Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Controller Asthma Medications

First Line Controllers

Corticosteroids (Inhaled)

  • Inhaled route is the preferred method of delivery.
  • Inhaled steroids are recommended as the mainstay of treatment for persistent asthma in children, except for those whose disease is so mild that they only require infrequent, as-needed ß2-agonist treatment (Boulet et al., 2001).

Corticosteroids (Systemic)

  • Used in short bursts for asthma exacerbations.
  • Used longer term for severe persistent asthma not responding to usual first line therapy.
  • Less side effects with low dose alternate day dosing (Murray & Nadel, 2000)

Second Line Cntrollers

Leukiotriene Antagonists

  • Are used in conjunction with inhaled corticosteroids and are not to be used as first line medication for asthma in children (Ducharme & Hicks, 2000).

 Long-Acting ß2-agonists (LABA)

  • When additional therapy is required, long-acting ß2-agonists (salmeterol and formoterol) are the primary choice, versus theophylline or ipratropium bromide (Boulet et al., 1999).
  • LABA’s assist corticosteroids in achieving and maintaining asthma control and are not recommended for use in the absence of inhaled anti-inflammatory therapy.

Third Line Controllers


  • No evidence that aminophylline is of benefit for mild to moderate asthma and side effects are common (Boulet et al., 1999).
  • May have steroid sparing effects.
  • Therapy should only be attempted in children with severe or steroid dependent asthma.
  • Serum levels need to be monitored regularly.

Sodium Cromoglycate/Nedocromil

  • Non-steroidal anti-inflammatory controller medications that have an inconvenient dosing frequency.
  • Sodium cromoglycate is ineffective in children (Tasche, Uijen, Bernsen, de Jongste & van Der Wouden, 2000).
  • Nedocromil is of benefit in 5-12 year olds (Spooner, Saunders & Rowe, 2000).

Teaching Tips for Nurses:

  • Emphasize to parents that inhaled corticosteroids need to be taken on a regular/daily basis long-term to be effective, even when the child seems well.
  • Advise children/parents that controller medication should not be decreased or stopped unless advised by a physician.