How to use asthma inhaler?

Asthma inhalers: how do I use my puffer?

There are a number of different devices for delivering asthma medicine into your lungs. One of the most commonly used is the pressurised metered dose inhaler (pMDI) or puffer.

The medicine contained in the inhaler is in a fine mist. When you press the canister this mist is released, and you breathe in to deliver the medicine to your airways. It is important that you use your inhaler correctly, so that you receive the correct dosage.

How to use your inhaler

To make sure you are using your inhaler properly, follow these steps:

  1. Remove the cap from the mouthpiece, ensuring that the mouthpiece is free from dust and grit.
  2. Hold the inhaler upright and give it a good shake.
  3. Breathe out gently.
  4. Tilt your head slightly back.
  5. Put the mouthpiece in your mouth, and close your lips around it. (Do not bite the mouthpiece).
  6. Start to breathe in slowly and deeply through your mouth, and at the same time press down firmly on the canister to fire one puff of the medicine (use both hands if you cannot manage with one). Continue to breathe in slowly and deeply.
  7. Remove the inhaler from your mouth, continuing to hold your breath for about 5 seconds.
  8. Breathe out gently through your nose.
  9. Replace the cap.
  10. If you need to take a second puff, wait about a minute before repeating steps 2-8.

Because your inhaler technique can deteriorate over time, it’s a good idea to check your technique with your pharmacist or doctor from time to time.

If you have problems coordinating drug release and inhalation, you may be better using the puffer in conjunction with a spacer. Alternatively, you may be better off using a breath-activated device (such as Autohaler, Turbuhaler or Accuhaler), which may also be more appropriate for people who have arthritis of the hands and find pressing the device difficult.

Using a spacer device with your puffer will improve the amount of medicine that reaches your small airways. You should use a spacer when using your reliever inhaler for an asthma flare-up, or asthma attack. It is also recommended that you use a spacer with preventer puffers that contain inhaled corticosteroids, to reduce side effects such as oral thrush (a fungal infection of the lining of the mouth or throat) and hoarse voice.

Don’t forget to wash your inhaler regularly. Some inhalers need daily washing and air drying. Your doctor or pharmacist can advise you and show you how to do this properly.

Share this:

Last Reviewed: 21/09/2015

myDr

How to use a Standard MDI (puffer)

Using your inhaler (puffer) properly is important when you have asthma or COPD (chronic obstructive pulmonary disease).

This short clip shows you how to use a standard metered dose inhaler (MDI), often called a puffer.

Medications

A standard puffer is used with many different medications. These include:

  • Airomir (salbutamol)
  • Alvesco (ciclesonide)
  • APO-Salbutamol (salbutamol)
  • Asmol (salbutamol)
  • Atrovent (ipratropium)
  • Flixotide and Flixotide Junior (fluticasone propionate)
  • Flutiform (fluticasone propionate)
  • Intal and Intal Forte (sodium cromoglycate)
  • Qvar (beclomethasone)
  • Seretide (fluticasone propionate plus salmeterol)
  • Tilade (nedocromil sodium)
  • Ventolin (salbutamol)

Checklist of steps

  1. Remove cap (some must be squeezed at the sides to release)
  2. Check dose counter (if device has one)
  3. Hold inhaler upright and shake well
  4. Breathe out gently (away from inhaler)
  5. Put mouthpiece between teeth (without biting) and close lips to form good seal
  6. Start to breathe in slowly through mouth and at the same time press down firmly on canister
  7. Continue to breathe in slowly and deeply
  8. Hold breath for about 5 seconds or as long as comfortable
  9. While holding breath, remove inhaler from mouth
  10. Breathe out gently (away from inhaler)
  11. If more than one dose is needed, repeat all steps starting from step 3
  12. Replace cap

Common problems

  • Holding the inhaler in the wrong position
  • Not breathing in at the same time as pressing the canister
  • Not breathing in deeply enough
  • Not holding breath for long enough
  • Taking several puffs without waiting or shaking the inhaler in between

Your inhaler will come with instructions in the package. Always check the package insert for any specific instructions.

