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A purple asthma inhaler:Best medicine for an asthma cough
Health Education

Best medicine for an asthma cough: Pharmacist recommendations

Cough syrup won’t treat an asthma cough, but there are various inhaled medications that can provide relief
Karen Berger medical writer and reviewer headshot
By | Feb. 16, 2024

Asthma is a chronic lung condition that makes it difficult to move air in and out of the lungs. Asthma symptoms may include:

  • Wheezing, or a whistling sound when you breathe
  • A frequent cough, which may or may not involve mucus
  • Shortness of breath, or the feeling that you cannot get enough air into the lungs
  • Tightness of the chest, especially during exercise or in cold weather

You may see many over-the-counter (OTC) products that treat cough and cold symptoms on the shelf at your pharmacy. However, these medications are not for coughs related to asthma. Instead, if you have an asthma-related cough, you’ll want to use your rescue inhaler, such as albuterol or levalbuterol. These inhaled medications, known as short-acting beta-agonists, open up the lungs and provide quick relief. There are also other medications that can be used for long-term control of asthma symptoms, including cough. Continue reading to learn about the different types of asthma medications. 

Medicines for asthma cough

There are various medications that can be used to prevent or treat asthma coughs and related symptoms. All drugs mentioned below are approved by the U.S. Food and Drug Administration (FDA). In addition to medication, you can also talk with your healthcare provider about avoiding triggers that cause you to experience asthma symptoms. 

Inhaled medications may be administered via:

  • Metered-dose inhalers (MDI): The most common type of inhaler pushes puffs of medicine into the lungs. Some people use a spacer (valved holding chamber) with an MDI. A spacer helps deliver the medicine to the airways and makes the MDI easier to use. 
  • Dry-powder inhalers (DPIs): Breath-activated devices that allow the patient to breathe in medicine in the form of a dry powder. Some DPIs contain lactose, so people with a milk protein allergy should consult their healthcare provider before using DPIs. 
  • Nebulized solutions: A nebulizer machine is used to turn liquid medicine into a fine mist that is inhaled over a period of time (usually 10 or 15 minutes) with a mouthpiece or mask. Nebulizers are often used by people who cannot easily use inhalers, such as infants or young children.

Short-acting beta-agonist medications

Short-acting beta-agonists (SABAs) are considered bronchodilators because they quickly open up (dilate) the muscles of the airways (bronchi), making it easier to breathe. Often referred to as rescue inhalers or quick-relief inhalers, SABAs are commonly used during asthma attacks or exacerbations to provide quick relief of symptoms such as coughing and wheezing. They can also be used before exercise by people with exercise-induced asthma.

Short-acting beta-agonists include:

Common side effects of SABAs include anxiety, fast heartbeat, headache, restlessness, and shaking. 

Other short-acting bronchodilators

Ipratropium is a short-acting bronchodilator that can be used for acute attacks. Ipratropium helps open up the airways, making it easier to breathe, and also stops the production of excess mucus in the lungs. It is available as both an inhaler and a nebulized solution.

Corticosteroids

Corticosteroids, or steroids, work by decreasing inflammation. Inhaled corticosteroids (ICS) are inhaled by mouth, delivering the medication directly to the lungs. This causes fewer side effects than taking steroids by mouth in pill form. Using ICSs helps decrease inflammation in the airways and helps control asthma symptoms—but ICSs are not rescue inhalers and do not help if you are having an asthma attack. After using an ICS, you should rinse your mouth with water and then spit. This helps avoid getting an oral yeast infection (yeast infection of the mouth) called thrush. ICSs are considered safe, effective, and well-tolerated. Some common side effects of ICSs include throat irritation, hoarseness, altered taste, thrush, sore throat, dry mouth, and headache. 

