How often to use inhaler?

Asthma: How to Use an Inhaler (for Children)

Whether your child is an infant or a teenager, an inhaler can be a vital part of the program for keeping his asthma under control. There are two main types of asthma medications: the first type is used regularly to prevent attacks by delivering anti-inflammatory drugs (it’s known as a controller); the other, called a bronchodilator, is used to open airways when an attack is under way (it’s known as a reliever). Both of these types of medication can be delivered using an MDI (Metered Dose Inhaler), often called a puffer, which has an advantage in that medication is delivered directly into the lungs.

The style of inhaler your child uses depends on his age. Your child’s doctor will explain how to operate it, but here are a few basic tips for different age groups:

Infants and Toddlers

Up to age 3, children generally use what’s known as a nebulizer. This requires a machine that breaks liquid medication into very small particles so that they can be inhaled. The nebulizer can be used with a mouthpiece or with a mask (for small children a mask is preferable). The nebulizer gives continuous medication (more than one type of medication can be mixed together), and works best in children less than 3 years old and for older children who are having an acute asthmatic attack and cannot use an MDI.

Medication for use in a nebulizer comes in two forms. In one method, the exact dose of medication to be added to the “cup” of the nebulizer is available in unit dose vials. In the other, large bottles of medication generally come with a calibrated dropper so that you can place the correct amount of liquid in the nebulizer. Your doctor will tell you the correct amount of medication to use and the number of times a day your child should use each medication. (He or she will also give you information about how to use the nebulizer if your child has an asthma attack.)

Start by adding the correct medication(s) to the nebulizer cup. Connect the tubing to the machine and then turn it on. Place the mask over your child’s nose and mouth and make sure that it is comfortable (this may take some time to get used to). Your child need only breath normally until all of the medication is removed from the nebulizer cup.

Some children under the age of 4 may be trained to use a Metered Dose Inhaler, although this is uncommon. The best method is to use a spacer with a mask (Aerochamber with a mask is one type). Start by placing the canister bottom up in the plastic holder, then removing the cap from the inhaler. Shake the canister before each dose (this is important). Reassure your child so he doesn’t feel scared, then place the mask over his mouth and nose, making sure it’s sealed tight. (If your child seems anxious, you might demonstrate on yourself first.) Release a puff of medicine by pressing down on the canister. Hold the mask in place until your child has taken at least six breaths.

Ages 4 to 8

Your youngster may no longer need a mask, although some 4-year-olds will still need it. However, all children should use an MDI with a spacer for best results. (Your doctor or health care professional can show you the different types and suggest one best suited for your child.) Children in this age group use the canister and plastic holder in the same way as described above. Have your child put his lips snugly around the mouthpiece of the spacer, with his teeth apart and his tongue out of the way. Activate the MDI, then ask him to breathe in slowly and deeply, and then hold this breath in his lungs for five to 10 seconds. Exhale, and then, with the mouthpiece still in place, have him breathe in deeply and hold his breath again to get the full benefit of the medicine.

Over Age 8

Your child can use either a standard metered-dose inhaler or a dry powder inhaler. Doctors recommend using a canister and spacer as described above, but your child can also try simply holding the inhaler one to two inches from his open mouth. (If he has trouble using it this way, he can also try putting the inhaler directly in his mouth with the lips open.) As he presses down on the canister to release the medicine, he should start breathing slowly, taking several seconds to inhale, then hold his breath for 10 seconds.

To use a dry powder inhaler, your child should simply put his mouth around the mouthpiece and inhale quickly and deeply. Many children and their parents prefer this type of inhaler, and a study published in the Journal of Allergy and Clinical Immunology found that almost all children over age 8 quickly learn how to use it.

National Library of Medicine. Inhaler Medication Administration.

American Lung Association. Five Asthma Medication Groups.

Cincinnati Children’s Hospital Medical Center. Metered-Dose Inhaler.

Health Info

Albuterol is a medication that is used as a bronchodilator — it opens up tight airway passages by relaxing the muscle that surrounds the airways. Albuterol is used most commonly for asthma, but it is sometimes prescribed for other conditions too.

How long will my child need the albuterol?

