Aims of treatment
There’s no cure for asthma, but with the right treatments and support most people can get on with their lives without symptoms.
The aim of asthma treatment is to control symptoms, improve lung function, and prevent asthma attacks.
Your doctor or asthma nurse aims to do this using the lowest dose of medicine possible, and to find the best treatment plan for you and your asthma.
If your medicines are working well, you should expect:
- no symptoms during the day
- better sleep because symptoms are not waking you up at night
- less need for your reliever inhaler
- no asthma attacks
- good lung function
- to be able to get on with daily life (including exercise) without asthma symptoms getting in the way
If you’re having symptoms, and your GP thinks it’s highly likely you have asthma, you may start asthma treatment while you wait for further tests to confirm a diagnosis.
This is known as a 'trial of treatment'. You'll be given an asthma preventer inhaler to see if it makes a difference. It may take a few weeks for you to see any benefits.
If your symptoms improve and asthma is confirmed, it’s likely you’ll carry on with these treatments.
Sometimes it can take a while to get a treatment plan that works best for you. You may need to try different inhalers or a different dose.
Your GP will always start you on the lowest dose possible to get good control and aim to find the best treatment for your asthma.
Everyone with asthma can benefit from a preventer inhaler.
Preventer inhalers prevent swelling and inflammation in the airways. This means you’re less likely to get symptoms if you come across your asthma triggers.
Regular preventer medicine helps prevent asthma attacks.
Find out more about preventer inhalers.
You need a preventer inhaler if:
- you've noticed symptoms three or more times a week
- you wake up at night with symptoms
- you've had an asthma attack in the last two years
Reliever inhalers relieve asthma symptoms like coughing, wheezing, breathlessness, and a tight chest.
You use your reliever inhaler just when you have symptoms or an asthma attack.
If your asthma is well controlled, you shouldn’t need to use your reliever inhaler often - or at all. But remember to always carry it with you in case symptoms do flare up.
A small number of people who have mild symptoms very infrequently may only need a reliever inhaler to use when they get symptoms.
However, some studies suggest that everyone should have a preventer inhaler too, to lower their risk of asthma attacks.
Find out more about reliever inhalers.
If you're using your reliever inhaler three or more times a week
see your GP or asthma nurse as soon as possible to review your treatment plan. If you've only been prescribed a reliever inhaler, see your GP or asthma nurse urgently to ask for a preventer inhaler too.
Not everyone needs add-on treatments for their asthma. Most people manage well with a regular preventer inhaler, and a reliever inhaler when needed.
But your GP may consider other treatments if you’re taking your preventer inhaler exactly as prescribed, but you’re still having symptoms.
These are known as ‘add-on’ treatments because you take them in addition to your preventer inhaler.
Before starting you on any extra medicines, your GP will check whether anything else could be making your asthma harder to manage, such as:
- finding it hard to stick to your treatment plan
- not taking your inhaler in the best way
- not managing to avoid triggers
- smoking, which stops preventer medicine from working as well
If you could benefit from extra medicines to help you manage your asthma, your GP may suggest you try one of these add-on treatments:
A long-acting bronchodilator opens up your airways. It contains reliever medicines that last 12 hours. It can lower your risk of asthma attacks.
You must continue to take your preventer inhaler as prescribed because long-acting bronchodilators cannot deal with the inflammation in your airways.
Your GP may prescribe a long-acting bronchodilator in a combination inhaler. This is one inhaler containing both the long-acting bronchodilator and your preventer medicine. You'll need your usual blue reliever inhaler too, in case you get symptoms.
A certain type of long-acting bronchodilator medicine, found in MART inhalers (Maintenance and reliever therapy), can give quick relief for asthma symptoms too. This means you can use your MART inhaler as an emergency reliever as well.
But not all combination inhalers can be used as a reliever so check with your GP. Make sure your GP or asthma nurse explains what your long-acting bronchodilator can and cannot do.
Montelukast is a preventer tablet. It is a leukotriene receptor antagonist (LTRA). This kind of medicine helps with the inflammation in your airways.
Unlike your preventer inhaler, montelukast does not contain steroids. You need to take it alongside your regular steroid preventer inhaler.
Read more about montelukast.
Your GP may prescribe you oral steroids (usually prednisolone) in addition to your usual asthma medicines.
Steroids help you get symptoms under control in the short term, or if you’ve had an asthma attack, by reducing the inflammation in your airways.
If you frequently need oral steroids, or you need to take them long-term, you should be referred to an asthma specialist to look at other ways to manage your asthma.
Read more about taking long-term steroids.
Keep your blue reliever inhaler handy
for quick relief of asthma symptoms. Not all combination inhalers can be used as a quick-acting reliever so check with your GP.
If your symptoms have not improved even though you’re taking your preventer medicines, and any add-on medicines as prescribed, you may be referred to a specialist.
Treating asthma attacks
Call 999 for an ambulance if:
you're having an asthma attack and your symptoms do not improve after ten puffs, 30-60 seconds apart, of your reliever inhaler, or if you feel worse at any point.
If you do have an asthma attack, the first line of treatment is your blue reliever inhaler. This can quickly get symptoms under control.
You’ll need to take a course of steroid tablets as part of your recovery plan.
See your GP for a follow up after being discharged from hospital. They can make sure you’re making a good recovery, and that you’re not at risk from another attack.
Remember: taking your preventer medicine every day is the best way to prevent symptoms from building up into an asthma attack.
Find out what to do in an asthma attack.
Increasing your treatment dose
Your GP will probably try you on an add-on treatment before increasing the dose in your usual preventer medicine. This is so you can continue on a low dose of steroid medicine and avoid side effects.
They may consider trying a different inhaler device that may be easier for you to use, before increasing the dose.
If you’re still having symptoms, even though you’re taking add-on treatments or have tried a new inhaler device, your GP may consider increasing the dose of your preventer. They would start with an increase from a low to a medium dose.
Whenever your medicines change you should have another appointment with your GP or asthma nurse within four to eight weeks, either in the surgery or over the phone, to see if the change is working well for you.
Ask your GP or asthma nurse to update your asthma action plan with any changes to your medicines.
Reducing asthma treatments
Always talk to your GP or asthma nurse before stopping or reducing any asthma medicines.
Any reduction in treatments needs to be done slowly and carefully to make sure you’re not more at risk of symptoms and asthma attacks. It may take a few months.
Before reducing treatments, your GP or asthma nurse will need to consider:
- any symptoms and how often you’re having them
- how long you’ve been on your current dose
- the benefits of the dose you’re on
- any side effects
You're more likely to be able to cut down on the medicine you're taking if you've had no symptoms for at least three months.
Go to regular asthma reviews
Your asthma review is a chance to talk about how you’re getting on with your asthma. You should go even if you feel well.
Your GP or asthma nurse can check if you’re on the right treatments to stay well with your asthma.