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Asthma inhalers

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 4 minutes read

Inhalers are designed for you to breathe in medication that reaches the lungs and targets inflammation or constriction. They come in a wide range of devices and modes of delivery. Your doctor will select the right one for you, and consider alternatives if it doesn’t suit you, but it helps to be informed of the different options out there so let’s talk you through it.

First things first, let’s get to grips with terminology. A spacer device is a plastic tube that fits to your inhaler at one end and your mouth at the other, allowing you to get a dose of medicine from your inhaler quickly and simply - medicine given via a spacer gets to your lungs more easily and completely.

Inhalers differ in how they deliver medicine to your lungs. Most inhalers are metered-dose inhalers (MDIs), which give a spray of medicine once you’ve pressed on the canister at the top, and these can be used with a spacer. Breath activated inhalers (BAIs) release a spray of medicine when you start to inhale, rather than pressing on the canister. Dry powder inhalers (DPIs) come as a powder rather than a spray, and you need to breathe in fairly hard to activate the inhaler.

Doctor’s advice

Which is best for me?

Certain factors may influence which inhaler is right for you. Age is one factor – those less than 12 years should use a spacer with their inhaler, which means they are restricted to certain MDIs. However, MDIs may be difficult for elderly people or those with a disability or coordination difficulty, so BAIs or DPIs may be a better choice. BAIs needs a certain strength of respiratory muscle to forcefully breathe in.

Convenience and ease of portability may be a high priority, such as putting your inhaler in your pocket, handbag or sports bag, therefore MDIs and DPIs can be less bulky than some BAIs.

Side effects may be important – higher dose steroids can cause thrush in the mouth, but the chance of this is reduced by using a spacer, which limits you to MDIs.

Your doctor's office may have demonstration inhalers for you to have a look at.

Your reliever inhaler

Everyone with asthma will be prescribed a reliever inhaler. It contains a medicine called albuterol, which is a short-acting bronchodilator. It works to relax and widen the airways, relieving chest tightness, wheezing and shortness of breath. Ventolin and Proventil are common brands of albuterol.

It’s a temporary relief when you need it, and for those with very occasional asthma, this may be all that’s needed. For most with asthma, your preventer inhaler provides ongoing treatment to keep symptoms at bay in the long term.

If you need to use your reliever three times a week or more to ease your symptoms – and you’re using it correctly - then this often means you should be using a preventer inhaler as well. However, if you only have very occasional symptoms (such as in cold weather or after sports for example) then using a reliever inhaler occasionally may be all you need.

Your preventer inhaler – steroid inhalers

Your preventer inhaler has medication to reduce swelling in your airways, but takes one to two weeks to reach full benefit. This is your long-term treatment to keep symptoms and flare-ups at bay.

The name of your inhaler will indicate if it contains a steroid: these include budesonide, mometasone, beclomethasone, fluticasone and ciclesonide. Some common brands are Qvar, Pulmicort, Alvesco, Arnuity, Flovent, and Asmanex.

Non-steroid inhalers and combinations

Long-acting bronchodilators may be added alongside a steroid inhaler. They work in a similar way to your reliever inhaler, but last for up to 12 hours. They can contain either salmeterol, where Serevent is a common brand, or formoterol.

If you need these for the long-term alongside your steroid inhaler, your doctor may switch to an inhaler combining steroids with long-acting bronchodilators. Common brands include Advair, Symbicort, Dulera and Breo.

Whichever inhaler you use, make sure you have learned the correct technique to get the required medication to the right place, and use your inhaler as prescribed on your personalized asthma plan. If this isn’t getting on top of your symptoms, your doctor can make an assessment and tweak the dose or change the type of inhaler.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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