Your GP or asthma nurse will prescribe you treatment based on the latest clinical evidence and guidelines.
Different treatment pathways are recommended for adults (aged 17 and over), for children aged 5-16, and for children under five. But in all cases the goal is to make sure asthma is as well managed as it can be, using the lowest doses of asthma medicine possible.
Taking your asthma preventer medicines, as prescribed by your GP or asthma nurse, will mean your airways are less inflamed and sensitive. This means you're less likely to get asthma symptoms.
When your asthma medicines are working well you can expect to notice:
- you're not getting daytime symptoms
- you're not waking up at night because of your asthma
- you don't need your blue reliever inhaler
- you're not having asthma attacks
- you're getting on with daily life (including exercise) without asthma symptoms getting in the way.
If your symptoms get worse, or you're having an asthma attack, you need to take your reliever inhaler.
But it's important to keep an eye on how often you're taking your reliever inhaler. If you're taking it three or more times a week it could be a sign that your asthma is not well managed.
Use a written asthma action plan to remind you when to take your asthma medicines. People who use an asthma action plan are better equipped to manage their symptoms and so less likely to be admitted to hospital for their asthma.
It can sometimes take time to find the right treatment for you, so it's important to keep in touch with your GP or asthma nurse and go back to review any new medicines you've been given.
Before changing your medicines or increasing the dose your GP will need to talk to you about:
- how regularly you’re taking your preventer medicine
- your inhaler technique
- any triggers you might be exposed to, such as cigarette smoke – which will make managing your asthma a lot harder
- anything else going on, such as hay fever.
Whenever your GP makes a change to your usual prescription you should get another appointment four to eight weeks later, either in the surgery or over the phone, to check the new medicines are working and are right for you.
It may be that with the right support, a good routine, the right inhaler technique and avoiding your asthma triggers, you'll be able to control your asthma symptoms without needing to be prescribed higher doses.
If you've been diagnosed with severe asthma, please visit our severe asthma section, which has lots of advice and information especially for you.
The treatment you're prescribed will depend on how often you're having asthma symptoms.
1. Just a reliever inhaler
If you only have very mild symptoms, for example if you occasionally come into contact with a particular, known trigger, your GP may just prescribe you a reliever inhaler to use when you get symptoms. Your reliever inhaler is usually blue.
But, if you notice you're using your reliever inhaler three times a week or more, or you're getting symptoms most weeks, go back to your GP or asthma nurse to talk about getting a preventer inhaler too.
“There are very few people who will be given a reliever inhaler without a preventer. Most people with asthma benefit from a regular preventer inhaler taken every day to prevent symptoms coming on,” says Dr Andy Whittamore, Asthma UK's in-house GP.
2. A reliever inhaler and a preventer inhaler
Most people with asthma also need a preventer inhaler to take every day as prescribed. Your preventer inhaler keeps you well with your asthma over time by preventing the inflammation in your airways. Preventer inhalers are often brown.
3. Add-on therapies
“Your GP may suggest you try either a long-acting bronchodilator or an LTRA preventer tablet in addition to your usual inhaled corticosteroid preventer,” says Dr Andy.
“Guidelines vary on which one you should try first, and both can make a difference. If one doesn’t seem to make a difference you can try another one.”
A reliever inhaler and a preventer inhaler and an LTRA tablet
If you're still having symptoms even though you're taking your preventer inhaler every day as prescribed, and in the right way, your GP might prescribe you a Leukotriene Receptor Antagonist tablet (LTRA), for example Montelukast.
This is to take every day as well as your preventer inhaler. LTRAs help stop your airways getting inflamed.
Your GP will check how you've responded to this treatment in four to eight weeks.
A long-acting bronchodilator
If your asthma is still uncontrolled even though you’re using a preventer inhaler and a long-acting bronchodilator every day, your GP may consider trying you on the MART regime.
MART inhalers include a steroid preventer medicine and a certain type of long-acting bronchodilator medicine which can also be used as your emergency reliever. Not all combination inhalers can be used as a reliever so check with your GP.
4. Other add-on treatments
If you’ve tried an LTRA preventer, and a long acting bronchodilator alongside your usual asthma medicines, but your symptoms haven’t improved, you may be referred to a specialist consultant for your asthma.
Special tests may be used, for example FeNO, to help work out the best treatment for you. You may be prescribed specialist treatments like theophylline, or oral steroids, to help you get control over your symptoms.
“Your GP may prescribe you oral steroids, but if you continue to need them long-term it's likely you'll be referred to specialist care to see what else can be done to help your asthma,” says Dr Andy.
At different times of your life, or even at different times of the year, your GP or asthma nurse may prescribe more, or less, treatment depending on your symptoms.
This is why it's so useful to go to your asthma review, so you and your GP can see how your asthma's been, and change medicines if needed.
Increasing your asthma medicines
You don't have to wait for your next review before booking in to see your GP or asthma nurse.
Book an appointment if you notice your asthma symptoms are getting worse. You might notice you're coughing or wheezing more, feeling breathless, or waking up at night.
Or perhaps you've noticed you're using your blue reliever inhaler more often than usual. If you're using your reliever inhaler three or more times a week it could be a sign that your asthma is not well managed.
Your GP or asthma nurse may increase your medicines or change the kind of inhaler device you're using.
Make sure there's a note of any changes to the medicines you need to take on your asthma action plan.
Reducing your asthma medicines
Sometimes your GP or asthma nurse may consider reducing your medicines.
This might mean taking a lower dose of medicine, or taking your medicine less often.
Before your GP reduces your medicines it’s important for them to consider:
- what symptoms you're getting and how often you're getting them
- the side effects of the treatment
- how long you've been taking the current dose
- the benefits of your current dose
- your wishes, or concerns about cutting down treatment.
You're more likely to be able to cut down on the medicine you're taking if your asthma has been well managed and you've had no symptoms for at least three months.
For example, you may be prescribed just a reliever inhaler for when symptoms come on.
You'll still need keep an eye on things and go back to your GP if you notice:
- you need your reliever inhaler three or more times a week
- you're coughing, wheezing or waking in the night
- you have a lower than usual peak flow score, or your score is up and down.
The GP may need to increase your medicines again to stop your airways being so sensitive and inflamed and causing symptoms.
Living with asthma
As well as taking your asthma medicines as prescribed there's a lot of other things you can do to help your asthma. For example, we have advice about quitting smoking, staying active, and managing your asthma triggers.
Last updated October 2019
Next review due April 2021