Editing Asthma (section)

===Medications<span class="anchor" id="Anti-asthmatic"></span>===
Medications used to treat asthma are divided into two general classes: quick-relief medications used to treat acute symptoms; and long-term control medications used to prevent further exacerbation.<ref name="NHLBI07p213" /> [[Antibiotic]]s are generally not needed for sudden worsening of symptoms or for treating asthma at any time.<ref>{{cite web|title=QRG 153 • British guideline on the management of asthma|url=http://www.sign.ac.uk/pdf/QRG153.pdf|website=SIGN|access-date=October 6, 2016|date=September 2016|url-status=live|archive-url=https://web.archive.org/web/20161009122108/http://www.sign.ac.uk/pdf/QRG153.pdf|archive-date=October 9, 2016}}</ref><ref>{{cite journal | vauthors = Normansell R, Sayer B, Waterson S, Dennett EJ, Del Forno M, Dunleavy A | title = Antibiotics for exacerbations of asthma | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD002741 | date = June 2018 | issue = 6 | pmid = 29938789 | pmc = 6513273 | doi = 10.1002/14651858.CD002741.pub2 }}</ref>

====Medications for asthma exacerbations====
[[File:Salbutamol2.JPG|thumb|upright|alt=A round canister above a blue plastic holder|[[Salbutamol]] metered dose inhaler commonly used to treat asthma attacks]]

* Short-acting [[Beta2-adrenergic agonist|beta<sub>2</sub>-adrenoceptor agonists]] (SABAs), such as [[salbutamol]] (''albuterol'' [[United States Adopted Name|USAN]]) are the first-line treatment for asthma symptoms.<ref name="NHLBI07p214" /> They are recommended before exercise in those with exercise-induced symptoms.<ref>{{cite journal |vauthors=Parsons JP, Hallstrand TS, Mastronarde JG, Kaminsky DA, Rundell KW, Hull JH, Storms WW, Weiler JM, Cheek FM, Wilson KC, Anderson SD |display-authors=6 |title=An Official American Thoracic Society Clinical Practice Guideline: Exercise-Induced Bronchoconstriction |journal=American Journal of Respiratory and Critical Care Medicine |volume=187 |issue=9 |pages=1016–1027 |date=May 2013 |pmid=23634861 |doi=10.1164/rccm.201303-0437ST }}</ref>
* [[Anticholinergic]] medications, such as [[ipratropium]], provide additional benefit when used in combination with SABA in those with moderate or severe symptoms and may prevent hospitalizations.<ref name="NHLBI07p214" /><ref name="Griffiths_2013">{{cite journal | vauthors = Griffiths B, Ducharme FM | title = Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children | journal = The Cochrane Database of Systematic Reviews | issue = 8 | pages = CD000060 | date = August 2013 | pmid = 23966133 | doi = 10.1002/14651858.CD000060.pub2 | pmc = 12047668 }}</ref><ref name="Kirkland_2017">{{cite journal | vauthors = Kirkland SW, Vandenberghe C, Voaklander B, Nikel T, Campbell S, Rowe BH | title = Combined inhaled beta-agonist and anticholinergic agents for emergency management in adults with asthma | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD001284 | date = January 2017 | issue = 1 | pmid = 28076656 | pmc = 6465060 | doi = 10.1002/14651858.CD001284.pub2 }}</ref> Anticholinergic bronchodilators can also be used if a person cannot tolerate a SABA.<ref name="Self, Timothy 2009" /> If a child requires admission to hospital additional ipratropium does not appear to help over a SABA.<ref>{{cite journal | vauthors = Vézina K, Chauhan BF, Ducharme FM | title = Inhaled anticholinergics and short-acting beta(2)-agonists versus short-acting beta2-agonists alone for children with acute asthma in hospital | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 7 | pages = CD010283 | date = July 2014 | pmid = 25080126 | doi = 10.1002/14651858.CD010283.pub2 | pmc = 10772940 }}</ref> For children over 2 years old with acute asthma symptoms, inhaled anticholinergic medications taken alone is safe but is not as effective as inhaled SABA or SABA combined with inhaled anticholinergic medication.<ref>{{cite journal | vauthors = Teoh L, Cates CJ, Hurwitz M, Acworth JP, van Asperen P, Chang AB | title = Anticholinergic therapy for acute asthma in children | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD003797 | date = April 2012 | pmid = 22513916 | doi = 10.1002/14651858.CD003797.pub2 | pmc = 11329281 | url = https://espace.library.uq.edu.au/view/UQ:274872/UQ274872_OA.pdf }}</ref><ref name="Griffiths_2013" /> Adults who receive combined inhaled medications, which include short-acting anticholinergics and SABA, may be at risk for increased adverse effects such as experiencing a tremor, agitation, and heart beat [[palpitations]] compared to people who are treated with SABAs alone.<ref name="Kirkland_2017" />
