Health library
Asthma Medications Compared: Rescue, Controller, and Add-On Options
Related Products
Albuterol
Albuterol is a prescription bronchodilator that helps open the airways in the lungs. Albuterol is used to prevent and treat bronchospasm in people with asthma, chronic obstructive pulmonary disease (COPD), and other breathing disorders. It works quickly by relaxing the muscles around the airways, often providing relief within minutes during asthma attacks or episodes of sudden shortness of breath. It is available by prescription only in several forms, including metered-dose inhalers (such as ProAir HFA), nebulizer solutions (such as AccuNeb), and tablets.
$18.52
Budesonide
Budesonide is a prescription corticosteroid used as a daily maintenance treatment to prevent and control asthma symptoms in adults and children. By reducing airway inflammation and swelling, it improves breathing and helps prevent asthma attacks. It is available as a dry powder inhaler and as a nebulizer suspension for those who have difficulty using inhalers. Budesonide must be used consistently as prescribed, even when symptoms are absent. After each use, rinse your mouth with water to help prevent oral thrush, a common side effect.
$44.99
Budesonide/Formoterol
Symbicort is a prescription combination inhaler used to manage asthma and chronic obstructive pulmonary disease (COPD). It contains a corticosteroid to reduce airway inflammation and a long-acting bronchodilator to relax airway muscles, improving breathing. Used daily as maintenance therapy, Symbicort helps prevent asthma attacks and COPD flare-ups but is not intended for sudden breathing issues. It must be used exactly as prescribed and not for acute shortness of breath—use a rescue inhaler instead. Rinse your mouth with water after each use to help prevent oral thrush.
$159.99
Fluticasone/Salmeterol
Fluticasone propionate and Salmeterol is a prescription inhaler used to manage asthma and chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. It combines a corticosteroid to reduce airway inflammation and a long-acting beta₂-agonist (LABA) to relax airway muscles, helping to prevent wheezing, coughing, and shortness of breath. It is taken regularly, usually twice daily, for long-term symptom control and is not a rescue inhaler.
$86.56
Montelukast
A once-daily tablet that helps prevent asthma symptoms and relieve seasonal allergies.
Video visit required
$8.80
Zafirlukast
Zafirlukast is a prescription medication used for the long-term management of asthma. It belongs to a class of drugs called leukotriene receptor antagonists (LTRAs). These medications help reduce airway inflammation and prevent asthma symptoms. Zafirlukast is not a rescue inhaler and does not provide immediate relief during an asthma attack. Instead, it is taken daily to help prevent symptoms such as wheezing, shortness of breath, chest tightness, and coughing. Although the brand name Accolate® has been discontinued in the United States, generic zafirlukast remains available.
$23.90
Benzonatate
A non-narcotic prescription cough suppressant that numbs the airways to reduce coughing.
Video visit required
$9.39
Asthma medication genuinely splits into two different jobs: stopping an attack already underway and preventing attacks from happening in the first place, and confusing the two is one of the most common sources of poor asthma control in practice. This guide compares what each category of medication actually does and when each one is genuinely used.
Rescue Medication: For an Attack Already Happening
Our conditions page covers asthma broadly, including the five recognized subtypes and how each tends to present; this article focuses specifically on comparing the medication categories once a diagnosis is already in hand, rather than on recognizing the condition in the first place.
A rescue inhaler works within minutes to relax the airway muscles during an active attack, and it is genuinely not meant to be used daily as a substitute for prevention. Albuterol, a short-acting beta agonist, has long been the standard rescue option: it opens the airways fast when symptoms start but does nothing for the underlying inflammation. For that reason, current GINA recommendations no longer advise albuterol-only treatment for adults and adolescents and instead prefer a budesonide/formoterol inhaler as the reliever, since it treats inflammation with every dose. Albuterol remains widely prescribed, typically alongside a daily controller.
How well a rescue inhaler is working, and how often it gets reached for, is itself useful diagnostic information. Someone who needs it rarely, only during a cold or after intense exercise, is in a genuinely different situation than someone reaching for it most days, even if both people carry the exact same prescription in their bag.
