asthma center

What Is the Safest Asthma Medication?

Reviewed on 11/9/2022
There isn't one drug that's considered the safest asthma medication. Asthma drugs are usually used in combination with others for the best results in controlling symptoms and reducing attacks. The medication choice depends on how the individual responds to them, as well as their underlying conditions.
Asthma drugs are usually used in combination with others for the best results in controlling symptoms and reducing attacks.

Asthma is a chronic respiratory disease that causes inflammation and narrowing of the airways, making it difficult to breathe. 

The drugs used to treat asthma are considered to have an acceptable safety profile by the Food and Drug Administration (FDA). There is no one asthma drug considered “the safest,” and in fact, asthma drugs are often used in combination for the best effect.

The goal of asthma medications is to control symptoms and reduce asthma attacks with a minimum of side effects. The choice of medication depends on the patient’s symptoms and their response to medication, along with any underlying conditions. 

Asthma Medications

Asthma is usually treated with two main kinds of medications: quick-relief and long-term control. Allergy shots (immunotherapy) may also be helpful.

  • Bronchodilators 
    • Quick-relief asthma medications used to expand the airways
    • Taken at the first sign of asthma symptoms for immediate relief
    • Should not be used more than twice weekly – if they are needed more often, then asthma is not considered to well-managed and long-term medications may need to be prescribed or changed
      • Short-acting inhaled beta2-agonists (inhalers)
      • Anticholinergics
  • Long-term asthma control medications are taken daily to prevent symptoms and asthma attacks and include:

For severe asthma, traditional medications may not be enough to control symptoms, and other therapies may be used, such as:

  • Biologics
    • Reslizumab (Cinqair)
    • Mepolizumab (Nucala)
    • Omalizumab (Xolair)
    • Benralizumab (Fasenra)
    • Dupilumab (Dupixent)
  • Oral corticosteroids
  • Immunotherapy, useful when asthma is triggered by an allergy
    • Allergy shots (subcutaneous immunotherapy [SCIT])
    • Sublingual (under the tongue) tablets or drops (sublingual immunotherapy [SLIT])
      • Only house dust mites and certain grass and ragweed pollens are treatable with tablets
      • Not used for severe or uncontrolled asthma

What Are Symptoms of Asthma?

Symptoms of asthma include the following:

  • Coughing, especially at night or early morning, during exercise, or when laughing
  • Difficulty breathing
  • Shortness of breath
  • Wheezing 
  • Chest tightness

People with asthma may also experience anxiety and depression because asthma can cause absences from work and school and an inability to participate in usual activities.

Asthma symptoms may...

  • Be triggered by allergies, exercise, cold air, or hyperventilation from laughing or crying
  • Worsen at night or in the morning
  • Come and go over time 
  • Start or worsen with viral infections, such as a cold

Asthma attacks are episodes when symptoms worsen significantly and usually require a change in regular treatment. Asthma attacks may come on gradually or suddenly and can be life-threatening. 

What Causes Asthma?

The cause of asthma is unknown, but it usually results from an immune system response to a substance in the lungs.

Common triggers for asthma symptoms include the following: 

  • Exposure to an allergen (such as pollen, ragweed, dust mites, mold, or animal dander)
  • Irritants in the air (such as smoke, strong odors, and chemical fumes) 
  • Illness, especially respiratory illness or the flu 
  • Certain medications
  • Extreme weather conditions
  • Stress
  • Exercise
  • Physical display of strong emotion that affects normal breathing patterns, such as laughing, crying, or shouting
  • Panic 
  • Some foods

 

How Do Doctors Diagnose Asthma?

Asthma is diagnosed with a patient history and a physical exam, which includes the doctor listening to a patient’s breathing and checking for allergic skin conditions. 

Tests used to help diagnose asthma or rule out other causes include: 

  • Pulmonary function tests
    • Spirometry    
    • Bronchoprovocation tests    
    • Peak expiratory flow (PEF)    
    • Fractional exhaled nitric oxide (FeNO) tests    
    • Provocation (trigger) tests
      • Exercise challenge
      • Irritant challenge
      • Methacholine challenge
  • Allergy skin or blood tests, in patients who have a history of allergies

Diagnosing asthma in children younger than 6 can often be difficult since they usually cannot perform a pulmonary function test such as spirometry. A doctor may try asthma medicines in young children for a few months to see how they respond.

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Reviewed on 11/9/2022
References
"Asthma." American College of Allergy, Asthma & Immunology. <https://acaai.org/asthma>.

Fanta, Christopher H., and Nora A. Barrett. "An overview of asthma management." UpToDate.com. Nov. 2, 2022. <https://www.uptodate.com/contents/an-overview-of-asthma-management>.

United States. National Heart, Lung, and Blood Institute. "What Is Asthma?" <https://www.nhlbi.nih.gov/health-topics/asthma>.