A variety of medications are used in the treatment of asthma both during asthma attacks and for longer term better control of asthma.
When your asthma is worsening, your doctor may prescribe you some of the following. Some are only available in hospital, and others with the intention to keep you out of hospital!
Prednisolone is a steroid taken either as tablets, soluble tablets or liquid. A short course lasting often between 3 - 7 days is given by your doctor to reduce the inflammation in your airways if you are having an asthma attack. Your doctor may also give you a prescription to keep at home that you can take at the start of worsening symptoms. Ensure you take your full course as prescribed.
If you have been on a prolonged course over 1 week, ensure you do not stop taking it suddenly as this can be dangerous - see your doctor urgently if you can't take them or are vomiting.
Short course of steroids very rarely have any side effects, however some people can temporarily have an upset stomach or change in behaviour, although these resolve after taking them.
Talk to your Asthma team if you have any questions
During severe asthma attacks some special medicines may be given to you by your doctor or nurse via a line (cannula) in your vein (intravenous), like in the picture.
These medicines include steroids to reduce inflammation in your airways, and "bronchodilators" which relax your airways. Bronchodilators include salbutamol, which is the same medicine as in your blue inhaler, magnesium sulphate, and aminophylline.
Some of these medicines are given in short doses, and others as longer infusions, depending on your clinical condition. Your doctors and nurses will explain this all to you as needed, and how they will be gradually weaned.
It is critical you follow your Asthma Action Plan to reduce the risk of severe asthma attacks.
Antibiotics are used to treat bacterial chest infections. They are not effective for viral infections like colds and flu, or chest infections caused by viruses.
It can sometimes be difficult to tell the difference between infections caused by bacteria or viruses, but your doctor will explain this to you. Signs which may be more suggestive of a bacterial infection include:
a persistent high temperature that gets worse after a few days
your phlegm being green or brown
worsening symptoms even after 2 weeks
High infection blood markers or significant changes on chest xrays.
In the past, a lot of antibiotics were prescribed ‘just in case’. We now know this causes antibiotic resistance and makes antibiotics less effective for you or your child. Thus antibiotics should never be taken unless evidence of a bacterial infection.
Long Term Management
In more difficult to control asthma, additional medicines may be prescribed for you. Your doctor or nurse will explain these in more detail. Medications such as theophylline and biologics are initiated by Paediatric Respiratory Specialists. Allergic symptoms and rhinitis may benefit from antihistamines and steroid nose sprays.
Montelukast is a type of medicine known as a leukotriene receptor antagonist. Most people with asthma do not need montelukast, but it can be a useful add-on preventer treatment to take alongside your usual preventer inhaler. Montelukast is not a steroid - it works in a different way to reduce inflammation. Montelukast comes as a tablet, a chewy tablet, or granules. Granules can either be sprinkled directly into the child’s mouth, or placed on a spoonful of cold (or room temperature) food, for example pureed fruit or yogurt.
Like all medicines, montelukast can cause side effects. Often, side effects can go, or improve, after two to three weeks of taking the medicine. Common side effects (affecting around 1 in 10-100 people) include diarrhoea, stomach-ache, sore throats and infections. Less common side effects (affecting around 1 in 100-1000 people) include sleep issues such as insomnia, nightmares or sleepwalking, and mood changes such as anxiety, depression, and irritability. Very rare possible side effects (affecting less than 1 in 10,000 people) include mental health disturbances. If your child, show signs that montelukast is affecting their mood talk to your doctor immediately.
Some people with poorly controlled or severe asthma may be prescribed theophylline as an add-on treatment by Asthma Specialists, to take by mouth, alongside their usual reliever and preventer asthma inhalers. It is not a steroid. Theophylline relaxes the smooth muscles in your airways so they open up and can let air flow through them more easily. At home it is given as a tablet twice every day, however in emergencies it can be used intravenously (as above). You must take it as prescribed and not miss any doses. Your doctor will regularly do some blood tests to monitor the level of the medicine in your blood and adjust the dose if needed. When first starting theophylline or any dose changes, you must have a blood test after 5 days. Target levels are 10-20mg/litre, with blood test taken at least 4-6 hours after taking your medication.
When taking theophylline, make sure you use the same brand every time. Make sure you tell your pharmacist, doctor or nurse that you are taking theophylline when buying any other medicines or herbal supplements as there can be interactions. Drinks/foods that contain caffeine such as coffee, tea, energy drinks, chocolate can also interact with theophylline.
Less common side effects can include vomiting, increased heart rate, seizures, rashes, so if you experience any of these seek medical advice urgently.
People with "eosinophilic asthma" or severe persistent allergic asthma are now being offered a newer type of treatment alongside their usual asthma medicines. These are known as Biologics, also referred to as Monoclonal Antibodies or mAbs.
Biologic therapies are a new type of medicine which works in a different way to traditional asthma treatments. They can improve symptoms and reduce asthma attacks in people with severe asthma by helping to stop the body processes that cause lung inflammation. If the biologic works well it can also reduce the need for steroids.
Biologic treatments are only offered by Specialist Asthma clinics. Your child will be referred to the asthma specialist clinic at Evelina London Children's Hospital to see if he/she would benefit from a biologic therapy.
Biologics are generally very safe, but can rarely cause side effects such as minor irritation at the injection site, headaches, tiredness and cold like symptoms.
Antihistamines are cheap and fast-acting. They come as tablets, liquid, or a nasal spray, and usually take just an hour or so to work.
Antihistamines help ease allergic and hayfever symptoms and so reduce aeroallergens triggering your asthma. See the section on aeroallergens for more information.
If certain aeroallergens trigger your asthma, you may benefit from taking an antihistamine everyday. This may be especially needed in particular seasons, such as in summer when pollen counts are high, or particular times such as if dust triggers your asthma and you have building work at your house.
Discuss this with your pharmacist, or doctor/nurse.
Common antihistamine available over the counter includes Cetirizine. Ask your pharmacist or doctor for more information. More information on Cetirizine can be found by clicking here.
Steroid nasal sprays can help unblock your nose and reduce allergic symptoms. They probably work the best out of all the hay fever treatments, but it can take some time to feel the benefits, so don’t expect to see immediate results.
Some nasal sprays use tiny amounts of steroids and/or antihistamines to reduce the swelling and irritation n your nose so you can breathe more easily too. Breathing through your nose rather than your mouth moistens and filters the air, so it’s less likely to irritate your sensitive airways.
Steroid nasal sprays can also help reduce sneezing, itching, a runny nose and itchy eyes, but you need to make sure you take your nasal spray correctly or it won’t work. You should notice the most effect from your nasal spray after two weeks.