Add-On Therapies

Some people with asthma may find they need extra or 'Add-on' therapies alongside their preventer medication to keep their asthma properly controlled.

Reliever inhaler and add-on therapies

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

The first 'add-on therapy' to be tried is usually a leukotriene receptor antagonist (LRA) which blocks 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 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, as chewables or as granules which may be given with food for children as young as 6 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 (e.g. Accolate)

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.

When are steroid tablets used in asthma?

If your asthma gets really bad or you have an asthma attack, your doctor may give you a short course of steroid tablets. These work quickly and powerfully to help calm down your inflamed airways. Short courses of tablets, as prescribed by your doctor, won’t cause any long-term side effects.

Oral steroid tablets (glucocorticosteroids) may be prescribed for a period of 3-5 days to regain control of your asthma following an asthma attack. They are useful for relieving short-term symptoms and can prevent hospitalisation. If you repeatedly need oral steroids to keep your asthma under control, then your doctor may refer you to a respiratory specialist.

Examples of Oral Steroid Tablets:

  • Prednisolone
  • Prednisone

Steroid tablets can lower the body's resistance to chickenpox, so you should contact your doctor if you or your child are taking steroids and come into contact with chickenpox.

A small number of people with severe asthma may need to take steroid tablets for a longer period. These people are more at risk of experiencing side effects, so do not hesitate to talk to your doctor or practice nurse about any concerns you have about the side effects of your asthma treatment.

Possible Side Effects of Oral Steroid Tablets

In some cases, oral steroids may cause disturbed sleep, hyperactivity and increased appetite. Oral steroids may also reduce resistance to chickenpox, which can be an issue for younger patients. Speak to your healthcare professional if you have any concerns.



Woman helping girl take reliever inhaler with spacer

Points to Remember

  • 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.