one of their asthma triggers, such as a particular
season or when staying at a pet owner's house.
The following are the main drugs in this category.
Steroids (also called corticosteroids) are very effective for long-term control
when taken daily. They are generally a doctor's first choice for daily medication
to treat persistent asthma at all levels of severity. For moderate-to-severe
asthma, they may be even more effective when combined with long-acting beta
agonists. (See combination therapy, below.) Steroids work by reducing inflammation
in the airways. Steroids are generally inhaled using a metered dose inhaler
(MDI) device or dry powder inhaler (DPI).
Pulmicort Respules is a drug approved for children 12 months - 8 years of
age. This medicine is administered using a nebulizer, and therefore may be
suitable for those who can't easily manipulate inhalers and spacers. Steroids
are also available as pills, liquids, and other forms, but these are generally
used in special cases, such as initial treatment to bring asthma under control
or severe persistent asthma that has not been brought under control by other
Examples of other steroids include flunisolide (Aerobid), mometasone (Asmanex),
triamcinolone (Azmacort), fluticasone (Flovent), and beclomethasone (Qvar).
Flovent HFA and Qvar are steroids using an environmentally friendly propellant
(non-CFC). Asmanex Twisthaler and Flovent Diskus are inhalation-driven devices
that do not use a propellant, thus eliminating the need for hand-breath coordination.
Other long-term control drugs
Other drugs may be prescribed for everyday use to control asthma. By themselves,
none has been demonstrated to be as effective as inhaled steroids. These other
- Long-acting beta-agonists — These help control moderate-to-severe
asthma, prevent nighttime symptoms, and prevent exercise-induced
attacks. The drugs work by relaxing the muscles of your bronchial tubes
and are effective for 12 or more hours after a single dose. They include
salmeterol (Serevent) and formoterol (Foradil). IMPORTANT NOTE: These drugs
are NOT formulated the same as "short-acting" beta-agonists, and should not
be used for quick relief of symptoms. They are only for preventing symptoms
from occurring in the first place. They are often used in combination with
inhaled steroids -- they are generally not used as the only medicine to control
asthma. Note: On November 18, 2005, the U.S. Food and Drug Administration
(FDA) notified manufacturers of Advair Diskus, Foradil Aerolizer, and Serevent
Diskus to update their existing product labels with new warnings and a Medication
Guide for patients to alert health care professionals and patients that these
medicines may increase the chance of severe asthma episodes, and death when
those episodes occur. All of these products contain long-acting beta2-adrenergic
agonists (LABA). Even though LABAs decrease the frequency of asthma episodes,
these medicines may make asthma episodes more severe when they occur. A Medication
Guide with information about these risks will be given to patients when a
prescription for a LABA is filled or refilled. See the FDA website for more
information, at www.fda.gov.
- Leukotriene modifiers — These are relatively new drugs for patients
with mild-to-moderate persistent asthma. They come in tablet or pill form.
For mild asthma, they may be considered as an alternative to inhaled steroids.
For moderate asthma, they may supplement inhaled steroids in place of long-acting
beta agonists. Leukotriene modifiers include monoleukast (Singulair), approved
for children 12 months of age and older; zafirlukast (Accolate), for kids
age 5 and older; and zileuton (Zyflo), for patients age 12 and older.
- IgE blockers — This new class of drug targets immunoglobulin E
(IgE), a molecule responsible for allergic asthma. Omalizumab (Xolair) is
used for people with moderate or severe persistent asthma who continue to
have symptoms even though they are taking inhaled steroids. Xolair is given
- Theophylline — This drug is used to help control mild-to-moderate
persistent asthma, especially to prevent nighttime symptoms. People who take
this drug need routine blood tests to make sure that the drug stays within
safe levels. Theophylline works by relaxing the muscles of your bronchial
tubes; it is not an anti-inflammatory drug. Theophylline is used less often
than it was in the past. Brands include Uniphyl.
- Cromolyn — This is a non-steroid medicine with anti-inflammatory
effects and may be used to control mild persistent asthma. Cromolyn is available
for use in a nebulizer, and therefore may be appropriate for young children.
It is also available as an aerosol. An example of cromolyn is Intal.
For moderate persistent asthma and for severe asthma in children over age
5 and in adults, strong evidence from clinical trials clearly shows that adding
a long-acting beta agonist to low-to-medium doses of inhaled steroids decreases
the frequency of asthma episodes and reliance on relief medicines. This is
because the steroid treats inflammation at the same time the beta agonist treats
airway constriction (tightening). The combination approach is recommended for
The two drugs can be taken with different inhalers, but products that combine
them into one inhaler (such as Advair HFA, Advair Diskus, or Symbicort) may
be more convenient and therefore used more consistently. Advair Diskus is a
dry powder inhaler. Both Advair and Symbicort are approved for ages 12 and
Note: On November 18, 2005, the U.S. Food and Drug Administration (FDA) notified
manufacturers of Advair Diskus, Foradil Aerolizer, and Serevent Diskus to update
their existing product labels with new warnings and a Medication Guide for
patients to alert health care professionals and patients that these medicines
may increase the chance of severe asthma episodes, and death when those episodes
occur. All of these products contain long-acting beta2-adrenergic agonists
(LABA). Even though LABAs decrease the frequency of asthma episodes, these
medicines may make asthma episodes more severe when they occur. A Medication
Guide with information about these risks will be given to patients when a prescription
for a LABA is filled or refilled. See the FDA website for more information,
For some patients, it may be appropriate to combine inhaled steroids with
leukotriene modifiers or theophylline or to double the steroid dose alone.
However, the evidence for the effectiveness of these combinations is not as
National Asthma Education and Prevention Program Expert Panel Report: guidelines
for the diagnosis and management of asthma update on selected topics -- 2002. J
Allergy Clin Immunol. 2002 Nov;110(Suppl 5):S141-219.
National Asthma Education and Prevention Program Expert Panel Report 2:
guidelines for the diagnosis and management of asthma. Bethesda (MD):
U.S. Department of Health and Human Services, Public Health Service, National
Institutes of Health, National Heart, Lung and Blood Institute; 1997 Jul.
NIH Publications 97-4051.
Williams SG, Schmidt DK, Redd SC, Storms W. Key clinical activities for quality
asthma care: recommendations of the National Asthma Education and Prevention
Program. MMWR Recomm Rep. 2003 Mar 28;52(RR-6):1-8.
Review Date: 5/16/2007
Reviewed By: Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Packard Children's Hospital, Stanford University School of Medicine; Chief Medical Officer, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-
A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.