Asthma is a chronic inflammatory disease that affects almost 26 million people on the U.S., including over 4 million children. People with asthma always have some swelling in their lungs, which is why controller medicines are essential to managing symptoms and preventing or reducing flare-ups. If it is poorly managed, permanent airway remodeling can occur. This is when the lungs become scarred, so asthma treatments are less effective. That is why sticking to an asthma action plan, one that was created with your healthcare provider, and sticking to your medicine schedule is essential.
What Are Controller Medicines?
Long-term control medicines, often referred to as maintenance medicines, are taken daily to reduce swelling (inflammation), mucus production and tightening of the smooth muscles of the airways called bronchoconstriction in the hopes of preventing asthma symptoms. Unlike quick relief medicine, which is used during attacks, controllers tackle the root cause of asthma by suppressing chronic inflammation. Controllers commonly contain inhaled steroids and need to be used regularly, even on days without symptoms, to be effective. So, it is important for individuals with asthma to take these medicines exactly as prescribed and with the right technique to receive the lifesaving benefits.
Types of controller medicine include:
- Inhaled corticosteroids (ICS) (such as fluticasone [previously Flovent®], or budesonide [Pulmicort®]: Considered a first-line treatment to prevent flare-ups, inhaled corticosteroids can reduce inflammation and prevent narrowing of the airways.
- Combination Therapy (ICS/ Long-Acting Beta2-Agonists) (such as fluticasone/ Salmeterol [Advair®], or budesonide/formoterol [Symbicort®]: Long-Acting Beta2-agonists (LABA) are used in combination with ICS to help relax the smooth muscles in the airways.
- Leukotriene Receptor Antagonists (LTRA) (such as montelukast [Singular®]: These medicines prevent chemical messengers from causing an inflammatory response. They are best for people with allergic asthma and can be an add-on option to take with other control medicine.
- Monoclonal Antibodies (Biologics) (such as omalizumab [Xolair®], dupilumab {Dupixent®], or Tezepelumab-ekko [Tezspire®]: These injectable options are used to treat severe, hard-to-control asthma and can be an add-on option to take with other control medicine.
Incorrect Asthma Claims May Lead to Dangerous Changes
Recent claims in the news have stated that asthma drug prescriptions have increased by 30% between 1999 and 2008, and an estimated 25-40% of mild cases are overprescribed. Not only is this NOT true, but there is significant evidence that asthma medicines are UNDER prescribed. Under prescribed asthma medicine may be due to a variety of factors, including cost and access to medicine, as one study found. Additionally, they have found that the impact of undertreatment and poor asthma control has resulted in around 1.8 million emergency room visits in the U.S. each year.
Over the years, asthma prevalence has increased, which correlates with the resulting increase in prescriptions. These prescriptions are commonly controller medicines that are used to significantly reduce symptom frequency, flare-ups and emergency room visits, and allow people to live healthier lives. It is concerning that many lawmakers fail to recognize the many different forms of asthma inhaled controller medicines, choosing instead to focus on oral corticosteroids, which are used to treat severe flare-ups, not as controller medicine.
It is misunderstandings like this that create a barrier for asthma patients, as only about 35% of asthma patients use a controller regularly.
Controller Medicine Means Living Healthier
Treating swelling (inflammation) daily is one of the keys to asthma control. With proper controller use and technique, asthma patients can:
- Prevent flare-ups, reducing urgent clinic, emergency department and hospital visits.
- Maintain daily activities, like school, work and sports without symptoms.
- Minimize the need for oral steroid bursts, which carry risk of side effects with use, to treat severe episodes.
Controller medicines are a strong foundation of asthma control. They allow people with asthma to lead healthy, active lives, but only if they are able to access them affordably and use them correctly. As we've seen, policy and pricing shifts can make the difference between control and crisis. Ensuring consistent access and affordability isn't just good healthcare—it's essential. Everyone should be able to breathe easily, without worrying about getting the medicine they need.
Blog last updated: July 25, 2025