In general, your child may need some albuterol as long as the wheezing trigger lasts. For illnesses that run their course (like bad colds), it may take about a week. On the other hand, if your child is frequently exposed to things that cause wheezing (like cigarette smoke or animal dander), it may seem like he or she always needs albuterol. (In that case, the best thing to do is to get rid of the allergic trigger!)

How often should I use albuterol?

In general, a dose of albuterol (either 2 puffs from an inhaler or one breathing treatment) may be given every four to six hours as needed. Give it for dry, hacking cough (especially nighttime cough), wheezing you can hear, or if your child is working harder to breathe. Unlike some other medicines, albuterol is safe to use occasionally on an as-needed basis. It can be started when there is a need for acute relief, tapered as the child improves, and stopped when he is better. However, if your child seems to need it very frequently for more than a day or two, doesn’t seem to be getting better with it, or seems to have frequent wheezing spells, he or she may need other medications and should be checked again in the office.

Remember, albuterol only helps one cause of cough: tight airways. It won’t help other kinds of coughs, like coughing from nasal drainage from a bad cold.

What side effects does albuterol have?

Most kids do well with it, but the most common side effects are rapid heartbeat, flushing, and jitteriness. In some kids, the jitteriness becomes hyperactivity! In most kids, these side effects wear off, or at least are much less bothersome, after about 10-15 minutes. If your child experiences side effects that are bad enough that you don’t want to give him or her albuterol, please let us know.

Should my child get albuterol through an inhaler or a nebulizer machine?

In general, inhalers (with spacers and masks) work better in most situations than nebulizer machines. They are also more convenient, since it only takes a minute to administer a few puffs from an inhaler (while it can take 10-15 minutes to give a breathing treatment.) Occasionally, there are some circumstances in which breathing treatments may work better, however. If you are not sure which method is best for your child, or need a demo on how to use one or both devices properly, ask us.

Does this mean my child has asthma?

Not every child who wheezes has asthma.

Many infants and toddlers wheeze with bad colds and other respiratory viruses but never wheeze again after they get to school-age. Other children who do have asthma start having wheezing spells as infants, and although it improves as they get older, they continue to have flare-ups from time to time as older kids. Because of this, we generally won’t diagnose asthma just based on one or two wheezing episodes in a baby or toddler.

Kids with true asthma tend to have other allergic symptoms (like eczema, food allergies, and allergic rhinitis) and family members with asthma. They tend to have persistent coughs, even when they don’t have cold or other illnesses. Learn more about asthma here.

What about liquid albuterol (by mouth)?

Albuterol also comes in a liquid form that can be taken by mouth, and a few doctors still use this for wheezing in babies. However, studies show it doesn’t give nearly as much relief as inhaled albuterol, so most pediatricians don’t use it anymore. Also, oral liquid albuterol tends to have more bothersome side effects than the inhaled method.

What about Xopenex?

Xopenex is the brand name of a kind of albuterol which is more concentrated than regular albuterol. There are a few studies which show its side effects may be slightly less bothersome than regular albuterol. However, it’s also about ten times as expensive as regular albuterol, which seems to work just as well for symptom relief in almost all kids.

Reliever inhalers

  • How do reliever inhalers help asthma?
  • Who needs a reliever inhaler?
  • Is a reliever inhaler all you need?
  • How does my reliever inhaler work alongside my preventer inhaler?
  • What kinds of reliever inhalers are there?
  • When do I need to take my reliever inhaler?
  • What are the possible side effects of reliever inhalers?
  • Keeping an eye on reliever prescriptions

How do reliever inhalers help asthma?

When you have an asthma attack your blue reliever inhaler gets the medicine straight to your lungs, so it can quickly relax the muscles surrounding your airways. The airways can then open more widely, making it easier to breathe again. You should feel a difference to your breathing within a few minutes.

Who needs a reliever inhaler?

Anyone diagnosed with asthma will be prescribed a reliever inhaler, including children under five with suspected asthma. This is to make sure you can relieve asthma symptoms quickly when they come on.

Is a reliever inhaler all you need?

If you only have very mild symptoms, for example if you come into contact with a known trigger, your GP may prescribe you just a reliever inhaler to use when you get symptoms.

But if you notice you’re using your reliever inhaler three or more times a week, or you’re getting symptoms most weeks, go back to your GP or asthma nurse to talk about getting a preventer inhaler too.

