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Living with asthma can be challenging, and unfortunately, there is currently no cure. However, most people can effectively manage the condition through a combination of medications, lifestyle changes, preventive measures, and support. The primary goal of treatment is to control your symptoms, improve your lung function, and prevent asthma attacks. In the long run, good asthma control will help prevent a decline in your lung function.
Controlling symptoms means they no longer interfere with your daily life. Your healthcare provider will work with you to review your symptoms and to adjust your treatment plan accordingly.
With new treatment options emerging, the medical field is shifting its focus toward a new goal: asthma remission. Asthma remission is a state in which symptoms are minimal or even completely absent for an extended period. The medical community is optimistic that achieving remission will become possible for more patients in the future.
If your treatment is working well, you can expect:
To evaluate your asthma control, your healthcare provider might ask you to keep an asthma control diary at home or complete an asthma control questionnaire. This will help your doctor to adjust your treatment until good asthma symptom control is achieved.
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Asthma treatment usually involves a combination of maintenance/controller and reliever medications. Most medications come in an inhaler, while others are taken in the form of tablets or in some cases even injections. A combination of medications is frequently needed to increase their efficacy and to reduce side effects. This can be achieved by using multiple inhalers or by using a single device that delivers a combination of medicines.
A lot of people with asthma will have to use maintenance or long-term controller medications. These are medications that are taken daily to reduce the inflammation in the airways, prevent asthma symptoms, and minimise the risk of asthma flare-ups.
(also known as glucocorticoids or corticosteroids)
Inhaled steroids decrease inflammation in the airways over time. Inhaled steroids reduce the frequency of asthma symptoms, improve your quality of life, decrease the risk of serious asthma flare-ups, and prevent lung function decline over time.
Inhaled steroids work locally in the airways, at the site of the inflammation. Hence, only a very low dose enters the bloodstream, leading to few side effects. Oral thrush (a yeast infection in the mouth) is the most common side effect, which you can prevent by rinsing and gargling with water after using your inhaler. Hoarseness or a sore throat can also occur, but is less common. These side effects can often be managed by switching to a different type of inhaler or by incorporating the use of a spacer device.
People with severe asthma may need higher doses, which can increase the risk of rare long-term side effects like osteoporosis or cataracts. Your doctor will always try to keep your dose as low as possible to reduce the risk. If you’re ever concerned about side effects, talk to your healthcare provider.
Long-acting beta-agonists, also called long-acting bronchodilators, relax the muscles around the airways to help open them up. LABAs work for over 12 hours, with some working within minutes (formoterol), while others can take several hours before reaching their maximal effect (like salmeterol). These types of inhalers should always be used alongside inhaled steroids, because they don’t act on the underlying inflammation.
A single inhaler containing both an inhaled steroid and the long-acting beta-agonist formoterol can be used as a daily controller medication and may also be used as a quick reliever of asthma symptoms. This convenient approach is called ‘Maintenance and Reliever Therapy (MART)’. Not all combination inhalers are suitable for use in case of an asthma flare-up, so make sure to check with your doctor which treatment to use as a reliever.
There are very few common side effects, and the side effects tend to get better after using the inhaler for a few weeks. You might notice headaches, a faster heart rate or feeling shaky. Correct inhaler technique and the use of a spacer can help avoid side effects. If you’re ever concerned about side effects, talk to your healthcare provider.
Leukotriene modifiers, like montelukast, work by opening narrowed airways, decreasing the level of inflammation, and lowering mucus production. This medication is taken in the form of tablets. They are typically less effective in controlling asthma compared to inhaled steroids, but they are sometimes used as an alternative for mild asthma, particularly in patients with other allergy symptoms that are also responsive to this type of medication.
They have very few common side effects, but agitation or depression have been described. If you’re ever concerned about side effects, talk to your healthcare provider.
Long-acting muscarinic antagonists (LAMAs) work by relaxing the muscles around the airways. LAMAs are a type of long-acting bronchodilator. If you already use an inhaled steroid plus a LABA and your asthma still is not controlled, your healthcare provider may add a LAMA.
The most common side effect is dry mouth. Take frequent sips of water or try stimulating saliva production by chewing some sugar-free gum or sucking on sugar-free hard candy. If you’re ever concerned about side effects, talk to your healthcare provider.
Relievers, also called quick-relief medications, are inhalers that contain a kind of medicine that rapidly opens up the airways. Sometimes they also contain medicine to decrease inflammation, but this medicine takes more time to work.
Anti-inflammatory relievers are medications that combine fast-acting medicines to open up the lungs (bronchodilators, like formoterol or salbutamol/albuterol) with inhaled steroids, which decrease swelling and inflammation in the airways over time. This type of reliever is being promoted by international asthma guidelines because, besides quick relief, the underlying inflammation is also treated at the same time. This has been found to reduce asthma attacks compared to the use of short-acting beta-agonists alone as relievers.
This reliever combines two medicines, so side effects may include a sore throat, hoarseness, or oral thrush from the inhaled steroid, and shakiness or a fast heartbeat from the bronchodilator. These side effects are usually mild and manageable. Rinsing and gargling with water after using your inhaler or using a spacer can help prevent them. If you’re ever concerned about side effects, talk to your healthcare provider.
Short-acting beta-agonists (SABAs), like salbutamol/albuterol, quickly relieve asthma symptoms by relaxing the muscles around your airways, making it easier to breathe. These inhalers are used as needed for fast relief or before exercise if that triggers your asthma. You should feel better within minutes. Using a reliever every day isn’t helpful and can make your asthma worse. If you need it more than twice a week, talk to your doctor.