* Older, less selective [[adrenergic receptor|adrenergic agonists]], such as inhaled [[epinephrine (medication)|epinephrine]], have similar efficacy to SABAs.<ref name="Rodrigo">{{cite journal | vauthors = Rodrigo GJ, Nannini LJ | title = Comparison between nebulized adrenaline and beta2 agonists for the treatment of acute asthma. A meta-analysis of randomized trials | journal = The American Journal of Emergency Medicine | volume = 24 | issue = 2 | pages = 217–22 | date = March 2006 | pmid = 16490653 | doi = 10.1016/j.ajem.2005.10.008 }}</ref> They are, however, not recommended due to concerns regarding excessive cardiac stimulation.<ref name="NHLBI07p351">{{harvnb|NHLBI Guideline|2007|p=351}}</ref>
* Corticosteroids can also help with the acute phase of an exacerbation because of their antiinflammatory properties. The benefit of systemic and oral corticosteroids is well established. Inhaled or nebulized corticosteroids can also be used.<ref name="BertrandSánchez2020" /> For adults and children who are in the hospital due to acute asthma, systemic (IV) corticosteroids improve symptoms.<ref>{{cite journal | vauthors = Smith M, Iqbal S, Elliott TM, Everard M, Rowe BH | title = Corticosteroids for hospitalised children with acute asthma | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD002886 |year = 2003 | volume = 2003 | pmid = 12804441 | doi = 10.1002/14651858.CD002886 | pmc = 6999806 }}</ref><ref>{{cite journal | vauthors = Rowe BH, Spooner C, Ducharme FM, Bretzlaff JA, Bota GW | title = Early emergency department treatment of acute asthma with systemic corticosteroids | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD002178 |year = 2001 | pmid = 11279756 | doi = 10.1002/14651858.CD002178 | pmc = 7025797 }}</ref> A short course of corticosteroids after an acute asthma exacerbation may help prevent relapses and reduce hospitalizations.<ref>{{cite journal | vauthors = Rowe BH, Spooner CH, Ducharme FM, Bretzlaff JA, Bota GW | title = Corticosteroids for preventing relapse following acute exacerbations of asthma | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD000195 | date = July 2007 | pmid = 17636617 | doi = 10.1002/14651858.CD000195.pub2 | s2cid = 11992578 }}</ref>
* Other remedies, less established, are intravenous or nebulized magnesium sulfate and helium mixed with oxygen. Aminophylline could be used with caution as well.<ref name="BertrandSánchez2020" />
* Mechanical ventilation is the last resort in case of severe hypoxemia.<ref name="BertrandSánchez2020" />
* Intravenous administration of the drug [[aminophylline]] does not provide an improvement in bronchodilation when compared to standard inhaled beta<small><sub>2</sub></small> agonist treatment.<ref name=Nai2012>{{cite journal | vauthors = Nair P, Milan SJ, Rowe BH | title = Addition of intravenous aminophylline to inhaled beta(2)-agonists in adults with acute asthma | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | pages = CD002742 | date = December 2012 | issue = 12 | pmid = 23235591 | doi = 10.1002/14651858.CD002742.pub2 | pmc = 7093892 }}</ref> Aminophylline treatment is associated with more adverse effects compared to inhaled beta<sub><small>2</small></sub> agonist treatment.<ref name=Nai2012/>

==== Long–term control ====
[[File:Fluticasone.JPG|thumb|upright|alt=A round canister above an orange plastic holder|[[Fluticasone propionate]] metered dose inhaler commonly used for long-term control]]

