Some people with asthma may find they need extra or ‘add-on’ therapies alongside their preventer medication to keep their asthma properly controlled.
If your asthma is not well controlled even while using your controller medicine regularly, you should go and see your doctor again. Before increasing the dose of your preventer/controller, your doctor may suggest other treatments or ‘add-on’ therapies to help you.
LTRAs (Leukotriene Receptor Antagonists)
Leukotriene receptor antagonists (LTRA) block the action of naturally occurring immune chemicals in the lungs (leukotrienes) which lead to inflammation in both the upper and lower airways.
An LTRA may be prescribed instead of or alongside preventer/controller medication to help get your asthma under control. They are particularly effective for people with exercise-related symptoms. LTRAs are available in tablet form (often as chewables or as granules) which may be given with food for children as young as six months. However, it is important to note that LTRAs do not work for everyone, and your doctor may change treatment if there is no improvement in symptoms.
If asthma control is still not good after adding an LRA to treatment, a long-acting reliever may be prescribed alongside your steroid preventer/controller. Long-acting relievers should always be taken with an inhaled steroid. Your doctor may prescribe these separately or in a combined inhaler.
Long-acting relievers go on working for a longer time than normal relievers and are usually taken twice a day to have an effect. Your doctor may also prescribe a slow-releasing theophylline.
Examples of LTRAs
- Montelukast (e.g. Singulair)
- Zafirlukast
Possible side effects of LTRAs
The most common side effects caused by LTRAs are headaches, dizziness, abdominal pain, sore throat and rhinitis. Speak to your healthcare professional for more detailed information on the possible side effects of LTRAs.
Steroid tablets
Steroid tablets (also known as oral corticosteroids) are an anti-inflammatory medicine prescribed for a wide range of conditions, including asthma and COPD. They are mainly used to reduce inflammation and suppress the immune system.
For asthma, steroid tablets treat the chronic inflammation of the airways that can cause a sudden flare-up. This inflammation is a swelling and irritation of the airways causing commonly known symptoms of asthma – coughing, wheezing, shortness of breath and chest tightness.
Steroid tablets are an effective and inexpensive treatment for asthma and short courses are commonly used to treat asthma attacks. They are also sometimes prescribed as part of daily maintenance therapy for patients with severe asthma. However, they can be associated with significant side effects.
Steroid tablets should be prescribed at the lowest effective dose for the shortest possible time. Unnecessary use or over-use of the treatment can cause more harm to the patient than good.
Steroid tablets vs steroid inhalers
Oral corticosteroids (steroid tablets) are different to the inhaled corticosteroids (steroid inhalers) prescribed by your physician for regular use to keep your asthma under control. Oral corticosteroids come in tablet form and contain a different steroid to those in inhaled corticosteroids.
Steroid inhalers are an essential cornerstone of asthma maintenance therapy. They deliver the steroid directly to the breathing system of a person with asthma. They do not involve the risks associated with steroid tablets.
Steroid inhalers reduce the risk of asthma deaths, hospitalisation and asthma attacks requiring steroid tablets and usually have little or no side effects, if used correctly and as prescribed.
Examples of oral steroid tablets
- Prednisolone
- Prednisone
Potential side effects
There are potential adverse effects that are associated with both short-term use and long-term use of steroid tablets.
Potential harmful side effects from short term use include:
- Sleep disturbance
- GORD (gastric reflux/heartburn)
- Appetite increase
- Hyperglycaemia
- Sepsis and increased risk of infection
- Mood changes
- A large population-based study has been associated with increased rates of thromboembolism and fracture within 30 days of oral corticosteroid initiation
Potential harmful side effects from prolonged or frequent use include:
- Cataract
- Glaucoma
- Hypertension
- Diabetes
- Depression
- Adrenal suppression
- Osteoporosis
Uncontrolled asthma
For most people, the prolonged use of steroid tablets can be a sign of uncontrolled asthma. Our recent survey of people with asthma in Ireland has shown worrying signs of potentially high levels of uncontrolled asthma. Take the one-minute quiz below to check your symptoms and whether you may need an asthma review.
Top tips for asthma control (to avoid steroid tablets)
- Take your controller (or combined) inhaler medication every day – even when you feel well – and your reliever inhaler (if you have a separate one) when your symptoms flare.
- Try to maintain good hygiene habits in your household – regular handwashing, coughing or sneezing into your elbow, disinfecting surfaces regularly and controlling the spread of cold and flus.
- Get the flu COVID-19 vaccines every year as advised.
- If you have needed even one course of steroid tablets two years in a row (or more) for your asthma, you could benefit from a review with your GP to update your Asthma Action Plan.
- Do not stop taking steroid tablets without talking to your doctor first as doing so could be dangerous.
Things to remember about ‘add-on’ therapies
Before changing any medicines or offering you new ones, your doctor or nurse should speak to you about how you take your medicines, whether your inhaler technique is correct and whether you are taking the prescribed dose at the right frequency.
If you are taking an ‘add-on’ therapy that is not helping to control your asthma symptoms, your doctor may stop it before you start a different treatment.