What are the names of preventer drugs?

The medications prescribed to prevent asthma symptoms and control underlying airway inflammation are generally referred to as preventers or controllers. These drugs are fundamental to managing asthma because they address the root cause—chronic inflammation and airway hypersensitivity—rather than just treating the immediate attack. ^[3][10] Unlike the fast-acting relievers used for acute symptoms, preventers must be taken regularly, often daily, even when an individual feels perfectly well, to maintain control and lower the risk of future exacerbations. ^[3][4] Understanding the names associated with these preventer drugs means exploring several key classes of medication.

# Corticosteroid Names

The cornerstone of long-term asthma control lies with Inhaled Corticosteroids (ICS). ^[1][7] These medications are favoured because they are highly effective at reducing inflammation and swelling within the airways, often requiring much smaller doses when delivered directly to the lungs compared to oral steroids. ^[1][5] Several generic names fall under this category, with various brand names associated with their delivery devices:

• Beclomethasone (sometimes listed as Beclomethasone Dipropionate): This generic is found in products like `Qvar RediHaler` and `Clenil Modulite`. ^[6][9][4]
• Budesonide: A very common agent available in devices such as `Pulmicort Flexhaler` and the nebulised `Pulmicort Respules`. ^[6][7][5]
• Ciclesonide: This medication is available under the brand name `Alvesco` Inhalation Aerosol. ^[6][7][5]
• Fluticasone: This compound appears in several forms, including Fluticasone Propionate and Fluticasone Furoate. Generic propionate versions come as `Flovent HFA`, `Flovent Diskus`, and `Flovent Rotadisk`. ^[5][6] The furoate version is seen in `Arnuity Ellipta`. ^[6][7]
• Mometasone: Names associated with this ICS include `Asmanex Twisthaler` and `Asmanex HFA`. ^[6][7]
• Flunisolide: Mentioned as an ICS available in products like `Aerospan`. ^[8]
• Triamcinolone: Listed as a systemic glucocorticoid for asthma treatment. ^[6]

It is worth noting that ICS potency can vary significantly between these formulations. For instance, one review highlighted that a particular Fluticasone HFA strength was the weakest available, which dictates how a physician might structure the dosing schedule—often requiring twice-daily administration for many of these single-ingredient inhalers to achieve consistent inflammation control. ^[6][9]

# Combination Inhalers

To simplify treatment and often improve effectiveness, ICS drugs are frequently paired with other medications, most notably Long-Acting Beta Agonists (LABAs), which are bronchodilators that keep the airways open for extended periods. ^[1][3] Note that LABAs should not be used alone for asthma; they must be combined with a corticosteroid. ^[3]

A wide variety of brand names exist for these dual-therapy preventers:

• Fluticasone/Salmeterol: This pairing is widely known under the brand name `Advair` (Diskus, HFA). ^[6][7] A generic formulation is also available as `Wixela Inhub`. ^[7][9]
• Budesonide/Formoterol: This combination is marketed as `Symbicort` and is also available as the generic `Breyna`. It is noteworthy because it is sometimes used as a Single Maintenance and Reliever Therapy (SMART), which is a specialized approach discussed later. ^[6][7][4]
• Fluticasone Furoate/Vilanterol: This formulation is sold as `Breo Ellipta`. ^[6][7]
• Mometasone/Formoterol: This combination is available as `Dulera`. ^[6][7]

For patients requiring even greater control, triple therapy inhalers incorporate an ICS, a LABA, and a Long-Acting Muscarinic Antagonist (LAMA). Examples of these complex preventers include `Trelegy Ellipta` (containing Fluticasone Furoate, Umeclidinium, and Vilanterol) and `Breztri Aerosphere`. ^[6][7][2] The complexity of these devices means that while the drug names are numerous, the benefit often comes from having three different mechanisms of action in a single daily puff, potentially aiding adherence compared to managing three separate inhalers. ^[3]

# Non-Steroidal Types

While inhaled steroids are primary, other classes of medications work through different pathways to prevent symptoms, sometimes prescribed alongside ICS or for patients who cannot tolerate steroids well. ^[1][8]

