Long-term control medications are used daily to maintain control of asthma and prevent asthma symptoms. Your child needs to take these medications to prevent asthma symptoms, even when the asthma seems better.
Common inhaled steroids include:
- Alvesco® (ciclesonide)
- Arnuity® (fluticasone)
- Asmanex® (mometasone)
- Flovent® (fluticasone)
- Pulmicort® (budesonide)
- QVAR® (beclomethasone)
Inhaled steroids are long-term control medications. In addition to preventing swelling, they also reduce swelling inside the airways and may decrease mucus production. Inhaled steroids are the most effective long-term control medicine currently available. They improve asthma symptoms and lung function. They have also been shown to decrease the need for oral steroids and hospitalization. There have been concerns regarding the possibility of growth suppression in children. Recent studies have not shown growth suppression over several years of treatment.
Inhaled steroids are taken on a regular basis and cause few, if any, side effects in usual doses. Using a spacer with inhaled steroids (metered-dose inhaler) and rinsing your mouth after inhaling the medication reduce the risk of thrush. Thrush, a possible side effect, is a yeast infection causing a white discoloration of the tongue.
Leukotriene Modifiers
Common leukotriene modifiers are:
- Accolate® (zafirlukast)
- Singulair® (montelukast)
- Zyflo® (zileuton/not indicated for children under 12 years of age)
Leukotriene modifiers are also long-term control medications.
They reduce swelling inside the airways and relax smooth muscles around the airways. Leukotriene modifiers are available as tablets. They are less effective than inhaled steroids.
Zafirlukast and montelukast are available for use in children with few, if any side effects. They are effective at improving asthma symptoms and lung function, but not to the same extent as inhaled steroids.
Inhaled Steroid and Long-Acting Beta-Agonists
Common combinations of an inhaled steroid and long-acting beta-agonist include:
- Advair® (fluticasone and salmeterol)
- Breo® (fluticasone and vilanterol)
- Dulera® (mometasone and formoterol)
- Symbicort® (budesonide and formorterol)
This combination is effective at improving asthma symptoms and lung function in people with moderate to severe persistent asthma.
The inhaled steroid prevents and reduces swelling inside the airways. The long-acting beta-agonist opens the airways in the lungs by relaxing smooth muscle around the airways.
They last up to 12 hours. Breo lasts up to 24 hours. They should always be used in combination with inhaled steroids as a long-term control medication to open the airways in people with moderate to severe asthma.
Talk with your child’s doctor about side effects.
Long-Acting Bronchodilators (LAMAs)
A common long acting bronchodilator (LAMA) is:
This lasts 12 hours and may be used in combination with an inhaled steroid or a combination inhaled steroid and long-acting beta-agonist.
Immunomodulator
Common immunomodulators include:
- Nucala® (mepolizumab)
- Xolair® (omalizumab)
These medications are routinely given as a shot. The medication may be added to medications in people with severe persistent asthma. Talk with your child’s doctor about side effects and special precautions to take when using these medications.
Theophylline
Common theophyllines include:
- Uni-phyl®
- Theo-24® and others (theophylline)
Theophylline is available as a tablet, capsule or syrup. Theophylline relaxes the smooth muscles around the airways. Theophylline is another long-term control medication. A theophylline blood level between 5 – 15 mcg/ml usually gives relief of symptoms while avoiding side effects. Theophylline is not one of the first medications used for long-term control of asthma. There are safer and more effective medicines available, such as inhaled steroids and leukotriene modifiers. Talk with your child’s doctor about side effects and special precautions to take when using this medication.
Clinical Trials