Managing asthma typically involves the use of two main types of medications: long-term control medications (controllers) and fast-acting relief medications (relievers).

A. Controllers

These medications help prevent asthma attacks by reducing airway inflammation and limiting mucus production, thereby protecting lung function. The main categories of controller medications include:

1. Corticosteroids

Corticosteroids are among the most effective and widely prescribed medications for asthma. They work by inhibiting inflammatory compounds such as histamines, leukotrienes, and prostaglandins, which contribute to airway inflammation. They are categorized as follows:

Inhaled Corticosteroids (ICSs): These are considered first-line anti-inflammatory therapy for managing asthma. Regular use helps minimize symptoms, reduce flare-ups, and improve lung function. Examples of ICSs include:
Beclomethasone
Budesonide
Fluticasone

Oral Corticosteroids: These are typically reserved for short-term treatment of moderate to severe asthma episodes. Prolonged use is generally avoided due to potential side effects. Common examples include:
Prednisone
Prednisolone

2. Leukotriene Receptor Antagonists

These medications block the effects of leukotrienes, which are inflammatory chemicals that contribute to airway constriction and mucus buildup. By inhibiting leukotrienes, these drugs help in reducing asthma symptoms and preventing allergic reactions. Examples include:

Montelukast
Zafirlukast

3. Biological Therapies

Biologic treatments, such as monoclonal antibodies targeting IgE, are used for patients with severe, uncontrolled asthma. These medications help reduce the frequency of asthma attacks and are administered through subcutaneous injections every 2–4 weeks. They are recommended for individuals with high serum IgE levels or those who do not respond well to ICS therapy combined with other controller medications. Example:

Omalizumab

B. Relievers (Bronchodilators)

These medications provide immediate relief from asthma symptoms by relaxing the airway muscles, thereby allowing easier breathing. They are essential for managing acute asthma symptoms but do not address the underlying inflammation.

1. Short-Acting Beta Agonists (SABA)

These medications are fast-acting and provide quick symptom relief, typically within five minutes, with effects lasting up to six hours. Examples include:

Salbutamol
Terbutaline
Levalbuterol

2. Long-Acting Beta Agonists (LABA)

These medications offer extended symptom control and are typically used in combination with inhaled corticosteroids. While they take slightly longer to act, their effects last for at least 12 hours. Examples include:

Salmeterol
Formoterol
Indacaterol
Olodaterol
Vilanterol

3. Methylxanthines

These medications help alleviate asthma symptoms by reducing inflammation and relaxing airway muscles. Theophylline is the most commonly prescribed drug in this category.

4. Anticholinergic Drugs

These medications work by blocking acetylcholine, a neurotransmitter involved in airway constriction and inflammation. They are further classified as:

Short-Acting Muscarinic Antagonists (SAMA):
Ipratropium – Used to relieve and prevent asthma symptoms, often prescribed for both asthma and chronic obstructive pulmonary disease (COPD).
Long-Acting Muscarinic Antagonists (LAMA):
Tiotropium – Commonly used for COPD and severe asthma management.

C. Other Therapies

For individuals whose asthma remains uncontrolled despite maximal inhaler therapy, bronchial thermoplasty may be an option. This procedure involves the use of thermal energy to reduce the thickness of airway smooth muscle, potentially decreasing asthma exacerbations.