Tips

  • Keep your chin up and the inhaler upright (not aimed at the roof of your mouth or your tongue)
  • If you are using a standard inhaler for a corticosteroid preventer medication, also use a spacer
  • If you are using this inhaler for a corticosteroid preventer medication, with or without a spacer, rinse your mouth with water and spit after inhaling the last dose to reduce the risk of side-effects
  • People with weak hands or osteoarthritis who have difficulty using a standard inhaler should ask their pharmacist about a Haleraid device

Getting the most out of your inhaler

Ask your doctor, pharmacist or asthma & respiratory educator to:

  • Explain how your inhaler should be used
  • Check you are using your inhaler properly
  • Tell you where to find the expiry date on your inhaler
  • Show you how to check if your inhaler is empty or nearly empty
  • Discuss any unwanted effects from your medication
  • Explain how to clean your inhaler and spacer (if you have one)

Different brands of inhalers sometimes have slightly different instructions to each other for similar steps. The checklists in our How-To Video library have been simplified and standardised where possible to reduce confusion.

Your inhaler will come with instructions in the package. Always check the package insert for any specific instructions.

Other inhaler types

See our complete How-to video library for other inhaler types and how to use them.

Acknowledgement

Thanks to Ms Judi Wicking, asthma and respiratory educator, and the patient who participated in this film clip.

Development of this How-to video was supported by the Australian Government Department of Veterans’ Affairs as part of the Prevent Puffer Problems campaign. The National Asthma Council Australia retained editorial control.

How to Use an Inhaler

The first step you will take with your inhaler is to prime it before you use it the first time. It should also be primed if you haven’t used it for 2 weeks or if it has been dropped. Check the instructions that came with your inhaler for specifics, but here are some general guidelines: Insert the canister, bottom up, into the holder. Shake the inhaler vigorously, take the cap off, point it away from you, and spray. Repeat this shaking and spraying process three or four times. Now your inhaler is ready to use.

Using the inhaler

  • Make sure the cap is off the mouthpiece.
  • You may want to use a spacer, a tube that carries medicine from the inhaler directly to the mouth. A spacer lets patients breathe at their own pace and helps deliver the medicine deep into the airways. Spacers are especially helpful for young children and people taking corticosteroids. Ask your doctor if you’re not sure if a spacer would be right for you. If you’re using a spacer, attach the spacer to the inhaler.
  • Breathe out, releasing as much air as possible.
  • If you’re using a spacer, put one hand around the spacer and one hand firmly around the inhaler, and place your mouth firmly around the end of the spacer.
  • If you’re not using a spacer, place the mouthpiece into your mouth and close your lips around it tightly.
  • Breathe in deeply as you press down as far as you can on the top of the canister. After the spray comes out, take your finger off the canister.
  • After you have inhaled as much as you can in one breath, take the inhaler out of your mouth and close your mouth. Hold your breath as long as you can, up to 10 seconds, then breathe normally.
  • If your doctor has prescribed more than one spray, wait one minute, shake the inhaler, and repeat the process, starting with exhaling as much air as you can.
  • You can clean the plastic mouthpiece periodically by separating it from the canister and washing it with warm soap and water. Allow it to air dry and put the two pieces back together for your next use.

Dry-powder inhaler:

  • Put your mouth around the mouthpiece tightly and inhale quickly and deeply. Remove the inhaler from your mouth and hold your breath for 10 seconds before exhaling.

Asthma Society of Canada, How to use your inhaler, http://www.asthma.ca/adults/treatment/meteredDoseInhaler.php

Ventolin HFA Product Instructions.

How to use ProAir HFA.

PrventilHFA. Using Your Inhaler.

Next Generation Inhalers: What This Means for You. American Academy of Allergy Asthma and Immunology.

Patient information: Asthma inhaler techniques in adults. UpToDate.com.

HFA Propellant. National Jewish Health.

Using your inhalers

Using the right inhaler technique, whether it’s your preventer or your reliever inhaler, helps you breathe the medicine straight into your lungs, where it’s needed. You’re less likely to get side effects, because not much of the medicine is absorbed into the rest of your body, and you’re giving yourself the best chance of managing your symptoms.

Want to check you’re using your inhaler properly? Watch our short videos

How does good inhaler technique help you manage your asthma?

If you’re using your preventer inhaler as prescribed, and using the right inhaler technique, it can help you:

  • cut your risk of an asthma attack
  • feel less breathless climbing stairs
  • cope better with your usual asthma triggers
  • get a good night’s sleep
  • have less time off work
  • take part in exercise and family activities.

Good inhaler technique can really make a difference to how well you manage your asthma. It could also mean you’ll be able to manage your asthma symptoms without needing to be prescribed higher doses.

Read our tips on how to avoid common inhaler mistakes here.

How does good inhaler technique help you avoid side effects of medicines?

Using the wrong technique can also mean you’re more likely to get side effects like oral thrush or a sore throat, because the medicine might be hitting the back of your throat, or just staying on your tongue or in your mouth. Good inhaler technique means the medicine goes down into your lungs where it’s needed.