“There are a very few people who only need to be prescribed just a reliever inhaler for when they get symptoms. Most people with asthma benefit from a regular preventer inhaler taken every day to prevent symptoms coming on.” Dr Andy Whittamore, Asthma UK’s in-house GP.

Questions about your reliever inhaler? Call our friendly asthma nurses on 0300 222 5800 (Mon – Fri; (9am – 5pm) for advice.

How does my reliever inhaler work alongside my preventer inhaler?

Your reliever inhaler and preventer inhaler work alongside each other to help reduce your risk of asthma attacks.

  • A reliever inhaler treats asthma symptoms quickly so you’re less likely to have an asthma attack. And if you do have an asthma attack your reliever inhaler can come to the rescue.
  • A preventer inhaler is for every day. It works in the background to calm down the inflammation and sensitivity in your airways. If you take your preventer inhaler every day as prescribed, you’re less likely to react to triggers and get asthma symptoms. And you’ll be less at risk of an asthma attack.

If you need to use your reliever inhaler three times a week or more, it’s a sign your asthma isn’t well managed. You should see your GP or asthma nurse urgently for an asthma review.

They may need to change your medicine or check your inhaler technique to make sure you’re getting the full benefits from your preventer inhaler.

What kinds of reliever inhalers are there?

Usually blue, short-acting reliever inhalers contain medicine that relaxes the airways and makes it easier for you to breathe. For example:

  • Metered dose inhalers (MDIs) give the medicine in a spray form (aerosol), for example Ventolin, Airomir and Salamol.
  • Breath actuated inhalers (BAIs), such as Easi-breathe, Airmax, and Autohaler, automatically release a spray of medicine when you begin to inhale.
  • Dry powder inhalers (DPIs), such as Accuhaler, give the medicine in a dry powder instead of a spray.

Whatever inhaler you’re prescribed, you need to know how to use it in the best way. Good inhaler technique gets the right dose of asthma medicine into the lungs.

To make it easier to get the best from your asthma medicine, MDI aerosol inhalers can be used with a spacer.

When do I need to take my reliever inhaler?

Use your reliever inhaler as soon as you notice asthma symptoms. It can help get your asthma back under control and prevent an asthma attack.

Your written asthma action plan will remind you what symptoms to look out for and when you need to use your reliever inhaler.

If your asthma is triggered by exercise your GP or asthma nurse may suggest you take your reliever inhaler 20 minutes before you start exercising. This can prevent symptoms coming on.

If exercise often triggers symptoms for you though, it’s worth making an appointment to have an asthma review. Asthma symptoms brought on by any kind of exercise can be a sign that your asthma is not well managed.

If you need to take your reliever three or more times a week it could be a sign that your asthma isn’t well controlled. Your GP or asthma nurse can review your asthma treatments.

Get the best from your reliever inhaler

  • Keep your reliever inhaler with you at all times, so it’s there when you need it. If your child is at nursery or school you should leave a spare inhaler there in case your child needs it. It’s helpful for the school to keep your child’s spare inhaler in its original box.
  • If you’ve got an MDI inhaler use it with a spacer to make sure your medicine is getting where it needs to. Using a spacer also cuts side effects.
  • Make sure your reliever is in date. If your asthma is well managed, you may not be using your reliever much. The medicine could go out of date so check the expiry date. You can find it on the bottom of the box, or on the side of the cannister.
  • Make sure there’s enough medicine left in your reliever especially when you’re going away on holiday or over the Christmas holidays when your GP surgery is closed. Some inhalers have indicators on the side to tell you how much medicine is left. But shaking the inhaler, or the canister inside, can also give you an idea of how much there is inside.
  • Use your reliever as an early warning system. If you notice you’re using your reliever inhaler three or more times a week, it’s a sign that your asthma is not well controlled. Ask your GP or asthma nurse to review your asthma and the medicines you’re taking for it. If you haven’t got a preventer inhaler yet, it could be that you need one. A preventer inhaler will help prevent symptoms starting in the first place.
  • Know when to call 999. If you’re having asthma symptoms and your reliever inhaler isn’t helping, you’re probably having an asthma attack. Your asthma action plan will remind you what you need to do to get your symptoms under control. But if nothing’s helping and you’re still not feeling any better you need to call 999 urgently. An asthma attack is an emergency.
  • Have your inhaler technique checked by your GP or asthma nurse. Using the correct inhaler technique will help get the asthma medicine straight into your lungs where it’s needed. Ask your GP or asthma nurse to show you the best way to take your inhaler at each asthma review.
  • Always keep the cap on your reliever when you’re not using it. Small objects could get stuck in the mouthpiece if you don’t put the cap on – especially if you carry your inhaler in your bag. This is dangerous because you could end up inhaling them when you next come to use your inhaler.
  • Store your reliever inhaler at the right temperature. Extreme temperatures and high altitudes can affect the medicine in your reliever inhaler. Check the label on your inhaler for storage instructions, or speak to your GP or asthma nurse for advice. You can also call our Helpline on 0300 222 5800 (Mon-Fri, 9am-5pm) if you have any questions on using and storing your reliever inhaler.