* Corticosteroids are generally considered the most effective treatment available for long-term control.<ref name=NHLBI07p213/> Inhaled forms are usually used except in the case of severe persistent disease, in which oral corticosteroids may be needed.<ref name=NHLBI07p213/> Dosage depends on the severity of symptoms.<ref name="NHLBI07p218">{{harvnb|NHLBI Guideline|2007|p=218}}</ref> High dosage and long-term use might lead to the appearance of common adverse effects which are  growth delay, adrenal suppression, and osteoporosis.<ref name="BertrandSánchez2020" /> Continuous (daily) use of an inhaled corticosteroid, rather than its intermitted use, seems to provide better results in controlling asthma exacerbations.<ref name="BertrandSánchez2020" /> Commonly used corticosteroids are  [[budesonide]], [[fluticasone]], [[mometasone]] and [[ciclesonide]].<ref name="BertrandSánchez2020" />
* [[Long-acting beta-adrenoceptor agonist]]s (LABA) such as [[salmeterol]] and [[formoterol]] can improve asthma control, at least in adults, when given in combination with inhaled corticosteroids.<ref name=Ducharme2010>{{cite journal | vauthors = Ducharme FM, Ni Chroinin M, Greenstone I, Lasserson TJ | title = Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD005535 | date = May 2010 | pmid = 20464739 | pmc = 4169792 | doi = 10.1002/14651858.CD005535.pub2 | veditors = Ducharme FM }}</ref><ref name=Duc2009>{{cite journal | vauthors = Ni Chroinin M, Greenstone I, Lasserson TJ, Ducharme FM | title = Addition of inhaled long-acting beta2-agonists to inhaled steroids as first line therapy for persistent asthma in steroid-naive adults and children | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD005307 | date = October 2009 | pmid = 19821344 | pmc = 4170786 | doi = 10.1002/14651858.CD005307.pub2 }}</ref> In children this benefit is uncertain.<ref name=Ducharme2010/><ref name="pmid20393943">{{cite journal | vauthors = Ducharme FM, Ni Chroinin M, Greenstone I, Lasserson TJ | title = Addition of long-acting beta2-agonists to inhaled steroids versus higher dose inhaled steroids in adults and children with persistent asthma | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD005533 | date = April 2010 | pmid = 20393943 | pmc = 4169793 | doi = 10.1002/14651858.CD005533.pub2 | veditors = Ducharme FM }}</ref><ref name=Duc2009/> When used without steroids they increase the risk of severe [[side-effect]]s,<ref name=Fanta2009>{{cite journal | vauthors = Fanta CH | title = Asthma | journal = The New England Journal of Medicine | volume = 360 | issue = 10 | pages = 1002–14 | date = March 2009 | pmid = 19264689 | doi = 10.1056/NEJMra0804579 }}</ref> and with corticosteroids they may slightly increase the risk.<ref name=Cates2012>{{cite journal | vauthors = Cates CJ, Cates MJ | title = Regular treatment with formoterol for chronic asthma: serious adverse events | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 4 | pages = CD006923 | date = April 2012 | pmid = 22513944 | pmc = 4017186 | doi = 10.1002/14651858.CD006923.pub3 | veditors = Cates CJ }}</ref><ref name="pmid18646149">{{cite journal | vauthors = Cates CJ, Cates MJ | title = Regular treatment with salmeterol for chronic asthma: serious adverse events | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD006363 | date = July 2008 | pmid = 18646149 | pmc = 4015854 | doi = 10.1002/14651858.CD006363.pub2 | veditors = Cates CJ }}</ref> Evidence suggests that for children who have persistent asthma, a treatment regime that includes LABA added to inhaled corticosteroids may improve lung function but does not reduce the amount of serious exacerbations.<ref name=Chau2015>{{cite journal | vauthors = Chauhan BF, Chartrand C, Ni Chroinin M, Milan SJ, Ducharme FM | title = Addition of long-acting beta2-agonists to inhaled corticosteroids for chronic asthma in children | journal = The Cochrane Database of Systematic Reviews | issue = 11 | pages = CD007949 | date = November 2015 | volume = 2015 | pmid = 26594816 | pmc = 4167878 | doi = 10.1002/14651858.CD007949.pub2 }}</ref> Children who require LABA as part of their asthma treatment may need to go to the hospital more frequently.<ref name=Chau2015/>