Are you using the correct inhaler technique?

Some people tell us inhalers can be hard to use. Even if you think your inhaler technique is OK, it might not be – a recent survey we carried out found that up to a third of people with asthma aren’t using their inhaler in the right way.

Find out if you’re doing it right by watching our short video guides.

Getting your inhaler technique checked by your nurse or GP

Whenever you go to see your GP or nurse about your asthma, whether it’s your annual asthma review, or another asthma appointment, ask them to check your inhaler technique.

This is especially important if:

  • you’ve recently had symptoms or an asthma attack
  • you’re prescribed a new type of inhaler
  • the design of your inhaler has changed.

Even if you’re using the same inhaler you’ve always had, it’s easy for little mistakes to slip in.

You can also ask your pharmacist to show you how to use your inhalers correctly.

Cleaning and storing your inhaler

Keeping your inhaler clean will mean it works at its best and you can avoid problems like accidentally breathing in bits of fluff from the mouthpiece.

Storing it somewhere cool and dry is important too. Avoid keeping your inhaler on a hot windowsill, or in a damp bathroom cabinet.

Read our advice on cleaning and looking after your inhaler.

Last reviewed November 2018

Next review due November 2021

Types of asthma inhalers

The medicine inside an inhaler goes straight into the airways when you breathe in. This means that you need a much smaller dose than if you were to take the medicine as a tablet or liquid by mouth. The airways and lungs are treated, but little of the medicine gets into the rest of the body.

The proper medicine name is called the generic name. Different drug companies can use the generic medicine and produce different brands – the proprietary medicine names. There are many different brands of inhalers. Inhalers can have generic names and be produced by different drug companies too. For some medicines there are different inhaler devices that deliver the same medicine. This means that there are many types of inhaler available on prescription, all of which are produced in different colours. This can be confusing.

Because there are lots of different-coloured inhalers available, it is helpful to remember their names, as well as the colour of the device. This might be important if you need to see a doctor who does not have your medical records – for example:

  • In A&E.
  • If you are on holiday.
  • Outside the normal opening hours of your GP surgery.

It might be helpful to keep a list of the names of your medicines and inhalers in your wallet or purse. This information will prevent mistakes and confusion.

In the treatment of asthma, the medicine inside inhalers can be grouped into relievers (short-acting bronchodilators), preventers (steroid inhalers) and long-acting bronchodilators.

Need an emergency inhaler?

Book a consultation with a local pharmacist via Patient Access at a time that’s convenient for you

Book now

Reliever inhalers – contain bronchodilator medicines

You can take a reliever inhaler as required to ease symptoms when you are breathless, wheezy or tight-chested. The medicine in a reliever inhaler relaxes the muscle in the airways. This opens the airways wider, and symptoms usually quickly ease. These medicines are called bronchodilators as they widen (dilate) the airways (bronchi).

The two main reliever medicines are salbutamol and terbutaline. These come in various brands made by different companies. There are different inhaler devices that deliver the same reliever medicine. Salbutamol brands include Airomir®, Asmasal®, Salamol®, Salbulin®, Pulvinal Salbutamol® and Ventolin®. Terbutaline often goes by the brand name Bricanyl®. These inhalers are often (but not always) blue in colour. Other inhalers containing different medicines can be blue too. Always read the label.

If you only have symptoms every now and then, the occasional use of a reliever inhaler may be all that you need.

If you need a reliever three times a week or more to ease symptoms, a preventer inhaler is usually advised.

Preventer inhalers – usually contain a steroid medicine

These are taken every day to prevent symptoms from developing. The type of medicine commonly used in preventer inhalers is a steroid. Steroids work by reducing the inflammation in the airways. When the inflammation has gone, the airways are much less likely to become narrow and cause symptoms such as wheezing.

Steroid inhalers are usually taken twice per day. If you have an exacerbation (flare-up) of your asthma symptoms, you may be advised to take the preventer inhaler more often.

It takes 7-14 days for the steroid in a preventer inhaler to build up its effect. This means it will not give any immediate relief of symptoms (like a reliever does). After a week or so of treatment with a preventer, the symptoms have often gone, or are much reduced. It can, however, take up to six weeks for maximum benefit.

If your asthma symptoms are well controlled with a regular preventer you may then not need to use a reliever inhaler very often, if at all.

Inhalers that contain medicines called sodium cromoglicate (brand name Intal®) or nedocromil (brand name Tilade®) are sometimes used as preventers. However, they do not usually work as well as steroids.