What are the possible side effects of reliever inhalers?

Relievers are a safe and effective medicine and have very few side effects. Some people have these side effects after taking a few puffs of their reliever inhaler:

  • Their heart beats faster for a short while
  • Their muscles shake slightly

These usually pass within a few minutes or a few hours at most and are not dangerous.

The best way to avoid these side effects is to have your asthma reviewed regularly so that your GP or asthma nurse can make sure you’re doing all you can to prevent asthma symptoms in the first place.

If you’re worried about your child taking asthma medicines, our page answers all your common concerns.

You can also call our Helpline on 0300 222 5800 to speak to one of our asthma nurses or send them an email.

If you’re using your reliever inhaler a lot

If you usually take your reliever inhaler three or more times a week you’re only dealing with your immediate asthma symptoms. What your reliever can’t do is deal with the underlying inflammation that’s causing them. This means that your airways are less able to cope with asthma triggers and you’re at a much higher risk of an asthma attack.

Also, using your reliever inhaler regularly could mean that your body starts to get used to the reliever medicine and you need higher doses for it to work.

If you stick to a good routine of taking your preventer inhaler every day, even when you’re feeling well, you won’t need to use your reliever inhaler so much. This is because your preventer inhaler stops symptoms coming on in the first place.

Keeping an eye on reliever prescriptions

If you think you’ve collected more than 12 prescriptions for your reliever inhaler in a year (or you get through more than one inhaler in a month) see your GP or asthma nurse. It could be that your asthma’s not well managed and you’re at higher risk of an asthma attack.

Of course what really counts is how many reliever inhalers you’re using – you may have collected your prescriptions (especially if you’ve got a repeat prescription) but not used them.

Some people get more reliever inhalers to have as spares, perhaps to keep in the car, or at school or work but are not necessarily using them.

If you can’t remember how many reliever prescriptions you’ve collected, and are worried about your risk, the key question to ask yourself is: am I using my reliever inhaler three or more times a week?

If you are, your asthma isn’t well managed and you need to see your GP or asthma nurse to review your treatment.

Long-acting reliever inhalers

If you have a preventer inhaler and are using it in the right way as prescribed, but you’re still having asthma symptoms, you might also need a long-acting reliever inhaler. It’s really important to understand that you need to use your long-acting reliever inhaler alongside a preventer, never on its own.

Last reviewed January 2018

Next review due January 2021

What Not to Do With Your Asthma Inhaler

What Not to Do With Your Inhaler

When it comes to asthma inhaler mistakes, improper technique tops the list. Following Shah’s tips, including using a spacer, often helps. You might also be making a mistake if you use the inhaler too often. “When using a rescue inhaler, two to four puffs should be sufficient,” Shah says. “If you find you need more than four puffs, it might be a good idea to consult a doctor.” You may have to adjust your treatment plan.

This advice also applies to relief inhalers.. Relief inhalers are for occasional use to stave off acute asthma attacks. “Using a relief inhaler more than two days a week because you need it means you need to be on a prophylactic inhaler in addition to a relief inhaler,” explains Dr. Rubin.

Other asthma inhaler tips really come down to common sense, such as keeping your inhaler in a safe place away from pets and children — and where it won’t get damaged. There are no restrictions about inhalers when it comes to food and alcohol, and there’s also no risk due to pressure changes on an airplane. Just use basic medication precautions when traveling to avoid security delays at airports. “If you have to take your asthma inhaler on a plane, make sure it is well-labeled and carry the original box or prescription with it,” suggests Shah.