* [[Antileukotriene agents|Leukotriene receptor antagonists]] (anti-leukotriene agents such as [[montelukast]] and [[zafirlukast]]) may be used in addition to inhaled corticosteroids, typically also in conjunction with a LABA.<ref name="Antileukotriene agents" /><ref>{{cite journal | vauthors = Chauhan BF, Ducharme FM | title = Addition to inhaled corticosteroids of long-acting beta2-agonists versus anti-leukotrienes for chronic asthma | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD003137 | date = January 2014 | volume = 2014 | pmid = 24459050 | doi = 10.1002/14651858.CD003137.pub5 | pmc = 10514761 | url = http://openaccess.sgul.ac.uk/2678/1/CD003137.pdf }}</ref><ref name=Cha2017>{{cite journal | vauthors = Chauhan BF, Jeyaraman MM, Singh Mann A, Lys J, Abou-Setta AM, Zarychanski R, Ducharme FM | title = Addition of anti-leukotriene agents to inhaled corticosteroids for adults and adolescents with persistent asthma | journal = The Cochrane Database of Systematic Reviews | volume = 3 | pages = CD010347 | date = March 2017 | issue = 4 | pmid = 28301050 | pmc = 6464690 | doi = 10.1002/14651858.CD010347.pub2 }}</ref><ref name="pmid22592708">{{cite journal | vauthors = Watts K, Chavasse RJ | title = Leukotriene receptor antagonists in addition to usual care for acute asthma in adults and children | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | issue = 5 | pages = CD006100 | date = May 2012 | pmid = 22592708 | doi = 10.1002/14651858.CD006100.pub2 | veditors = Watts K | pmc = 7387678 }}</ref>  For adults or adolescents who have persistent asthma that is not controlled very well, the addition of anti-leukotriene agents along with daily inhaled corticosteriods improves lung function and reduces the risk of moderate and severe asthma exacerbations.<ref name=Cha2017/> Anti-leukotriene agents may be effective alone for adolescents and adults; however, there is no clear research suggesting which people with asthma would benefit from anti-leukotriene receptor alone.<ref>{{cite journal | vauthors = Miligkos M, Bannuru RR, Alkofide H, Kher SR, Schmid CH, Balk EM | title = Leukotriene-receptor antagonists versus placebo in the treatment of asthma in adults and adolescents: a systematic review and meta-analysis | journal = Annals of Internal Medicine | volume = 163 | issue = 10 | pages = 756–67 | date = November 2015 | pmid = 26390230 | pmc = 4648683 | doi = 10.7326/M15-1059 }}</ref>  In those under five years of age, anti-leukotriene agents were the preferred add-on therapy after inhaled corticosteroids.<ref name="BertrandSánchez2020" /><ref name=bts2009p43>{{harvnb|British Guideline|2009|p=43}}</ref> A 2013 [[Cochrane (organisation)|Cochrane]] systematic review concluded that anti-leukotriene agents appear to be of little benefit when added to inhaled steroids for treating children.<ref>{{cite journal | vauthors = Chauhan BF, Ben Salah R, Ducharme FM | title = Addition of anti-leukotriene agents to inhaled corticosteroids in children with persistent asthma | journal = The Cochrane Database of Systematic Reviews | issue = 10 | pages = CD009585 | date = October 2013 | pmid = 24089325 | pmc = 4235447 | doi = 10.1002/14651858.CD009585.pub2 }}</ref> A similar class of drugs, [[Arachidonate 5-lipoxygenase|5-LOX]] inhibitors, may be used as an alternative in the chronic treatment of mild to moderate asthma among older children and adults.<ref name="Antileukotriene agents" /><ref name="USFDA Zileuton">{{cite web|title=Zyflo (Zileuton tablets)|url=http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020471s017lbl.pdf|website=United States Food and Drug Administration|publisher=Cornerstone Therapeutics Inc.|access-date=December 12, 2014|pages = 1|date=June 2012|url-status=live|archive-url=https://web.archive.org/web/20141213015155/http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020471s017lbl.pdf|archive-date=December 13, 2014}}</ref> {{As of|2013}} there is one medication in this family known as [[zileuton]].<ref name="Antileukotriene agents" />
* [[Mast cell stabilizer]]s (such as [[cromolyn sodium]]) are safe alternatives to corticosteroids but not preferred because they have to be administered frequently.<ref name=NHLBI07p213/><ref name="Antileukotriene agents" />
* Oral [[theophylline]]s are sometimes used for controlling chronic asthma, but their used is minimized due to side effects.<ref name="BertrandSánchez2020" />
* [[Omalizumab]], a monoclonal antibody against IgE, is a novel way to lessen exacerbations by decreasing the levels of circulating IgE that play a significant role at allergic asthma.<ref name="BertrandSánchez2020" /><ref name="Solèr ">{{cite journal | vauthors = Solèr M | title = Omalizumab, a monoclonal antibody against IgE for the treatment of allergic diseases | journal = International Journal of Clinical Practice | volume = 55 | issue = 7 | pages = 480–483 | date = September 2001 | pmid = 11594260 | doi =  10.1111/j.1742-1241.2001.tb11095.x| s2cid = 41311909 | access-date =  }}</ref>