The main inhaled steroid preventer medications are:

  • Beclometasone. Brands include Asmabec®, Clenil Modulite®, and Qvar®. These inhalers are usually brown and sometimes red in colour.
  • Budesonide. Brands include Easyhaler Budesonide®, Novolizer Budesonide® and Pulmicort®.
  • Ciclesonide. Brand name Alvesco®.
  • Fluticasone. Brand name Flixotide®. This is a yellow-coloured or orange-coloured inhaler.
  • Mometasone. Brand name Asmanex Twisthaler®.

Bone strength (density) may be reduced following long-term use of high doses of inhaled corticosteroids. Therefore people who use steroid inhalers for asthma need to make sure they have a good supply of calcium in their diet. Milk is a good source of calcium but dairy products may need to be avoided for some people with asthma. Other good dietary sources of calcium include:

  • Bread.
  • Some vegetables (curly kale, okra, spinach and watercress).
  • Some fruits (eg, dried apricots).

See the separate leaflet called Preventing Steroid-induced Osteoporosis.

Long-acting bronchodilator inhalers

The medicines in these inhalers function in a similar way to relievers, but work for up to 12 hours after each dose has been taken. They include salmeterol (brand name Serevent® and Neovent®) and formoterol (brand names Atimos®, Foradil®, and Oxis®).

A long-acting bronchodilator may be advised in addition to a steroid inhaler if symptoms are not fully controlled by the steroid inhaler alone.

Some brands of inhaler contain a steroid plus a long-acting bronchodilator for people who need both to control their symptoms. Examples of combination inhalers are:

  • Fostair® (formoterol and beclometasone).
  • Seretide® (salmeterol and fluticasone). This is a purple-coloured inhaler.
  • Symbicort® (formoterol and budesonide).

Inhaler devices

Different inhaler devices suit different people. Inhaler devices can be divided into four main groups:

  • Pressurised metered dose inhalers (MDIs).
  • Breath-activated inhalers – MDIs and dry powder inhalers.
  • Inhalers with spacer devices.
  • Nebulisers.

The standard MDI inhaler

A standard MDI is shown above. The MDI has been used for over 40 years and is used to deliver various types and brands of medicines. It contains a pressurised inactive gas that propels a dose of medicine in each ‘puff’. Each dose is released by pressing the top of the inhaler. This type of inhaler is quick to use, small, and convenient to carry. It needs good co-ordination to press the canister and breathe in fully at the same time. Sometimes these are known as evohalers (depending upon the manufacturer).

The standard MDI is the most widely used inhaler. However, many people do not use it to its best effect. Common errors include:

  • Not shaking the inhaler before using it.
  • Inhaling too sharply or at the wrong time.
  • Not holding your breath long enough after breathing in the contents.

Until recently, the propellant gas in MDI inhalers has been a chlorofluorocarbon (CFC). However, CFCs damage the Earth’s ozone layer and so are being phased out. The newer CFC-free inhalers work just as well, but they use a different propellant gas that does not damage the ozone layer.

Breath-activated inhalers

These are alternatives to the standard MDI. Some are still pressurised MDIs, but don’t require you to press a canister on top. The autohaler shown above is an example. Another example of a breath-activated MDI is the easi-breathe inhaler.

Other breath-activated inhalers are also called dry powder inhalers. These inhalers do not contain the pressurised inactive gas to propel the medicine. You don’t have to push the canister to release a dose. Instead, you trigger a dose by breathing in at the mouthpiece. Accuhalers, clickhalers, easyhalers, novolizers, turbohalers and twisthalers are all breath-activated dry powder inhalers. You need to breathe in fairly hard to get the powder into your lungs. Some types are shown below.

The individual devices all have some differences in how they are operated but, generally, they require less co-ordination than the standard MDI. They tend to be slightly bigger than the standard MDI.

Spacer devices

Spacer devices are used with pressurised MDIs. There are various types – an example is shown above. The spacer between the inhaler and the mouth holds the medicine like a reservoir when the inhaler is pressed. A valve at the mouth end ensures that the medicine is kept within the spacer until you breathe in. When you breathe out, the valve closes. You don’t need to have good co-ordination to use a spacer device.

A face mask can be fitted on to some types of spacers, instead of a mouthpiece. This is sometimes done for young children and babies who can then use the inhaler simply by breathing in and out normally through the mask.

There are several different types of spacer. Examples are Able Spacer®, Aerochamber Plus®, Nebuchamber®, Optichamber®, Pocket Chamber®, Volumatic® and Vortex®. Some spacer devices fit all MDIs; others are only compatible with specific brands of inhalers.