Ventolin, Proair and Proventil are the albuterol inhalers commonly prescribed for people with asthma, reactive airway disease, or even for a persistent cough after an upper respiratory infection. Albuterol inhalers relax the muscles in the wall of the airways to improve wheezing and cough. Whether you’re prescribed a nebulizer or metered dose inhaler (MDI), albuterol is generally well tolerated—yet the same minor side effects are reported over and over again. So what can you expect to feel after using an albuterol inhaler?

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  1. Tremor, especially of the hands, is the most frequent side effect occurring in 5% – 38% of people using these inhalers. Interestingly, the frequency increases with age. This will diminish quickly as your response to the drug peaks.
  2. Increased heart rate and palpitations may occur if you are using your inhaler frequently. The use of a spacer or chamber device reduces the chance of the “racing heart” side effect by reducing the amount of medication that deposits in your mouth. Xopenex (levalbuterol) is similar to albuterol but has less effect on your heart rate—so if you are experiencing heart symptoms from your albuterol inhaler let your doctor know. Be aware that Xopenex is slightly pricier.
  3. Dry mouth is another common symptom reported with the use of an albuterol inhaler. For short-term relief of dry mouth, over the counter products like Biotene may help.
  4. Excitement is more common in children and adolescents 2 to 14 years, yet is still reported in as many as 1 in 5 adult albuterol users.
  5. Nervousness is reported in 4 – 15% of Ventolin, Proair, or Proventil users, but it should quickly resolve.
  6. Worsening asthma/bronchospasm. Wait, an inhaler designed to help your asthma may make symptoms worse? Yes, in 11 – 13% of folks, worsening symptoms of tight airways/asthma may occur. It’s called “paradoxical bronchoconstriction.” If you feel more wheezing, tightness, or shortness of breath after using albuterol, stop using it and speak to your doctor.
  7. Sore throat (pharyngitis). Pain and irritation of the throat is another symptom that as many as 14% of folks experience after the use of albuterol inhalers.
  8. Upper respiratory tract infection. This also seems odd, but up to 20% of adults using albuterol inhalers report upper respiratory tract infections as a result of their inhaler.
  9. Runny nose (rhinitis) is reported in 5 – 16% of those using albuterol inhalers.
  10. Nausea. More commonly reported in frequent albuterol inhaler users (with doses taken every 4 hours), the symptom of nausea occurs in 1 in 10 folks.

What have you noticed?

Dr O.

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  • 7 Ways People Misuse Their Inhalers

    Are you using your asthma inhaler the right way? I mean, how hard can it be, right?!

    I’m at the airport waiting for my flight, and I watched the woman across from me start to cough violently and then use her inhaler. My husband leaned over and said, “She didn’t use that right. She doesn’t have a spacer.” I answered, “And she didn’t wait one minute between puffs!”

    As a Certified Asthma Educator (AE-C), should I have approached her and corrected her technique? Well, some people are Happy Travelers and some… aren’t. And some people don’t like others telling them what to do. So I’ll share a little info here. These are the Top 7 Mistakes I see when I work with families.

    1. Not checking the opening of the inhaler for debris.

    Depending on where you keep your asthma inhaler, the opening can collect all sorts of things – dimes, lint, crumbs, etc. Always check the opening! I heard of a woman who pulled her inhaler out of her purse, didn’t check the opening and inhaled a dime that was stuck in the inhaler. I have a family member who keeps his inhaler in his pocket and he inhaled – you guessed it – lint.

    2. Not priming your inhaler

    If you drop your inhaler, or it hasn’t been used in 2 weeks, you must prime it. This varies by brand, but most manufacturers recommend priming your inhaler by spraying the inhaler 1-4 puffs BEFORE you use it. You may need to look up your brand of inhaler and see how many puffs you need to spray to prime it. This makes sure you get the right amount of medication.

    3. Not shaking your inhaler before use

    You must shake your inhaler to mix the medicine and propellant. Kind of like how you shake up a can of spray paint before you use it.

    4. Not exhaling BEFORE your use your inhaler

    You need to breathe out first so there’s room in your lungs to take a nice deep breath and inhale all that lovely medicine.

