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Understanding Your Asthma: Types, Severity, and What to Do Without an Inhaler
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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.
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Montelukast
A once-daily tablet that helps prevent asthma symptoms and relieve seasonal allergies.
Video visit required
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Benzonatate
A non-narcotic prescription cough suppressant that numbs the airways to reduce coughing.
Video visit required
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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.
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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.
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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.
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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.
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Asthma is not one single condition that looks the same in everyone who has it. Several distinct subtypes exist, severity is measured more precisely than "mild" or "bad," and asthma is often confused with related conditions more than most people realize. This guide covers each in turn, along with one piece of information that must be stated plainly and directly: what to do during an attack if a rescue inhaler isn't available.
The Asthma Subtypes You Might Not Know You Have
Exercise-induced asthma causes airway narrowing triggered specifically by physical activity, usually starting a few minutes in and often worsening after exercise stops rather than during it. Cold, dry air makes it more likely, which is why it shows up more in winter sports than in swimming pools. Albuterol or Montelukast, taken before activity, can prevent it in many people. Montelukast needs to be taken about two hours beforehand and carries an FDA boxed warning for mood and behavior changes, and frequent exercise symptoms usually signal that a daily controller is needed.
Eosinophilic asthma is a distinct inflammatory pattern driven by elevated eosinophils, a type of white blood cell, rather than the more typical allergy-driven inflammation. It tends to develop in adulthood, often runs more severe than average, and in its severe form can remain uncontrolled despite high-dose inhaled steroids, which is where biologic medications targeting eosinophils come in, which is part of why it gets specifically named and tested for rather than treated as generic asthma.
Cough-variant asthma shows up as a persistent, often nighttime cough with little or no wheezing, which makes it genuinely easy to miss or mistake for a lingering cold. Benzonatate can ease the cough itself while the underlying airway inflammation gets treated separately, but it does not treat the asthma driving the cough in the first place. Inhaled controller medication is the actual treatment, and benzonatate must be kept away from children, since accidental ingestion can be fatal.
Read More: Respiratory Conditions: Symptoms, Causes, Diagnosis, and Treatment
Asthma Exacerbations and How Asthma Differs From Related Conditions
An asthma exacerbation is genuinely a real flare-up where symptoms escalate meaningfully beyond someone’s own usual baseline, not simply an ordinary bad day passing through. It typically means increased rescue inhaler use, worsening breathing that genuinely doesn't settle down, and symptoms that don't respond to medication the way they normally would.
Reactive airway disease is not actually a formal diagnosis; it is a placeholder term clinicians sometimes use, especially in young children, when asthma-like symptoms appear, but a confident asthma diagnosis cannot yet be made with real certainty. Many children labeled this way are later diagnosed with asthma once they are old enough for more definitive lung-function testing, though a meaningful share of them are not and outgrow the symptoms entirely instead.
Asthma and COPD both narrow the airways, but the key difference is reversibility: asthma’s airway narrowing typically responds well to medication and can return close to normal between flares, while COPD’s damage is largely permanent and progressive over time. Asthma often starts in childhood without any smoking history at all. COPD is strongly tied to long-term smoking and usually appears later in adult life.
How Severe Is Your Asthma?
The Asthma Control Test is a validated 5-question survey covering symptom frequency, activity limits, nighttime symptoms, rescue inhaler use, and self-rated control over the past 4 weeks. Each question scores 1 to 5, for a total of 5 to 25. A score of 20 or above suggests well-controlled asthma, while 19 or below suggests it may not be, and it's worth bringing it up at your next appointment.
For severe asthma that genuinely does not respond well to standard treatment, the following additional treatment options generally exist to consider.
Budesonide/Formoterol, a higher-dose inhaled steroid and bronchodilator combination
Fluticasone/Salmeterol, another higher-dose combination option
Budesonide, a standalone inhaled steroid
Zafirlukast, an add-on option for allergy-driven or exercise-triggered patterns
Biologic injections exist for the most severe, treatment-resistant cases.
Asthma can qualify as a disability under both the ADA and Social Security, but the bar differs considerably: the ADA’s standard, whether asthma substantially limits a major life activity, is broader and easier to meet than Social Security’s, which additionally requires specific work-history credits and meeting detailed medical criteria in its own respiratory listings.
What to Do During an Asthma Attack Without an Inhaler
There is no substitute for a rescue inhaler during a genuine asthma attack, and nothing in this section is intended as one. If you or someone nearby is having a severe attack and no inhaler is available, call 911 immediately, especially if lips or fingernails look bluish, speaking full sentences becomes difficult, or symptoms keep getting worse rather than better over time.
While waiting for help to arrive, sitting upright rather than lying down, moving away from whatever triggered the attack if possible, and staying as calm as possible with slow, steady breathing can make breathing modestly easier. None of this treats the underlying airway narrowing the way medication does, and none of it is a reason to wait instead of calling for help.
This matters because asthma attacks are genuinely fatal in some cases: more than 3,500 people die from asthma in the United States every year, nearly ten people a day. Most of these deaths are considered preventable with prompt treatment, which is exactly why urgency, not a wait-and-see approach, is the right response without an inhaler on hand.
Where to Start
If a subtype like exercise-induced, eosinophilic, or cough-variant asthma sounds like your own pattern, name it specifically at your next appointment rather than just describing symptoms generally, since each one can genuinely shift what your prescriber considers first. Taking the Asthma Control Test beforehand gives that conversation a concrete number to work from, rather than a vague impression of how things have been going.
If you have never been formally tested and are unsure whether "reactive airway disease" or asthma applies to you specifically, ask directly, since the distinction affects what long-term treatment looks like. Our conditions page covers the full range of asthma medications in one place, including how rescue and controller inhalers are meant to work together.
Read More: Respiratory Conditions: Symptoms, Causes, Diagnosis, and Treatment