Tips on using a spacer device. The following are tips if you are prescribed a holding spacer. These have a valve at the mouth end – the spacer in the picture above is an example:

  • If your dose is more than one puff then do one puff at a time.
  • Shake the inhaler before firing each puff.
  • Start breathing in from the mouthpiece as soon as possible after firing the puff.
  • Try to hold your breath for a few moments when you have breathed in.
  • Breathe in and out a few times before firing the next puff. Try to hold your breath for a few moments each time you breathe in.
  • Check that the valve opens and closes with each breath.
  • A face mask can be put on to the valve end for babies and young children. They just breathe normally with their face against the mask. The valve opens and closes with each breath in and out. Hold the spacer slightly tilted with the inhaler end uppermost to help the valve open and close easily.
  • Static charge can build up on the inside of the plastic chamber. This can attract particles of medicine, and reduce the output when the spacer is used. To prevent this, wash the plastic spacer as directed by the maker’s instructions. This is usually before first use, and then about once a month with washing up liquid and water. Let it dry in air without rinsing or wiping.

Nebulisers

Nebulisers are machines that turn the liquid form of your short-acting bronchodilator medicines into a fine mist, like an aerosol. You breathe this in with a face mask or a mouthpiece. Nebulisers are no more effective than normal inhalers. However, they are extremely useful in people who are very tired (fatigued) with their breathing, or in people who are very breathless. Nebulisers are used mainly in hospital for severe attacks of asthma when large doses of inhaled medicines are needed. They are used less commonly than in the past, as modern spacer devices are usually just as good as nebulisers for giving large doses of inhaled medicines. You do not need any co-ordination to use a nebuliser – you just breathe in and out, and you will breathe in the medicine.

Common questions and further information

Do you get side-effects from inhalers?

At standard inhaled doses, the amount of medicine is small compared with tablets or liquid medicines. Therefore, side-effects tend to be much less of a problem than with tablets or liquid medicines. This is one of their main advantages. However, some side-effects do occur in some people. Read the leaflet that comes with the inhaler for details of possible side-effects. The following just highlights the more common and important ones to be aware of.

One problem that might occur when using a steroid inhaler (especially if you are taking a high dose) is that the back of your throat may get sore. Thrush infection in the mouth may develop. This can usually be treated easily with a course of pastilles to suck or liquid that you hold in your mouth. You might also notice that your voice becomes more hoarse.

If you rinse your mouth with water and brush your teeth after using a steroid inhaler you are less likely to develop a sore throat or thrush. Also, some inhaler devices (such as spacers) are less likely to cause throat problems. A change to a different device may help if mouth problems or thrush occur.

Note: a persistent hoarse voice that does not settle, needs further investigation as it can be due to other causes. If you have this symptom you should tell your GP.

If you use a high dose of inhaled steroid over a long time it may be a risk factor for developing osteoporosis. You can help to prevent osteoporosis by taking regular exercise, not smoking, and eating a diet with enough calcium.

Children who use an inhaled steroid over a long time should have their growth monitored. There is a small risk that enough steroid may get from the lungs and into the body (via the bloodstream), to delay growth. This risk has to be balanced against the risk of a child with asthma not having a steroid preventer. Long-term ill-health (such as with conditions like severe asthma) could also affect a child’s growth.

Steroid medicines may aggravate depression and other mental health problems, and may occasionally cause mental health problems. This is more a concern with steroid tablets but, rarely, can be caused by steroid inhalers. Even a severe form of mental health problem called psychosis may, rarely, be triggered by a steroid inhaler. Seek medical advice if worrying mood or behavioural changes occur.

Which is the best inhaler device to use?

This depends on various factors such as:

  • Convenience. Some inhalers are small, can go easily in a pocket, and are quick to use. For example, the standard MDI inhaler.
  • Your age. Children under the age of 6 years generally cannot use dry powder inhalers. This is because such a strong breath is needed to inhale the medicine within the inhaler. Children aged under 12 years generally cannot use standard MDI inhalers without a spacer. Some elderly people find the MDI inhalers difficult to use.
  • Your co-ordination. Some devices need more co-ordination than others.
  • Side-effects. Some of the inhaler medicine hits the back of the throat. Sometimes this can cause problems such as thrush in the mouth. This tends to be more of a problem with higher doses of steroid inhalers. Less medicine hits the throat when using a spacer device. Therefore, a spacer device may be advised if you get throat problems, or need a high dose of inhaled steroid.