    5. Not using a spacer/holding chamber

    Best practice recommends using a spacer (tube-like device) that attaches to your asthma inhaler. You spray your inhaler into the spacer/holding chamber which will “hold” the medicine until you breathe it in. It can be easier for people that can’t coordinate when to spray the inhaler and when to breathe in. (I have no coordination – in fact, I can hardly chew gum and walk at the same time! So I use a spacer.)

    NOTE: If you don’t use a spacer, you may need to use a different inhaler technique. You would start to breathe in FIRST (with the inhaler in your mouth and lips closed around it) and THEN press down on the inhaler. Since you are already breathing in, it’s easier to pull the medicine down into your lungs. If you spray it and then try to breathe in, most of the medicine can end up in the back of your throat.

    6. Wait one minute between puffs

    A pharmacist told me there are a couple of reasons why. The 1st puff will go about halfway through the lungs and stop. (Your lungs branch out 28 times – like tree branches – so the medicine has a long way to go.) Since the 1st puff has cleared a path, that makes it easier for the 2nd puff to quickly travel through the first part of lungs, then plow through to the end of the lungs. The other reason is that it gives the propellant and medicine time to swirl around and mix.

    7. Not rinsing your mouth after you use your controller inhaler

    Have you ever heard of thrush? It’s an uncomfortable fungal infection on the tongue. Your tongue can turn white and can get red spots on it which can bleed. Food may also taste a little “off.” Controller inhalers are made with a yeast base, so if you don’t rinse your mouth out, you can get thrush.

    Good technique is so important to make sure you are getting ALL of the medicine you need!

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    Ventolin HFA

    SIDE EFFECTS

    Use of VENTOLIN HFA may be associated with the following:

    • Paradoxical bronchospasm
    • Cardiovascular effects
    • Immediate hypersensitivity reactions
    • Hypokalemia

    Clinical Trials Experience

    Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.

    The safety data described below reflects exposure to VENTOLIN HFA in 248 subjects treated with VENTOLIN HFA in 3 placebo-controlled clinical trials of 2 to 12 weeks’ duration. The data from adults and adolescents is based upon 2 clinical trials in which 202 subjects with asthma aged 12 years and older were treated with VENTOLIN HFA 2 inhalations 4 times daily for 12 weeks’ duration. The adult/adolescent population was 92 female, 110 male and 163 white, 19 black, 18 Hispanic, 2 other. The data from pediatric subjects are based upon 1 clinical trial in which 46 subjects with asthma aged 4 to 11 years were treated with VENTOLIN HFA 2 inhalations 4 times daily for 2 weeks’ duration. The population was 21 female, 25 male and 25 white, 17 black, 3 Hispanic, 1 other.

    Adult and Adolescent Subjects Aged 12 Years and Older: The two 12-week, randomized, double-blind trials in 610 adult and adolescent subjects with asthma that compared VENTOLIN HFA, a CFC 11/12-propelled albuterol inhaler, and an HFA-134a placebo inhaler. Overall, the incidence and nature of the adverse reactions reported for VENTOLIN HFA and a CFC 11/12-propelled albuterol inhaler were comparable. Table 1 lists the incidence of all adverse reactions (whether considered by the investigator to be related or unrelated to drug) from these trials that occurred at a rate of 3% or greater in the group treated with VENTOLIN HFA and more frequently in the group treated with VENTOLIN HFA than in the HFA-134a placebo inhaler group.

    Table 1: Adverse Reactions with VENTOLIN HFA with ≥ 3% Incidence and More Common than Placebo in Adult and Adolescent Subjects

    Adverse Reaction Percent of Subjects
    VENTOLIN HFA
    (n = 202) %
    CFC 11/12-Propelled Albuterol Inhaler
    (n = 207) %
    Placebo HFA-134a
    (n = 201) %
    Ear, nose, and throat
    Throat irritation 10 6 7
    Upper respiratory inflammation 5 5 2
    Lower respiratory
    Viral respiratory infections 7 4 4
    Cough 5 2 2
    Musculoskeletal
    Musculoskeletal pain 5 5 4

    Adverse reactions reported by less than 3% of the adult and adolescent subjects receiving VENTOLIN HFA and by a greater proportion of subjects receiving VENTOLIN HFA than receiving HFA-134a placebo inhaler and that have the potential to be related to VENTOLIN HFA include diarrhea, laryngitis, oropharyngeal edema, cough, lung disorders, tachycardia, and extrasystoles. Palpitations and dizziness have also been observed with VENTOLIN HFA.