Some people may feel a bit shaky or notice a faster heartbeat after using a SABA. These side effects are usually short-lived but can feel uncomfortable—especially when you're already dealing with asthma symptoms. If you’re ever concerned about side effects, talk to your healthcare provider.
When asthma symptoms continue to significantly affect daily life despite various treatments, following the prescribed medication plan, and avoiding known triggers, people with severe asthma may be considered for add-on treatment with biologics. Biologics are a type of medication made up of antibodies that target specific parts of the immune system. In asthma, the immune system is overactive, and this treatment helps to calm that response. Biologics are given by injection and should only be started under the supervision of a specialist.
Availability and reimbursement policies differ from country to country. While effective, this treatment can be expensive and does not replace other medications completely. So it is often considered when other options have not worked.
Sometimes a biologic given for asthma also reduces CRS symptoms and vice versa.
When starting treatment with biologics, your healthcare provider will train you on how to give yourself a dose via injection. After practising a few times at the hospital, you will usually be able to do the injections by yourself at home (like insulin injections for diabetes). Since a proper technique is essential for the medicine to work and to ensure you get the full dose, we have created videos to assist you with the correct technique whenever you need it. There are two types of injections: (i) via a prefilled pen or (ii) via a prefilled syringe. Instructions depend on the device you use.
Bronchial thermoplasty is a treatment option for people with severe asthma. It’s usually only considered when asthma remains difficult to control, even after using all the recommended medications, or if a person cannot use certain advanced treatments like biologics. It’s a procedure that is performed in a specialist centre. It uses gentle heat to remove excess muscle around the airways. By reducing this excess muscle, the lungs have more room to expand. This will help you breathe more easily. The procedure is performed under local anaesthetic (you are awake, but won’t feel anything from the procedure) and it usually takes place over three separate sessions, with a few weeks in between. The most common risk is that your asthma symptoms might temporarily worsen before they get better.
An asthma flare-up, also called an asthma attack, is a sudden worsening of your asthma symptoms that can make it hard to go about your usual daily activities. Common symptoms include coughing, wheezing, chest tightness, and shortness of breath.
If you use a peak flow meter at home, a flare-up may also show as a drop in your peak flow readings below a certain level.
If you’ve been diagnosed with asthma, you likely have an asthma action plan. This is a personalised guide that tells you what steps to take during a flare-up and when to get emergency help. It often includes specific peak flow values, a percentage of your personal best, to help you know how serious the situation is.
Most people can manage an asthma attack using their quick-relief inhaler (see above). The dosing and frequency of administration should be discussed with your treating physician and should be written down in an asthma action plan. If your asthma attack doesn’t respond to or even worsens despite reliever treatment, it’s important to seek professional medical help.
For significant asthma attacks, physicians might recommend a short (5- to 10-day) course of oral steroids alongside your regular asthma treatment, to quickly reduce your asthma symptoms. While oral steroids can quickly reduce swelling in the airways, they can also cause side effects, so doctors usually use them only when truly necessary. Short-term side effects include insomnia, increased appetite, and changes in mood.
Steroids can also spike your blood sugar, which is an important element to consider if you also have diabetes. If you frequently need oral steroids or need prolonged courses, you are at an increased risk of other steroid-related side effects. These side effects could be weight gain, bone loss (osteoporosis), and conditions of the eye such as cataracts or glaucoma (increased pressure in the eye).
Your healthcare provider will work with you to optimise your asthma treatment to minimise the need for repeated or prolonged oral steroid courses as much as possible.
There are many other treatments available — some by prescription, others over-the-counter-that claim to help with symptoms like coughing or mucus. These include things like cough suppressants, mucus-thinning medicines (mucolytics), and common cold remedies. However, these do not improve your breathing or treat the narrowing of the airways during an asthma attack. That’s why they are not recommended for asthma attacks.
Some home remedies, like breathing in steam or using essential oils, may feel soothing, but they do not lower the risk of serious asthma symptoms. Because of this, doctors generally do not advise using them as a way to manage asthma.
Taking your medicines the right way is just as important as taking them regularly. For treatment to work properly, it needs to reach the affected area in your body. Take your time to watch the inhaler technique video that matches your inhaler device and review any materials your doctor has provided about using your medicines correctly.
The fact that you're already taking the time to learn more about asthma is a big step forward—well done! Understanding your condition and knowing your treatment options can really help you feel more in control of your asthma and your overall health.
Following below are a few tips to help self-manage your asthma:
Why is it so important to use asthma treatment daily if you don’t experience any symptoms?
Note: This information applies only to people with asthma who have been prescribed daily (maintenance) treatment by their healthcare provider.
Not everyone with asthma requires daily medication. For some individuals with infrequent symptoms and little to no impairment of lung function, a reliever inhaler (based on an inhaled steroid and a bronchodilator) may be sufficient. Always follow your doctor’s specific instructions for your asthma treatment plan.
To help manage your asthma, it is very important to take your medication just as your doctor prescribes. This means following the dose and using it day in and day out. When you stick to your treatment plan, you are more likely to feel better and may avoid needing stronger short-term medicines with potential severe side effects. Nevertheless, we know taking medication daily can be challenging. Find some helpful tips here:
Follow your treatment plan and keep track of your symptoms and lung function over time. An asthma diary can help you record how you're feeling each day. If you have a peak flow meter at home, use it regularly to monitor your breathing.
In case your symptoms remain hard to manage even after trying first-line treatments, it might be time to see a lung specialist.
However, if you also have issues like a runny or blocked nose, facial pain or pressure, or a loss of smell, it could be a sign of chronic rhinosinusitis (CRS). In that case, consider seeing your GP and/or an ear, nose, and throat (ENT) specialist.
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