Often the choice of inhaler is just personal preference. Most GPs and practice nurses have a range of devices to demonstrate, and let you get a feel for them. If you are unhappy with the one you are using then ask your GP or practice nurse if you can try a different type.

How to use the Yellow Card Scheme

If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:

  • The side-effect.
  • The name of the medicine which you think caused it.
  • The person who had the side-effect.
  • Your contact details as the reporter of the side-effect.

It is helpful if you have your medication – and/or the leaflet that came with it – with you while you fill out the report.

Asthma Medications

Long-term asthma control medications are taken daily. They’re used to prevent asthma symptoms rather than treat sudden asthma attacks. For long-term treatment, your doctor may prescribe an anti-inflammatory drug, a bronchodilator, or a combination of the two.

Long-term asthma control medications are divided into the following groups.

Inhalable corticosteroids

These anti-inflammatory drugs are the strongest and most commonly prescribed long-term asthma drugs. Examples of these drugs include:

  • beclomethasone (QVAR)
  • budesonide (Pulmicort Flexhaler)
  • flunisolide (Aerospan)
  • fluticasone (Flovent Diskus, Flovent HFA)
  • mometasone (Asmanex)

The more common side effects of inhalable corticosteroids include:

  • throat irritation
  • nosebleed
  • headache
  • nose irritation

Rare but serious side effects can include:

  • bronchospasm
  • vision problems
  • increased blood pressure in the eyes
  • decreased growth in children

Oral corticosteroids

Corticosteroids are systemic drugs, which means they affect your entire body. They can be used to treat severe asthma symptoms. These drugs are anti-inflammatories, and they work by relieving swelling and inflammation in your airways. Oral corticosteroids are taken by mouth.

Examples of these drugs include:

  • prednisone
  • methylprednisolone
  • hydrocortisone

The more common side effects of these drugs include:

  • weight gain
  • high blood sugar levels
  • trouble sleeping
  • slow wound healing

Long-term use of corticosteroids can cause side effects that may be serious. Therefore, these drugs should only be used for short-term treatment. Examples of serious side effects include:

  • peptic ulcers
  • osteoporosis
  • glucose intolerance
  • weight gain

Long-acting beta agonists

Long-acting beta agonists (LABAs) are bronchodilators. They’re used to help prevent asthma attacks and are typically taken twice per day using an inhaler. They’re always used along with an inhalable corticosteroid. These drugs are fast-acting and can provide relief for up to 12 hours.

Examples of these drugs include:

  • formoterol (Perforomist)
  • salmeterol (Serevent Diskus)

The more common side effects of these drugs include headache and muscle pain. Rare but serious side effects can include bronchospasm and throat spasm.

Combination inhalers

Combination inhalers are common prescriptions for asthma. They include a combination of a corticosteroid and a LABA. Combinations available in the United States include:

  • budesonide and formoterol (Symbicort)
  • fluticasone and salmeterol (Advair Diskus)

The more common side effects of these drugs include headache and throat infection. Rare but serious side effects can include heart arrhythmias, increased blood pressure, and bronchospasm.

Leukotriene modifiers

Leukotriene modifiers are considered anti-inflammatory drugs, but they work differently from corticosteroids. They come in tablet form and work by blocking the action of leukotrienes. Leukotrienes are substances in your lungs that cause the air passages to constrict. They also cause your lungs to make excess mucus.

Examples of leukotriene modifiers include:

  • montelukast (Singulair)
  • zafirlukast (Accolate)
  • zileuton (Zyflo, Zyflo CR)

The more common side effects of these drugs include headache, stomach pain, and muscle pain. More serious side effects can include liver damage, blood disorders, and seizures.

Methylxanthines

Methylxanthines are bronchodilators that are also thought to have some anti-inflammatory effects. These drugs come as pills. One example of a methylxanthine is theophylline (Theochron, Theo-24, Elixophyllin).

These drugs are rarely prescribed. This is because they require close monitoring to make sure that the amount of drug in your body stays within a narrow range. If the amount goes above that range, it puts you at risk of serious side effects such as heart arrhythmias and seizures.

The more common side effects of these drugs include:

  • headache
  • trouble sleeping
  • nausea
  • vomiting

Immunomodulators

Immunomodulators are also called biologics. They affect your immune system, blocking substances that cause asthma attacks. These drugs are typically only prescribed for people who can’t control their asthma symptoms with other types of asthma medications. Examples of these drugs include:

  • mepolizumab (Nucala)
  • omalizumab (Xolair)
  • reslizumab (Cinqair)

Each of these drugs can cause different side effects, but the common ones include:

  • headache
  • tiredness
  • injection site reactions
  • muscle and joint pain
  • infections

More serious side effects can include:

  • hypersensitivity reactions, which can include anaphylaxis
  • bronchospasm
  • heart attack
  • stroke

Asthma Medication

Most people with asthma need two kinds of medications: quick-relief and long-term control. Allergy shots (immunotherapy) can also be helpful.

