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Asthma Treatment: Quick‑Relief & Long‑Control Medications

Asthma management relies on two medication categories: quick‑relief (rescue) for acute symptoms and long‑term control to prevent exacerbations.

Quick‑Relief (Rescue) Medications

Short‑acting beta‑agonists (SABAs) relax airway smooth muscle within minutes.

  • Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA)
  • Levalbuterol (Xopenex HFA)

Less commonly used: Pirbuterol (Maxair), Terbutaline (Brethine).

Usage: Inhale at first sign of symptoms (wheezing, cough, chest tightness) or before known triggers (exercise). Not for daily scheduled use.

Long‑Term Control Medications

Taken daily to suppress airway inflammation and prevent symptoms.

Inhaled Corticosteroids (ICS) – Cornerstone

  • Budesonide (Pulmicort)
  • Ciclesonide (Alvesco)
  • Fluticasone (Flovent HFA, Arnuity Ellipta)
  • Mometasone (Asmanex HFA)

Combination Inhalers (ICS + LABA)

  • Fluticasone/salmeterol (Advair)
  • Budesonide/formoterol (Symbicort)
  • Fluticasone/vilanterol (Breo Ellipta)
  • Mometasone/formoterol (Dulera)

LABA monotherapy is contraindicated in asthma without ICS.

Other Controllers

  • Leukotriene modifiers: Montelukast (Singulair), zafirlukast (Accolate), zileuton (Zyflo).
  • Long‑acting muscarinic antagonists (LAMA): Tiotropium (Spiriva) as add‑on.
  • Biologics (severe asthma): Anti‑IgE (omalizumab), anti‑IL‑5 (mepolizumab, reslizumab, benralizumab), anti‑IL‑4Rα (dupilumab), anti‑TSLP (tezepelumab).
  • Oral corticosteroids: Prednisone for severe flares; avoid chronic use due to side effects.

Non‑Pharmacologic Strategies

  • Identify and avoid triggers (allergens, smoke, pollution, cold air).
  • Allergy immunotherapy (shots/sublingual) for allergic asthma.
  • Pulmonary rehabilitation.
  • Annual flu vaccine; COVID‑19 and pneumococcal vaccines per guidelines.
  • Written Asthma Action Plan developed with your clinician.

Key Principle

Step‑up/step‑down therapy guided by symptom control, lung function (spirometry/FeNO), and exacerbation history. Regular follow‑ups ensure optimal control with minimal medication.

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