* Anticholinergic medications such as ipratropium bromide have not been shown to be beneficial for treating chronic asthma in children over 2 years old,<ref>{{cite journal | vauthors = McDonald NJ, Bara AI | title = Anticholinergic therapy for chronic asthma in children over two years of age | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD003535 |year = 2003 | volume = 2014 | pmid = 12917970 | doi = 10.1002/14651858.CD003535 | pmc = 8717339 }}</ref> and are not suggested for routine treatment of chronic asthma in adults.<ref>{{cite journal | vauthors = Westby M, Benson M, Gibson P | title = Anticholinergic agents for chronic asthma in adults | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD003269 |year = 2004 | volume = 2017 | pmid = 15266477 | pmc = 6483359 | doi = 10.1002/14651858.CD003269.pub2 }}</ref>
* There is no strong evidence to recommend [[chloroquine]] medication as a replacement for taking corticosteroids by mouth (for those who are not able to tolerate inhaled steroids).<ref>{{cite journal | vauthors = Dean T, Dewey A, Bara A, Lasserson TJ, Walters EH | title = Chloroquine as a steroid sparing agent for asthma | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD003275 |year = 2003 | pmid = 14583965 | doi = 10.1002/14651858.CD003275 }}</ref> [[Methotrexate]] is not suggested as a replacement for taking corticosteriods by mouth ("steroid-sparing") due to the adverse effects associated with taking methotrexate and the minimal relief provided for asthma symptoms.<ref>{{cite journal | vauthors = Davies H, Olson L, Gibson P | title = Methotrexate as a steroid sparing agent for asthma in adults | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD000391 |year = 2000 | volume = 1998 | pmid = 10796540 | pmc = 6483672 | doi = 10.1002/14651858.CD000391 }}</ref>
* [[Macrolide]] antibiotics, particularly the azalide macrolide [[azithromycin]], are a recently added [[Global Initiative for Asthma]] (GINA)-recommended treatment option for both eosinophilic and non-eosinophilic severe, refractory asthma based on azithromycin's efficacy in reducing moderate and severe exacerbations combined.<ref>{{cite journal | vauthors = Hiles SA, McDonald VM, Guilhermino M, Brusselle GG, Gibson PG | title = Does maintenance azithromycin reduce asthma exacerbations? An individual participant data meta-analysis | journal = The European Respiratory Journal | volume = 54 | issue = 5 | date = November 2019 | pmid = 31515407 | doi = 10.1183/13993003.01381-2019 | s2cid = 202567597 | doi-access = free }}</ref><ref>{{cite web |last1=GINA |title=Difficult-to-Treat and Severe Asthma in Adolescent and Adult Patients: Diagnosis and Management |url=https://ginasthma.org/severeasthma/ |website=Global Initiative for Asthma |access-date=August 1, 2021}}</ref> Azithromycin's mechanism of action is not established, and could involve  pathogen- and/or host-directed anti-inflammatory activities.<ref>{{cite journal | vauthors = Steel HC, Theron AJ, Cockeran R, Anderson R, Feldman C | title = Pathogen- and host-directed anti-inflammatory activities of macrolide antibiotics | journal = Mediators of Inflammation | volume = 2012 | pages = 584262 |year = 2012 | pmid = 22778497 | pmc = 3388425 | doi = 10.1155/2012/584262 | doi-access = free }}</ref> Limited clinical observations suggest that some patients with new-onset asthma and with "difficult-to-treat" asthma (including those with the asthma-COPD overlap syndrome – ACOS) may respond dramatically to azithromycin.<ref>{{cite journal | vauthors = Hahn DL | title = When guideline treatment of asthma fails, consider a macrolide antibiotic | journal = The Journal of Family Practice | volume = 68 | issue = 10 | pages = 536;540;542;545 | date = December 2019 | pmid = 31860697 }}</ref><ref name="Outcomes of Antibiotics in Adults w" /> However, these groups of asthma patients have not been studied in randomized treatment trials and patient selection needs to be carefully individualized.