Read More: Respiratory Conditions: Symptoms, Causes, Diagnosis, and Treatment
Controller Medication: For Preventing Attacks
Controller medications are usually taken daily regardless of symptoms, and their job is to reduce airway inflammation over time so attacks happen less often in the first place rather than simply reacting once one starts. Needing a rescue inhaler more than twice a week is generally the signal that a controller medication should genuinely be part of the picture, not an occasional add-on reserved for the worst weeks.
This distinction confuses people more than almost anything else in asthma care: a controller medication does nothing noticeable in the moment, since it is not treating a symptom happening right now, and people sometimes stop taking it specifically because it genuinely does not feel like it is doing anything at all. The actual evidence of it working shows up as fewer rescue-inhaler days and fewer attacks over weeks and months of consistent use, not as any immediate sensation the way a rescue inhaler provides.
Budesonide, an inhaled corticosteroid used alone as a daily controller, reduces the airway inflammation that drives asthma attacks over time rather than treating any single episode directly; rinsing the mouth and spitting after each use helps prevent oral thrush and hoarseness
Budesonide/Formoterol, combining that same inhaled steroid with a long-acting bronchodilator, is often used when a steroid alone is not fully controlling symptoms on its own; some regimens use this specific combination both daily and for symptom relief under a prescriber’s direction
Fluticasone/Salmeterol, a comparable combination inhaler pairing a different steroid with a different long-acting bronchodilator, is a reasonable alternative depending on individual response, tolerability, and which formulation a person finds easier to use consistently; unlike budesonide/formoterol, it is used only as a daily controller and should not be used as a rescue inhaler, since salmeterol takes longer to start working
Switching between these two combination options is common and generally straightforward when one is not providing adequate control or causes bothersome side effects, since both work through the same basic two-part mechanism even though the specific molecules involved genuinely differ from each other.
Add-On Options for Specific Triggers
Some asthma medications target a specific trigger pattern rather than serving as a universal daily controller and are genuinely added on top of standard treatment rather than replacing it entirely.
Montelukast, a leukotriene receptor blocker taken as a daily tablet rather than an inhaler, is particularly useful for allergic and exercise-induced asthma, since it works through a pathway distinct from either the rescue or the standard controller inhalers; it carries an FDA boxed warning for neuropsychiatric side effects, including mood changes, sleep disturbances, and suicidal thoughts, so any change in mood or behavior should be reported to a prescriber promptly
Zafirlukast, another leukotriene blocker working through essentially the same mechanism as montelukast, is a reasonable alternative when one is not well tolerated for whatever reason; it is taken twice daily on an empty stomach and has been linked to rare liver injury
Benzonatate, a non-opioid cough suppressant that may ease a persistent cough for short-term comfort; it does not treat asthma itself, since cough-variant asthma is managed with the same inhaled controllers as typical asthma, and it must be stored away from children, since accidental ingestion can be fatal.
Where to Start
If a rescue inhaler is being used more than twice a week, that specific detail is worth naming directly to a prescriber, since it is the clearest practical signal that daily prevention needs to be added or genuinely adjusted, rather than something to mention only if asked directly. If a rescue inhaler is not relieving symptoms, is needed more often than every four hours, or breathing becomes difficult enough to limit speaking, seek emergency care. Bringing an actual count, tracked over the past couple of weeks, gives a much clearer and more useful picture than a general impression of "a lot" or "not too bad."
It is also worth mentioning specifically which category each current medication falls into, rescue, controller, or add-on, since patients are sometimes genuinely unclear on which their own prescriptions actually are, especially when a combination inhaler is doing double duty as both. Knowing the category matters more for day-to-day decisions and troubleshooting than knowing the exact drug name alone ever does.
Our conditions page covers the full symptom and diagnosis picture that this article builds on.
Read More: Respiratory Conditions: Symptoms, Causes, Diagnosis, and Treatment