Add-On Asthma Medicines: The Third Inhaler, the Pill, and What Your Care Team Weighs

Sometimes the daily inhaler and the one-inhaler plan aren't quite enough on their own. When that happens, your care team has a few more tools. Here's what they are, in plain terms — including one pill you should know a little more about.

A third kind of inhaler

If your asthma needs more help, one option is adding a different kind of inhaler that relaxes the airway muscles in a way your other inhalers don't. Used together with your daily controller, it can help you breathe easier and cut down on flare-ups. Some people end up on a combination that puts a few of these medicines into a single inhaler — your care team will keep it as simple as they can.

The key point: this is an add-on, not a replacement. You keep taking your daily controller. More tools working together, not swapping one for another.

The pill — and an FDA warning worth understanding

There's also an asthma medicine that comes as a pill instead of an inhaler, called montelukast (you may know the brand name Singulair). For some people — especially anyone who struggles with inhalers — a once-a-day pill is easier to stick with.

But here's something you should know. In March 2020, the FDA added its strongest type of warning (a "boxed warning") to montelukast. The warning is about mood and behavior changes in some people who take it — things like feeling agitated, depressed, anxious, having trouble sleeping, or, in serious cases, thoughts of self-harm.

This does not mean the medicine was taken off the market, and it doesn't mean it's wrong for you. Plenty of people take it safely. It means it's now a decision your care team makes carefully with you, weighing how much it helps against that risk.

What matters most for you to know:

If you or a family member is on montelukast, watch for changes in mood, sleep, or behavior — in yourself or in a child taking it.

If you notice something, tell your care team. Don't wait for the next scheduled visit if it's serious.

Never just stop it on your own. Stopping an asthma medicine suddenly can let your asthma flare. Always make the change with your care team.

What your care team is weighing

You don't have to sort out which add-on is right — that's their job. But it helps to know how they think about it. They're balancing how much a medicine helps against its downsides, how easy it is for you to actually take, and what else is going on with your health. That's why they ask so many questions.

And this is the part where you make the biggest difference: be honest about the parts that are hard. Missing doses? Worried about a side effect? Cost getting in the way? Say so.

Your care team may even check your pharmacy refill records — not to catch you out, but because it's one of the simplest honest signals of how a plan is really going. There's no judgment here. Most people miss doses. What they can't do is fix a problem they don't know about. A quick, honest conversation almost always beats quietly going off a medicine.

Test your knowledge

1. Which asthma medicine is a pill that carries an FDA warning about mood and behavior changes? a) Montelukast. b) Your rescue inhaler. c) The daily steroid inhaler.

2. If you notice a mood or behavior change on montelukast, what should you do? a) Stop it right away on your own. b) Tell your care team. c) Ignore it.

3. When your care team adds a third medicine, what happens to your daily controller inhaler? a) You stop it. b) You keep taking it — the new one is an add-on. c) You only use it during flare-ups.

Answers

1. a. Montelukast (brand name Singulair) is a once-a-day pill. In March 2020 the FDA added its strongest warning about possible mood and behavior changes.

2. b. Tell your care team — and if it's serious, don't wait. But never just stop an asthma medicine on your own, because that can let your asthma flare. Make the change together.

3. b. Add-ons work alongside your daily controller. You keep the controller going; the new medicine is extra help, not a swap.

This article is for education only and isn't a substitute for medical care. Questions about your situation? Call the office — we're happy to help.