Examples of ICSs include:

Oral or injected steroids may be prescribed in high doses for people who are having a severe asthma attack. In some cases, oral steroids may need to be continued for a period of time if nothing else is controlling symptoms. If taken for a long time, steroids can cause serious side effects, including osteoporosis (bone loss), high blood sugar, cataracts, and other problems. Examples of oral corticosteroids include:

Long-acting beta-agonists (LABAs)

LABAs are used to prevent asthma attacks. They do not treat an acute attack. LABAs work for about 12 hours, so they are usually prescribed to take twice per day. A LABA can never be prescribed alone. This is because a LABA alone (without an ICS) can increase the risk of death. Therefore, a LABA will always be prescribed along with an ICS, either as a combination inhaler (see below), or as two separate products.

Common side effects of LABAs include heart palpitations, nervousness, shaking, dry mouth, and throat irritation. Serevent Diskus (salmeterol) is an example of a LABA used for  maintenance treatment of asthma.

Combination inhaled medications

Combination medications contain two or three types of medications in one inhaler, such as an ICS plus a LABA. They are used to prevent and control asthma symptoms. Side effects vary based on the individual ingredients. Examples include:

SMART stands for single maintenance and reliever therapy, which combines an ICS and LABA in one inhaler. People with asthma can use a SMART inhaler to both control and prevent symptoms as well as for quick relief of asthma symptoms. Currently, Symbicort or Dulera can be used for SMART therapy under the supervision of your doctor.

Airsupra contains a SABA (albuterol) and an ICS (budesonide). It is expected to be available sometime in 2024. It can be used in adults as needed to prevent or treat bronchoconstriction (tightening of the airways) and to prevent asthma symptoms.  

Long-acting muscarinic agonists (LAMAs)

LAMAs such as Spiriva Respimat (tiotropium) and umeclidinium (an ingredient in Trelegy Ellipta) are used to control asthma symptoms and are usually used in combination with an ICS. 

Mast cell stabilizers

Cromolyn is a mast cell stabilizer, which can be inhaled via a nebulizer. It works by preventing mast cells from releasing chemicals that cause inflammation. This makes the airways less likely to narrow. When taken on a regular basis, this medication helps prevent asthma attacks. 

Leukotriene modifiers

Leukotriene modifiers are oral medications (taken by mouth) that help control asthma symptoms. They have an anti-inflammatory effect and work by preventing the action or production of leukotrienes, chemicals made by the body that cause asthma symptoms. These drugs include:

  • Accolate (zafirlukast) oral tablet
  • Singulair (montelukast) oral tablet, chewable tablet, or granules
  • Zyflo (zileuton) oral tablet

Theophylline

Theophylline is an oral medication that opens up the lungs and is used to prevent asthma. People who take this medication must be closely monitored by blood tests because too much medication in the blood can cause life-threatening abnormal heart rhythms or seizures. Common side effects include headaches and feeling jittery, but these side effects tend to go away as you get used to the medicine. Higher doses can cause serious problems like palpitations, vomiting, and seizures, making theophylline a less popularly prescribed medication. 

Biologics

People with moderate to severe asthma that is not well-controlled with typically prescribed medications may need an “add-on” treatment known as a biologic, or monoclonal antibody. These medications are targeted to various types of asthma, such as eosinophilic asthma or allergic asthma, and are injected or infused. 

When allergies are involved

Additionally, if your asthma cough is triggered by allergies, your healthcare provider may recommend other treatments such as:

How to prevent an asthma cough

Talk to your healthcare provider about the best ways to prevent an asthma cough. Some methods may include:

  • Taking preventive medication every day to keep symptoms under control
  • Avoiding asthma triggers such as pollen, pet dander, mold, smoke, pollution, chemical fumes, strong odors, and stress—and keeping track of what triggers your symptoms
  • Keeping appointments with your healthcare providers and following your asthma action plan

How to choose the best medicine for asthma coughs

The best medicine for you can depend on many factors, such as the type and severity of your symptoms, potential side effects, and insurance coverage. A combination of preventive and acute treatments may be needed. You should always consult a healthcare professional for medical advice and more information about an asthma cough or your asthma medicine.

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