    Pediatric Subjects Aged 4 to 11 Years: Results from the 2-week clinical trial in pediatric subjects with asthma aged 4 to 11 years showed that this pediatric population had an adverse reaction profile similar to that of the adult and adolescent populations.

    Three trials have been conducted to evaluate the safety and efficacy of VENTOLIN HFA in subjects between birth and 4 years of age. The results of these trials did not establish the efficacy of VENTOLIN HFA in this age-group . Since the efficacy of VENTOLIN HFA has not been demonstrated in children between birth and 48 months of age, the safety of VENTOLIN HFA in this age-group cannot be established. However, the safety profile observed in the pediatric population younger than 4 years was comparable to that observed in the older pediatric subjects and in adults and adolescents. Where adverse reaction incidence rates were greater in subjects younger than 4 years compared with older subjects, the higher incidence rates were noted in all treatment arms, including placebo. These adverse reactions included upper respiratory tract infection, nasopharyngitis, pyrexia, and tachycardia.

    Postmarketing Experience

    In addition to adverse reactions reported from clinical trials, the following adverse reactions have been identified during postapproval use of albuterol sulfate. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These events have been chosen for inclusion due to either their seriousness, frequency of reporting, or causal connection to albuterol or a combination of these factors.

    Cases of paradoxical bronchospasm, hoarseness, arrhythmias (including atrial fibrillation, supraventricular tachycardia), and hypersensitivity reactions (including urticaria, angioedema, rash) have been reported after the use of VENTOLIN HFA.

    In addition, albuterol, like other sympathomimetic agents, can cause adverse reactions such as hypokalemia, hypertension, peripheral vasodilatation, angina, tremor, central nervous system stimulation,hyperactivity, sleeplessness, headache, muscle cramps, drying or irritation of the oropharynx, and metabolic acidosis.

    Read the entire FDA prescribing information for Ventolin HFA (Albuterol Sulfate Inhalation Aerosol)

    Question

    Asked by Paul

    Can I Drink Alcoholic Beverages While Using An Albuterol Inhaler?

    The box that the Albuterol inhaler comes in does not have any warnings about alcohol consumption. There is no mention on the instructional paper inside the box either. Because alcohol tends to relieve my asthma for a bit, I just want to make sure it’s okay to consume a safe amount while also using my Albuterol inhaler?

    Answer

    Hi Paul,

    While there is no direct information regarding alcohol use and albuterol, it is always best to consult your doctor about drinking alcohol while taking any medication. Sometimes it can be as simple as the alcohol preventing your body from using the medication or absorbing it properly. Sometimes there can be a dangerous interaction, particularly since alcohol impairs motor function. You can read about Albuterol here (brand name Proventil) and if you are interested in learning about other medications commonly prescribed for asthma, you can check those out here in the drugs database.

    It is possible that your perception that the alcohol helps your asthma is because your asthma is brought on by anxiety and stress and the alcohol loosens you up and you are able to breathe easier. Fred Little, a resident expert here, wrote an excellent share post about stress and its ability to exacerbate asthma in some people. You can read that sharepost here.

    I hope this helps! Take care and let us know how you are doing!

    Vicki M

    April 4, 2000 — Some asthmatics learn the hard way that drinking alcohol can trigger the wheezing, coughing symptoms of an asthma attack. A new study lends credibility to that link, and suggests that chemicals, such as sulfite preservatives in wine, may be the cause of these attacks.

    Of all the alcoholic drinks included in the study, “wines were clearly the major offenders,” says Hassan Vally, BSc (Hons), author of the study in the March issue of the Journal of Allergy and Clinical Immunology. Vally is a researcher with the department of medicine at the University of Western Australia and the Asthma and Allergy Research Institute in Western Australia.

    The basis for Vally’s study was a questionnaire sent to members of the Asthma Foundation of Western Australia. More than 350 members were included in the study, ranging in age from 18 to 83 years, with an average age of 48.

