If you’ve been told your asthma is “severe,” the usual rescue inhaler probably isn’t enough. You’ll need stronger medicines that keep symptoms down day after day and cut down flare‑ups. Below is a quick rundown of the main drug groups, why they’re prescribed, and practical advice for getting the most out of them.
Inhaled corticosteroids (ICS) – These are the backbone of long‑term control. They shrink airway inflammation so you breathe easier. Popular options include fluticasone, budesonide, and beclomethasone. Use a spacer if you have trouble coordinating your breath; it delivers more medicine to the lungs and less to your throat.
Long‑acting beta agonists (LABA) – LABAs such as salmeterol or formoterol relax airway muscles for 12‑24 hours. They’re never used alone; they always pair with an inhaled steroid because using a LABA by itself can increase risk of asthma‑related deaths.
Oral corticosteroids – Prednisone or prednisolone tablets are reserved for severe attacks or when inhalers aren’t enough. Short bursts (5‑7 days) are common; long‑term use can cause weight gain, bone loss, and high blood pressure, so doctors keep a close eye on dosage.
Biologic therapies – These are newer, targeted injections for people whose asthma is driven by specific immune pathways. Examples include omalizumab (anti‑IgE), mepolizumab and benralizumab (anti‑IL‑5). They’re given every 2‑8 weeks via a simple shot or clinic visit and can dramatically cut hospital visits.
Leukotriene modifiers – Montelukast tablets block chemicals that cause airway swelling. They’re handy if you also have allergies, but they’re usually added to—not replace—ICS/LABA combos.
First, master your inhaler technique. Press the canister, breathe in slowly, hold for 10 seconds, then exhale. Rinse your mouth after each dose of a steroid inhaler; this prevents thrush and hoarseness.
If you start feeling shaky, rapid heartbeat, or jittery after a LABA, check that you’re not over‑using it. The rescue inhaler (usually albuterol) should be saved for sudden symptoms, not routine relief.
Oral steroids can mess with sleep and mood. Take them in the morning with food to lessen stomach upset, and ask your doctor about calcium or vitamin D supplements if you need long‑term therapy.
Biologics often cause mild injection site redness or a low‑grade fever. Most people feel better within weeks as asthma control improves. Keep a log of any side effects and share it with your prescriber; they can adjust the dose or switch drugs if needed.
Cost is a real concern. Many insurers cover inhalers, but biologics can be pricey. Check if you qualify for patient‑assistance programs from the drug maker, or ask a pharmacist about reputable online pharmacies that offer verified discounts—just verify they require a prescription and have a licensed pharmacist on staff.
Finally, schedule regular check‑ups. Your doctor will use tools like spirometry or FeNO testing to see if your medication plan is working. If you notice more night‑time coughing, increased rescue inhaler use, or frequent ER visits, call them right away—adjusting the dose early can prevent a severe attack.
Severe asthma doesn’t have to control your life. With the right mix of inhaled steroids, LABAs, occasional oral pills, and possibly a biologic, you can keep symptoms low and stay active. Keep your inhaler technique sharp, watch for side effects, and stay in touch with your healthcare team—you’ll be breathing easier sooner than you think.
