Controller medications, like inhaled corticosteroids, work in the background every day to keep lung inflammation down. Even when you feel fine, your lungs may still be irritated.
Rescue medications, like short-acting beta-agonists (SABAs), are used only when symptoms hit hard. They give fast relief, but they don’t stop the problem at its root.
So, when it comes to refills, which one really needs your attention—and why?
| 🔑 Key Takeaways ➤ Controller medications must be refilled regularly because they work quietly every day to keep your lungs calm. ➤ Taking controller medicine every day helps prevent a slow build-up of lung inflammation, even if you feel fine. ➤ Skipping these daily doses can lead to more frequent asthma attacks and worsen your health. ➤ Studies show that children who use their controller medications as directed have better breathing and fewer emergency visits. ➤ Rescue inhalers are used only when you have strong symptoms and are not meant for daily use. ➤ Using rescue inhalers too often is a sign that your asthma may not be well controlled. ➤ Proper use of controller medicine can help reduce the need for rescue inhalers and prevent flare-ups. |
Controller Medications
Controller medications for asthma need regular refills because they are important in controlling airway inflammation—even when symptoms aren’t obvious.
Asthma remains active in the lungs even during times when you feel fine. Without consistent treatment using controller medications, inflammation can quietly build up. This can lead to more frequent asthma attacks and worsen overall health and fitness.
But what happens when people don’t stick to their controller meds? Research has found some concerning patterns. According to a study, children who stopped using their inhaled corticosteroids regularly had poorer asthma control, which could lead to more emergency visits and worse symptoms. Similarly, another study found that children who stayed on inhaled corticosteroids had better growth outcomes and fewer asthma-related complications.
Another review pointed out that controller medications like corticosteroids reduce the number of asthma attacks, improve breathing, and help people live more comfortably. But these benefits only happen when the medicine is taken as prescribed—daily and not just when symptoms pop up.
So, why do refills matter? Without regular use and timely refills, controller medications can’t do their job of preventing inflammation. Skipping doses or stopping completely can make asthma worse. The inflammation that causes asthma doesn’t stop just because symptoms go away.
That’s why inhaled corticosteroids are recommended even for mild persistent asthma—to prevent flare-ups and maintain long-term control.
Rescue Inhaler Refill
Rescue inhaler refill patterns can tell us a lot about a person’s asthma control.
When patients use their short-acting beta₂-agonist (SABA) inhalers too often, it may mean their asthma is not well controlled. According to a study in the large Swedish cohort of the SABINA II study, patients who collected three or more SABA canisters per year faced a greater risk of asthma attacks and even death. Specifically, those who used 3–5 canisters had a 1.26 times higher risk of exacerbations compared to those using two or fewer. That risk kept rising with more use—1.44 times higher for 6–10 canisters and 1.77 times higher for 11 or more.
Another study analyzing UK data under the SABINA I program, also found that patients who used more than three SABA inhalers in a year had more hospital visits and primary care appointments. For instance, high SABA users at treatment step 1 had 1.7 to 2.2 times more asthma flare-ups compared to low users. Hospital visits were also more frequent. At steps 3–5, the rate of hospital visits for high users was 1.19 times higher.
In Latin America, research showed that nearly 40% of patients were prescribed at least three SABA canisters in a year. These patients were more likely to have uncontrolled asthma and experience severe exacerbations. Similarly, one report found that 23.9% of patients were prescribed at least three canisters per year, with nearly half having at least one severe asthma attack in the prior year.
So what do these refill patterns really mean? According to a study, patients who had filled enough inhaled corticosteroids (ICS) prescriptions—making up at least 50% of their total inhaler use—were 90% less likely to use SABAs inappropriately the following year. This shows that proper use of controller medicine like ICS helps prevent the overuse of reliever inhalers.
Still, it’s important to understand that these studies showed associations, not causes. High SABA use is likely a sign of poor asthma control, not the cause of it. Patients who use more SABA often skip or underuse their ICS treatment.
As a result, they don’t manage their inflammation properly, which leads to more symptoms—and more SABA use. This creates a cycle that needs to be broken.
Summary
Controller medications need regular refills because they work quietly in the background to keep airway inflammation under control—even when you feel okay.
Unlike rescue medications, which are taken during an asthma attack, controller meds like inhaled corticosteroids are used daily to prevent flare-ups from happening in the first place. If you skip doses or stop refilling them, inflammation builds up silently, increasing your chances of an asthma attack.
On the other hand, those who stuck to their controller meds had better breathing and even healthier growth. They’re a key part of staying ahead of asthma, keeping your lungs calm, and avoiding those scary emergency visits.
Here’s a quick look at how controller and rescue medications differ when it comes to refills:
| Medication Type | Purpose | Refill Pattern | What It Indicates |
| Controller (e.g., ICS) | Prevents inflammation and flare-ups | Needs regular, consistent refills | Good asthma control and fewer attacks when used daily |
| Rescue (e.g., SABA) | Relieves symptoms during attacks | Overuse means poor asthma control | High refill rates link to more attacks and hospital visits |
Frequently Asked Questions
What’s the difference between a rescue inhaler and a controller inhaler?
Rescue inhalers give fast relief during an asthma attack. Controller inhalers are used every day to help prevent symptoms from happening.
Can I use my rescue inhaler every day?
No, it’s not meant for daily use. If you need it often, talk to your doctor — your asthma may not be under control.
How many puffs of my rescue inhaler is too much?
If you’re using your rescue inhaler more than twice a week, it means your asthma may not be well controlled. Time to talk to your doctor.
Should I use my rescue inhaler before my controller inhaler?
Not unless your doctor tells you to. Using the rescue inhaler first doesn’t improve how your controller works — it may actually lead to overuse.
Sources
Chauhan, B. F., Chartrand, C., Ni Chroinin, M., Milan, S. J., & Ducharme, F. M. (2015). Addition of long-acting beta2-agonists to inhaled corticosteroids for chronic asthma in children. Cochrane Database of Systematic Reviews, 2015(11), CD007949. https://doi.org/10.1002/14651858.CD007949.pub2.
Zhang, L., Prietsch, S. O. M., & Ducharme, F. M. (2014). Inhaled corticosteroids in children with persistent asthma: Effects on growth. Cochrane Database of Systematic Reviews, 2014(7), CD009471. https://doi.org/10.1002/14651858.CD009471.pub2.
Jonas, D. E., Wines, R. C. M., DelMonte, M., Amick, H. R., Wilkins, T. M., Einerson, B. D., Schuler, C. L., Wynia, B. A., & Shilliday, B. B. (2011). Drug class review: Controller medications for asthma: Final update 1 report [Internet]. Oregon Health & Science University. https://www.ncbi.nlm.nih.gov/books/NBK56695/