* A 2024 study indicates that commonly used diabetes medications may lower asthma attacks by up to 70%.<ref>{{Cite journal |last1=Lee |first1=Bohee |last2=Man |first2=Kenneth K. C. |last3=Wong |first3=Ernie |last4=Tan |first4=Tricia |last5=Sheikh |first5=Aziz |last6=Bloom |first6=Chloe I. |date=2024-11-18 |title=Antidiabetic Medication and Asthma Attacks |url=https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2826086?&utm_source=BulletinHealthCare&utm_medium=email&utm_term=111924&utm_content=NON-MEMBER&utm_campaign=article_alert-morning_rounds_daily&utm_uid=5590102 |journal=JAMA Internal Medicine |volume=185 |issue=1 |pages=16–25 |doi=10.1001/jamainternmed.2024.5982 |pmid=39556360 |pmc=11574725 |pmc-embargo-date=November 18, 2025 |issn=2168-6106}}</ref> The research examined [[metformin]] and GLP-1 drugs such as Ozempic ([[semaglutide]]), Mounjaro ([[tirzepatide]]), and Saxenda ([[liraglutide]]). Among nearly 13,000 participants with both diabetes and asthma, metformin reduced the risk of asthma attacks by 30%, with an additional 40% reduction when combined with a [[GLP-1 drug]].<ref>{{Cite web |last=Mundell |first=Ernie |date=2024-11-18 |title=Diabetes Meds Metformin, GLP-1s Can Also Curb Asthma |url=https://www.healthday.com/health-news/asthma/diabetes-meds-metformin-glp-1s-can-also-curb-asthma |access-date=2024-11-20 |website=www.healthday.com |language=en}}</ref>

For children with asthma which is well-controlled on combination therapy of [[inhaled corticosteroids]] (ICS) and long-acting beta<sub>2</sub>-agonists (LABA), the benefits and harms of stopping LABA and stepping down to ICS-only therapy are uncertain.<ref>{{cite journal | vauthors = Kew KM, Beggs S, Ahmad S | title = Stopping long-acting beta2-agonists (LABA) for children with asthma well controlled on LABA and inhaled corticosteroids | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD011316 | date = May 2015 | volume = 2017 | pmid = 25997166 | pmc = 6486153 | doi = 10.1002/14651858.CD011316.pub2 | url = http://ecite.utas.edu.au/108910 }}</ref> In adults who have stable asthma while they are taking a combination of LABA and inhaled corticosteroids (ICS), stopping LABA may increase the risk of asthma exacerbations that require treatment with corticosteroids by mouth.<ref name=Ahm2015>{{cite journal | vauthors = Ahmad S, Kew KM, Normansell R | title = Stopping long-acting beta2-agonists (LABA) for adults with asthma well controlled by LABA and inhaled corticosteroids | journal = The Cochrane Database of Systematic Reviews | issue = 6 | pages = CD011306 | date = June 2015 | volume = 2015 | pmid = 26089258 | doi = 10.1002/14651858.CD011306.pub2 | pmc = 11114094 | url = http://openaccess.sgul.ac.uk/107422/1/CD011306.pdf }}</ref> Stopping LABA probably makes little or no important difference to asthma control or asthma-related quality of life.<ref name=Ahm2015/> Whether or not stopping LABA increases the risk of serious adverse events or exacerbations requiring an emergency department visit or hospitalization is uncertain.<ref name=Ahm2015/>

====Delivery methods====
