What are the different types of asthma inhalers?

GB-37399 DOP 04-2023

What is an asthma inhaler and how does it work?

An inhaler is a device used to treat and relieve symptoms of asthma by delivering medicine into the lungs.

There are two main types of inhalers - a reliever and a preventer.Reliever inhalers work by relaxing the muscles in your airways to open them up, allowing you to breathe more easily. A preventer inhaler prevents your airways from closing up, making it hard to get air in. Preventer inhalers contain a low dose of steroid medicine to reduce inflammation and swelling in your airways.

What are the different types of inhalers used for?

Dr Krishna Vakharia, GP and clinical director at Patient.info explains the difference between the two main types of inhaler: "Reliever inhalers are used to treat asthma symptoms when they occur, whereas preventer inhalers are used every day to reduce inflammation of the airways and help prevent symptoms of asthma. You can also get combination inhalers that do both.".

Preventer inhalers tend to be the most common method used for treating asthma - most reliever inhalers relieve but don't stop you getting symptoms, which is the aim in asthma treatment. Using an inhaler allows the medicine to travel to your airways with ease.

Your GP or asthma nurse will advise what type of inhaler you should be using and how often to take it.

If you use a preventer inhaler as prescribed, you should need your reliever inhaler less often (or ideally not at all) because your asthma is under control. Generally, you should find that you can do more in the day without getting out of breath or having to rely on your reliever inhaler. For example, you may find exercising easier and be able to sleep through the night without being woken by your asthma symptoms.

In addition to a preventer inhaler, most people with asthma will be prescribed a reliever inhaler (which is usually blue) to provide quick relief. These inhalers can save lives when attacks occur, and you should carry them with you at all times. Some inhalers contain a combination of preventer and long-acting reliever medication - if you have one of these, you may be advised to take this, rather than a traditional reliever, if you get symptoms.

How to use a pMDI inhaler

There are multiple types of inhalers, and they all require slightly different inhaler techniques. It's important to check your inhaler technique with your doctor or nurse before your medication is prescribed: if you're not using the correct technique, the medicine won't reach where it's needed and won't work effectively. Your pharmacist can also advise on inhaler technique.

One of the most commonly prescribed types of reliever inhaler is a pMDI (pressurised metered dose inhaler). Dr Vakharia offers step-by-step instructions on how to use a pMDI.

1. Hold your inhaler upright and remove the cap.

2. Make sure there is nothing inside the mouthpiece.

3. Shake the inhaler well.

4. If you haven't used this inhaler before, or haven't used it for at least five days, test it before you use it by pointing the mouthpiece away from you and pressing the cannister to release one puff.

5. Position yourself upright, whether seated or standing, and tilt your head up slightly.

6. Before you use your inhaler, breathe out slowly until you feel you've breathed out all the air and feel ready to breathe in.

7. Once you're ready, place your lips around the mouthpiece to create a seal and begin to breathe in gently while pressing the canister on the inhaler once. It's important to synchronise the pressing and breathing in.

8. Once your lungs feel full, remove the inhaler from your mouth and proceed to hold your breath for up to 10 seconds (with your lips closed), then breathe out.

If you have been told by your doctor to do a second puff, then wait 30-60 seconds, shake your inhaler, and repeat the above steps. Additional puffs might be required during a severe attack whilst waiting for emergency treatment.

Dr Vakharia says that once you have finished, you should replace the cap of your inhaler and, if your inhaler contains steroids, rinse your mouth out with water.

How do reliever inhalers work so fast?

Reliever inhalers can provide almost instant relief of asthma symptoms, often helping to prevent serious complications in the process.

They do this by delivering medicine straight to where it is needed, which is why you only need very small amounts compared to the dose you'd need to take of the same medicine in tablet form.

Reliever inhalers are able to relax the tightened muscles around the passageways to your lungs within minutes, meaning more air can flow through them and your breathing is not restricted. However, if you have 'red flag' symptoms - including being too breathless to speak or not getting relief from your reliever inhaler - you must seek urgent medical help.

Are there steroids in asthma inhalers?

Preventer inhalers usually contain a steroid medicine, which reduces swelling and inflammation in your airways.

These inhalers are also known as corticosteroid inhalers and are used to treat obstructive pulmonary disease (COPD) as well as asthma.

These inhalers are only available on prescription and different inhalers will contain different types of steroids, including:

• Beclomethasone

• Budesonide

• Fluticasone

• Mometasone

Most people can use steroid inhalers, but you should always tell your doctor if you have had an allergic reaction to steroids in the past, have ever had tuberculosis or are currently being treated for a lung infection. If you are pregnant or trying to get pregnant, your doctor may recommend a lower dose of medicine in your inhaler.

How to help asthma without an inhaler

You should always carry your inhaler with you since you never know when your asthma might be triggered. However, it's understandable that you might sometimes find yourself in situations where an attack occurs, and you cannot quickly access your asthma medication. In this instance, you might rely on the support and quick thinking of others to ease your flare-up.

Dr Vakharia offers tips for what to do if someone around you has an asthma attack when they aren't carrying their inhaler.

• Make sure that they stay upright, as lying down or slouching can restrict their airways further.

• Tell them to focus on their breathing to slow it down by taking long deep breaths through their nose.

• Breathe with them while counting to demonstrate what to do.

• Move them to a place with fresh, clean air if possible, which is particularly important if something such as dust or pollen has triggered the attack.

• If you can, give them a warm, caffeinated drink as this can temporarily improve airway functions. For example, ginger tea, green tea, and black tea can relax the respiratory muscles. You can add honey for further soothing.

If symptoms persist or worsen, call for medical assistance and never leave someone unattended.