Leukotriene Modifiers are a key alternative group. These medications work by blocking the action of leukotrienes, which are chemicals released by the body that contribute to asthma symptoms. ^[1][2] They typically come in tablet form:

• Montelukast: The most recognized leukotriene modifier, marketed as `Singulair`. ^[2][7][8]
• Zafirlukast: Sold under the brand name `Accolate`. ^[2][7]
• Zileuton: Available as `Zyflo`. ^[2][7]

It is important to note that leukotriene modifiers, particularly montelukast, carry warnings regarding potential serious psychological side effects, such as depression or suicidal thinking, which requires careful discussion with a healthcare provider. ^[1][10]

Long-Acting Muscarinic Antagonists (LAMAs), such as `Spiriva Respimat` (Tiotropium), are also used as controllers, often added to an ICS or an ICS/LABA combination when asthma remains uncontrolled. ^[1][3]

When considering the delivery method itself, a practical distinction emerges in how patients use these drugs daily. For instance, while many ICS/LABA combinations like `Advair` require a spacer for optimal delivery if the patient uses a Metered Dose Inhaler (MDI), many newer dry powder inhaler systems (like the Ellipta or Turbuhaler used for `Symbicort` or `Breo Ellipta`) do not require a spacer. ^[4][9] This device dependency is a small but significant factor in patient adherence; a patient who forgets or dislikes using a spacer might find a breath-actuated dry powder device preferable for ensuring the medication actually reaches the lower airways, regardless of the underlying chemical name of the preventer. ^[9]

# Injectable Biologics

For individuals with severe, treatment-refractory asthma, management shifts toward specialized Biologic injections. ^[1][7] These are not standard daily inhalers but targeted therapies designed to interfere with specific underlying biological drivers of inflammation, such as IgE antibodies or eosinophils. ^[1]

Specific biologic names include:

• Targeting Allergic Asthma (IgE): `Omalizumab` (brand name `Xolair`). ^[1][2][7]
• Targeting Eosinophilic Inflammation: This group includes `Benralizumab` (`Fasenra`), `Mepolizumab` (`Nucala`), `Dupilumab` (`Dupixent`), and `Reslizumab` (`Cinqair`). ^[1][2][7]
• Broad Target: `Tezepelumab-ekko` (`Tezspire`) is a newer option that reduces certain kinds of inflammatory cytokines. ^[1][2]

These powerful treatments are reserved for specific patient profiles, often requiring blood work to determine the best fit, and they are always used in conjunction with standard controller medications. ^[1]

# Maintenance Reliever Therapy

A newer protocol gaining traction, particularly for patients with moderate-to-severe asthma, is Single Maintenance And Reliever Therapy (SMART), also called Maintenance and Reliever Therapy (MART). ^[4][7][10] This approach centers around a specific combination inhaler that contains an ICS and the fast-acting LABA formoterol.

The key names here are the products that are approved for this dual role:

• Budesonide/Formoterol (e.g., `Symbicort` or `DuoResp Spiromax`). ^[4][10]

With SMART, the patient uses the inhaler as a daily preventer, but they also use the same inhaler whenever they need quick relief. This eliminates the need for a separate blue reliever inhaler, streamlining the daily routine. The formoterol component acts quickly like a rescue bronchodilator, while the budesonide acts as the long-term anti-inflammatory agent. ^[10][4] An interesting operational insight is that while this simplifies the medication list, it requires a significant shift in patient behaviour: the patient must remember to use their reliever as frequently as needed, which may reveal that their underlying asthma is not adequately controlled if they are reaching for it too often. ^[4][10] If a patient is relying heavily on their SMART inhaler as a reliever, it signals to the physician that the maintenance dose needs to be increased, even if the symptoms seem mild.

In summary, the names of preventer drugs span a wide spectrum, from the foundational inhaled corticosteroids like fluticasone and budesonide, to non-steroidal tablets like montelukast, to complex triple-therapy combinations, and finally to highly specialized injectable biologics like Nucala and Xolair. The choice of which specific medication name appears on a prescription depends entirely on the severity, type of inflammation, and the patient's ability to adhere to a complex regimen. ^[1][4]