Medications are typically provided as [[metered-dose inhaler]]s (MDIs) in combination with an [[inhaler spacer]] or as a [[dry powder inhaler]]. The spacer is a plastic cylinder that mixes the medication with air, making it easier to receive a full dose of the drug. A [[nebulizer]] may also be used. Nebulizers and spacers are equally effective in those with mild to moderate symptoms. However, insufficient evidence is available to determine whether a difference exists in those with severe disease.<ref name="NHLBI07p250">{{harvnb|NHLBI Guideline|2007|p=250}}</ref> For delivering short-acting beta-agonists in acute asthma in children, spacers may have advantages compared to nebulisers, but children with life-threatening asthma have not been studied.<ref>{{cite journal | vauthors = Cates CJ, Welsh EJ, Rowe BH | title = Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma | journal = The Cochrane Database of Systematic Reviews | issue = 9 | pages = CD000052 | date = September 2013 | volume = 2013 | pmid = 24037768 | doi = 10.1002/14651858.CD000052.pub3 | pmc = 7032675 |collaboration = Cochrane Airways Group }}</ref> There is no strong evidence for the use of intravenous LABA for adults or children who have acute asthma.<ref>{{cite journal | vauthors = Travers AH, Milan SJ, Jones AP, Camargo CA, Rowe BH | title = Addition of intravenous beta(2)-agonists to inhaled beta(2)-agonists for acute asthma | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | pages = CD010179 | date = December 2012 | issue = 12 | pmid = 23235685 | doi = 10.1002/14651858.CD010179 | pmc = 11289706 }}</ref> There is insufficient evidence to directly compare the effectiveness of a metered-dose inhaler attached to a homemade spacer compared to commercially available spacer for treating children with asthma.<ref>{{cite journal | vauthors = Rodriguez C, Sossa M, Lozano JM | title = Commercial versus home-made spacers in delivering bronchodilator therapy for acute therapy in children | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD005536 | date = April 2008 | volume = 2017 | pmid = 18425921 | pmc = 6483735 | doi = 10.1002/14651858.CD005536.pub2 }}</ref>

====Adverse effects====
Long-term use of inhaled corticosteroids at conventional doses carries a minor risk of adverse effects.<ref name=Safe09>{{cite journal | vauthors = Rachelefsky G | title = Inhaled corticosteroids and asthma control in children: assessing impairment and risk | journal = Pediatrics | volume = 123 | issue = 1 | pages = 353–66 | date = January 2009 | pmid = 19117903 | doi = 10.1542/peds.2007-3273 | s2cid = 22386752 }}</ref> Risks include [[oral candidiasis|thrush]], the development of [[cataract]]s, and a slightly slowed rate of growth.<ref name=Safe09/><ref>{{cite journal | vauthors = Dahl R | title = Systemic side effects of inhaled corticosteroids in patients with asthma | journal = Respiratory Medicine | volume = 100 | issue = 8 | pages = 1307–17 | date = August 2006 | pmid = 16412623 | doi = 10.1016/j.rmed.2005.11.020 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Thomas MS, Parolia A, Kundabala M, Vikram M | title = Asthma and oral health: a review | journal = Australian Dental Journal | volume = 55 | issue = 2 | pages = 128–33 | date = June 2010 | pmid = 20604752 | doi = 10.1111/j.1834-7819.2010.01226.x | doi-access =  }}</ref> Rinsing the mouth after the use of inhaled steroids can decrease the risk of thrush.<ref>{{cite book | vauthors = Domino FJ, Baldor RA, Golding J, Grimes JA |title=The 5-Minute Clinical Consult Premium 2015 |date=2014 |publisher=Lippincott Williams & Wilkins |isbn=978-1-4511-9215-5 |page=192 |url=https://books.google.com/books?id=T-XtAwAAQBAJ&pg=PA192 }}</ref> Higher doses of inhaled steroids may result in lower [[bone mineral density]].<ref>{{cite journal |vauthors=Skoner DP |title=Inhaled corticosteroids: Effects on growth and bone health |journal=Annals of Allergy, Asthma & Immunology |volume=117 |issue=6 |pages=595–600 |date=December 2016 |pmid=27979015 |doi=10.1016/j.anai.2016.07.043 }}</ref>