    They were asked when their asthma was diagnosed, how severe it was, what typically triggered attacks, and what asthma medications they were taking. They were also questioned about whether they had ever had an allergic, allergic-like, or asthmatic reaction to any alcoholic drinks. Specific drinks were listed: red and white wine, champagne, fortified wines (such as sherry and port), beer, and spirits (like brandy, whisky and vodka). A checklist of asthmatic symptoms was also included.

    Overall, 43% of the respondents reported having allergic or allergic-like reactions to various alcoholic drinks. Thirty-three percent said alcohol had brought on asthma symptoms, with 26% saying asthma was the main adverse symptom they experienced after drinking.

    Wines were the most frequent trigger, named by 38% of the respondents as causing allergic reactions and by 30% as causing asthma symptoms, the responses showed.

    Red wine in particular was the biggest culprit, causing allergic reactions in 30% and asthmatic reactions in 24%. White wine caused allergy flare-ups in 26%, and asthma symptoms in 22%.

    Asthma attacks triggered by drinking alcohol reportedly came on quickly (in less than an hour) and were of moderate severity. Women reported the most asthmatic reactions, as did people taking oral steroids, those who were young when they had their first asthma attack, and those who had visited an alternative health practitioner for asthma. Although the respondents reported numerous allergic symptoms associated with alcoholic drinks — including coughing, itching, facial swelling, stomach upset, and eczema — asthma was the adverse symptom most frequently reported.

    Mixing drugs and alcohol for better asthma inhalers

    (Medical Xpress)—Asthma inhalers could soon become much more effective, thanks to a clever new way of making the particles they deliver invented by a Melbourne chemical engineer and his team.

    Current puffer designs and typical size ranges of particles mean a large portion of the medication propelled into a patient’s throat remains there. Only a fraction reaches the lungs.

    But Monash University lecturer Dr Meng Wai Woo and his team have now developed a method of making ultra-fine particles, which will make drug delivery much more consistent and efficient. The new method, known as anti-solvent vapour precipitation, uses ethanol to dehydrate droplets, and results in super-small particles of uniform size.

    “Ultrafine uniform particles will ensure that fewer drug particles get stuck in the throat while more can reach the lower regions of the lungs,” said Dr Woo. “Because we can now make the small particles more uniform, it means the inhalers will work better.”

    The team’s work results in particles smaller than a micron (thousandth of a millimetre) in diameter – much smaller than those produced by conventional dehydrating mechanisms, which are limited by the size of the atomised droplet.

    The team’s discovery was unveiled at the 18th International Drying Symposium in Xiamen, China, last year. It is likely to excite a lot of interest among pharmaceutical companies. Infusion devices and metered dose inhalers account for around $US20 billion in worldwide sales each year, with the key development aim being to balance improved efficiency against the cost of manufacture.

    “From a drug manufacturer’s perspective, this new approach can maintain the uniformity of the particle and yet potentially maintain commercially viable production rate,” said Dr Woo.

    Investigations into using ethanol as a means of producing ultrafine particles began in 2011, as part of Dr Woo’s ongoing research into manufacturing processes in the dairy industry.

    Attempting to produce lactose crystals, his team decided to reject the traditional hot air drying method and use nitrogen laced with ethanol vapour as an alternative dehydrating agent.

    To their surprise, the result was not the crystals they expected, but hundreds of very tiny, very uniform lactose particles. Further testing showed that the amount of alcohol absorbed into the initial droplets was a key variable in influencing the outcome.

    Dr Woo’s method means that the pharmaceutical industry can now potentially deliver critical medicines via the airway direct into the lungs with much greater accuracy.

    Assisted by a grant from the Australian Research Council, the Monash team is now testing its method on another dairy product – whey – researching the ultrafine particle delivery of protein-based medicines. They are also building a demonstration unit to showcase the anti-solvent vapour precipitation process, which will be completed later this year.

    Dr Woo is one of 12 early-career scientists unveiling their research to the public for the first time thanks to Fresh Science, a national program sponsored by the Australian Government through the Inspiring Australia initiative.

    Explore further

    School classroom air may be more polluted with ultrafine particles than outdoor air Provided by Science in Public Citation: Mixing drugs and alcohol for better asthma inhalers (2013, July 22) retrieved 2 February 2020 from https://medicalxpress.com/news/2013-07-drugs-alcohol-asthma-inhalers.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

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