Controller Medicines for Asthma

Asthma Controllers
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There are many different kinds of controller medicines for asthma. Controller inhalers are usually brown, red, or orange.

Controller medicines help to control the swelling (inflammation) of your child’s airways. They are used for long periods of time. Usually, your child will need to take a controller every day to reduce swelling and mucus in the airways and to help prevent asthma attacks. Controller medicines should not be used as rescue medication during an asthma attack.

Your child will probably benefit from a daily controller medicine if he has any of the following:

  • regular asthma symptoms
  • frequent or severe asthma flare-ups
  • abnormal breathing test ( pulmonary function test or spirometry)

If your child’s doctor has prescribed a controller medicine, make sure your child takes it every day, even if he seems well. Your child should keep taking the controller medicine until the doctor tells you it is okay to stop.

There are several different kinds of controller medicines: inhaled steroids, long-acting bronchodilators, combination medicines, and leukotriene receptor antagonists.

Inhaled steroids (corticosteroids)

Inhaled steroids (corticosteroids) are the most effective controller medicines for asthma. They help to control swelling and decrease mucus in the airways. They can help to prevent asthma episodes.

On average, inhaled steroids usually take from 2 and 4 weeks to start working.

Corticosteroids are hormones that bodies naturally produce. Inhaled corticosteroids are very similar to these hormones. They are used in small amounts to treat mild, moderate, and severe asthma.

These are some examples of inhaled steroids:

Possible side effects

Inhaled steroids are given in very small amounts, and they are breathed into the lungs instead of going into the rest of the body. This means that very few children develop any side effects from inhaled steroids.

Some children may develop one or more of these side effects:

  • dry mouth or sore throat
  • thrush in the mouth

Thrush is caused by yeast infection. It looks like little white, creamy, slightly raised patches in the mouth. You can prevent your child from getting thrush by having him rinse out his mouth with water after using the steroid inhaler. For younger children, you can give them a drink of water after giving them inhaled steroids. Using a spacer will also help to prevent thrush.

Inhaled steroids used in the appropriate dosage generally do not affect your child’s growth. Children with asthma have no problem growing to normal adult height. You and your doctor should still monitor your child’s growth regularly. Because inhaled steroids help to control your child’s asthma, your child may actually grow better.

Long-acting bronchodilators

Long-acting bronchodilators open up the muscles that surround the airways. They can help inhaled steroids to work better. Long-acting bronchodilators take longer to work and last up to 12 hours. They should not be used during an asthma episode. They should never be used alone without inhaled steroids.

Some examples of long-acting bronchodilators are:

Your child may need to take a long-acting bronchodilator as well as inhaled steroids. For example, if your child’s asthma symptoms are worse after exercise or at night, using long-acting bronchodilators along with inhaled steroids can help to better control your child’s asthma.

Long-acting bronchodilators are also called long-acting beta-agonists (LABA).

Possible side effects

Some possible side effects of long-acting bronchodilators include:

  • faster heartbeat
  • anxiety
  • headache
  • tremor

Combination medicines

Combination medicines are a combination of inhaled steroids and long-acting bronchodilators. Combination medicines are a convenient way to receive both medicines at the same time. They may give better asthma control. They should not be given during a severe asthma episode.

Some examples of combination medicines are:

Combination medicines may cause side effects from both inhaled corticosteroids and long-acting bronchodilators.

Leukotriene receptor antagonists

Leukotriene receptor antagonists are pills to be taken daily. They help to prevent swelling and constriction of the airways. They may not be as effective as inhaled steroids in some children.

Examples of leukotriene-receptor antagonists are:

Leukotriene receptor antagonists may be used in these situations:

  • when a child has mild asthma
  • when it is not possible to use inhaled steroids
  • when a steroid dose cannot be increased
  • together with inhaled steroids

Possible side effects

Some side effects of leukotriene receptor antagonists are:

  • nausea
  • headache

Sharon Dell, BEng, MD, FRCPC

Bonnie Fleming-Carroll, MN, ACNP, CAE

Jennifer Leaist, RN, BScN

Rishita Peterson, RN, BScN, MN

Gurjit Sangha, RN, MN

James Tjon, BScPhm, PharmD, RPh