Quick-relief medications are taken at the first sign of asthma symptoms for immediate relief. They include:

  • Short-acting inhaled beta2-agonists (inhalers)
  • Anticholinergics

Both are bronchodilators, which means they expand the passageways into the lungs. This allows more air in and out of the lungs and improves breathing. They also help to clear mucus from the lungs by enabling the mucus to move more freely and get coughed out more easily. If you have exercise-induced asthma, your allergist may recommend using a bronchodilator before exercising.

Even though quick-relief medications can stop asthma symptoms, they do not control the cause of the symptoms: airway inflammation. Consider the rule of twos: If you find that you need your quick-relief medication to treat asthma symptoms more than twice a week, or you wake up at night with asthma symptoms two or more nights a month, then your asthma is not well-controlled. If you refill your quick relief medication more than two times per year, that is another sign your asthma isn’t well-controlled.

Long-term control medications are taken every day to prevent symptoms and asthma attacks.

They include:

  • Inhaled corticosteroids which include fluticasone, budesonide, mometasone, beclomethasone and ciclesonide. Inhaled corticosteroids are safe, well-tolerated and among the most effective medications for treating asthma.
  • Antileukotrienes or leukotriene modifiers which include montelukast sodium, zafirlukast, and zileuton.
  • Long-acting inhaled beta2-agonists (never taken alone, but can be extremelly useful when combined with an inhaled corticosteroid). These include salmeterol, formoterol, and vilanterol.

These medications are taken every day, even if you do not have symptoms. The most effective long-term control medications reduce inflammation in the airways and help improve asthma symptoms.

Speak with your allergist about what type of inhaler would work best for you, when you should use it, how to use it and how to track how you’re feeling. Your allergist will develop a personal treatment plan that works for you and requires the least amount of medication possible.

GET RELIEF

Find an allergist

Treatment


Asthma

Inhalers

Inhalers can help:

  • relieve symptoms when they occur (reliever inhalers)
  • stop symptoms developing (preventer inhalers)

Some people need an inhaler that does both (combination inhalers).

Watch a short video from Asthma UK to learn how to use your inhaler properly.

Read on to learn more about the different types of inhaler.

Reliever inhalers

Most people with asthma will be given a reliever inhaler. These are usually blue.

You use a reliever inhaler to treat your symptoms when they occur. They should relieve your symptoms within a few minutes.

Tell your GP or asthma nurse if you have to use your reliever inhaler 3 or more times a week. They may suggest additional treatment, such as a preventer inhaler.

Reliever inhalers have few side effects, but they can sometimes cause shaking or a fast heartbeat for a few minutes after they’re used.

Asthma UK has more information on reliever inhalers.

Preventer inhalers

If you need to use a reliever inhaler often, you may also need a preventer inhaler.

You use a preventer inhaler every day to reduce the inflammation and sensitivity of your airways, which stops your symptoms occurring. It’s important to use it even when you do not have symptoms.

Speak to your GP or asthma nurse if you continue to have symptoms while using a preventer inhaler.

Preventer inhalers contain steroid medicine.

They do not usually have side effects, but can sometimes cause:

  • a fungal infection of the mouth or throat (oral thrush)
  • a hoarse voice
  • a sore throat

You can help prevent these side effects by using a spacer, which is a hollow plastic tube you attach to your inhaler, as well as by rinsing your mouth or cleaning your teeth after using your inhaler.

Asthma UK has more information on preventer inhalers.

Combination inhalers

If using reliever and preventer inhalers does not control your asthma, you may need an inhaler that combines both.

Combination inhalers are used every day to help stop symptoms occurring and provide long-lasting relief if they do occur.

It’s important to use it regularly, even if you do not have symptoms.

Side effects of combination inhalers are similar to those of reliever and preventer inhalers.

Asthma UK has more information on combination inhalers.

Medicines and devices for treating asthma

Using an inhaler or nebulizer in the correct way is vital, as an accurate dose can greatly reduce the frequency and impact of attacks.

Inhaler

There are many different brands of inhaler. Read instructions thoroughly for efficient use.

Apply the following tips:

  1. Remove the cap of the inhaler, shake it, and “prime” the inhaler by spraying or pumping it. The manufacturer instructions will advise how best to achieve this. Do not shake a dry powder inhaler before use.
  2. Make sure the person receiving the dose is standing up or sitting up straight.
  3. Breathe in deeply, tilt back the head a little, and sharply breathe out to empty the lungs.
  4. Form a close, tight seal by squeezing the lips shut around the mouthpiece.
  5. Push down on the top of the canister while breathing in slowly for between 3 and 5 seconds.
  6. Count to 10 while holding a breath.
  7. Remove the inhaler and breathe out slowly.
  8. People who need two puffs should wait for one minute between the first and second.
  9. Rinse the mouth with water if taking corticosteroids through an inhaler.

As inhalers can save lives during respiratory distress, make sure using one becomes second nature. Speak to a doctor if the type of inhaler is causing difficulties.

Peak flow meter

To obtain an accurate peak flow reading, take the following steps:

  1. Assume a comfortable position, sitting up or standing. Either is fine but do it the same way each time.
  2. Pull the counter back all the way to reset the meter.
  3. The meter should be horizontal. Make sure the measurement scale is visible.
  4. Breathe deeply, filling the lungs completely.
  5. Bring the meter to the lips, forming a tight seal on the mouthpiece.
  6. Blow as fast as hard as possible into the device.
  7. Repeat three times for accuracy and write down the highest figure in a peak flow diary. The three readings should be about the same.

Be sure to take peak flow measurements at the same time each day for consistency. The highest peak flow at this time will indicate the personal best. This will be the target peak flow, and the further the peak flow falls from this figure, the higher the risk becomes of an attack.

When a person replaces their peak flow meter, they should find a new personal best, as different meters might show different readings. Allowing for growth in children is also essential, so find a new personal best every 6 months to represent this change.

Nebulizer

Share on PinterestA nebulizer turns medications into a fine mist.

This will also come with instructions, which anyone using a nebulizer should read closely.

  1. Wash the hands thoroughly before use.
  2. Follow manufacturer instructions to assemble the machine, tube, cup, and mouthpiece.
  3. Place the medicine into the medicine cup. Open any pre-measured capsules and empty the contents into the cup.
  4. Seal the lips around the mouthpiece, or make sure a facemask fits closely around the nose and mouth. Avoid holding the mouthpiece away from the face.
  5. Switch on the machine. A mist should start to form at the base of the tube.
  6. Breathe normally through the mouth until the medicine cup is empty. This might take around 10 minutes.
  7. Remove the mouthpiece or mask and power down the machine.
  8. Rinse the mouth after using corticosteroids.

Wash the hands, medicine cup, and mouthpiece or mask well after use, but do not wash the tubing. Shake off any remaining moisture, and air-dry the components on a tissue or paper towel.

Disinfect the different parts of the nebulizer once a week to sterilize the device. The packaging should provide precise instructions.

Store the nebulizer in a clean, dry plastic bag, and keep mouthpieces or masks separate if more than one person in the house uses the machine to treat asthma. Replace any broken or malfunctioning parts as soon as possible.

How to Use a Metered Dose Inhaler

Path to improved health

Each inhaler consists of a small canister of medicine connected to a mouthpiece. The canister is pressurized. As you press down on the inhaler, it releases a mist of medicine. You breathe that mist into your lungs. It’s important to use your inhaler correctly. Otherwise, your airways will not receive the right amount of medicine. Read and follow all instructions that come with your inhaler.

Here are the steps to correctly use your inhaler:

  • Remove the cap and hold the inhaler upright.
  • If your doctor recommends, use a spacer (a hollow, plastic chamber) to filter the medicine between the inhaler and your mouth. The chamber protects your throat from irritation from the medicine. Note: Check your insurance plan as some may not cover spacers.
  • Stand or sit up straight.
  • Shake the inhaler.
  • Tilt your head back slightly and breathe out all the way.
  • Put the inhaler in your mouth.
  • Press down on the inhaler quickly to release the medicine as you start to breathe in slowly.
  • Breathe in slowly for 3 to 5 seconds.
  • Hold your breath for 10 seconds to allow medicine to go deeply into your lungs.
  • Breathe out slowly.
  • Repeat puffs as directed by your doctor. Wait 1 minute before taking the second puff.

Some inhalers (steroid) also recommend rinsing your mouth out with water and gargling with water (spit out the water) after use.

These instructions are for a metered-dose inhaler only. Inhaled dry-powder inhalers are used differently. To use a dry powder inhaler, close your mouth tightly around the mouthpiece and breathe in quickly.

Talk to your doctor if you have any questions about how to take your inhaler.

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *