A guide to asthma inhalers & treatments

Inhalers, sometimes known as a puffer, are small handheld spray devices. They deliver medicine directly to the airways to prevent and reduce respiratory symptoms.

It delivers the medicine as a fine mist or dry powder into the mouth.

Inhalers are the most common asthma treatment. However, they also treat other conditions including, chronic obstructive pulmonary disorder (COPD), bronchitis and emphysema.

Most people with asthma will have two types of inhalers: reliever and preventer.

Almost everybody with asthma will have a reliever inhaler. You take it when you feel your symptoms getting worse. If you use your reliever often, you may also need a preventer inhaler.

You use your preventer every day. This reduces sensitivity and inflammation throughout the day so your symptoms don't flare up.

Some people tell them apart by their colour: blue and brown inhalers. However, this is not always the case. Always check the medication name.

Relievers

Reliever inhalers are for quick relief of symptoms and to prevent an asthma attack. They are usually blue but always check with your doctor.

They work by quickly relaxing the muscles in your airways. This allows you to breathe more easily.

You should always carry your reliever with you and use it when you start to notice symptoms. You may also use it before exercise if that is one of your asthma triggers.

There are two types of reliever inhalers available.

Short-acting bronchodilators (SABAs) are the most common type of reliever inhaler. The other type is known as short-acting muscarinic antagonists (SAMAs). SAMAs are more commonly prescribed for people with COPD.

Preventers

Preventer inhalers are the main way to treat asthma symptoms. They work long-term, so will not work if you are having an attack.

You take your preventer inhaler daily to help reduce inflammation in the airways. It means you’re less likely to react to triggers and reduce the risk of an asthma attack.

Preventers contain inhaled corticosteroids (ICSs). They contain steroids which work by reducing inflammation in the airways. The same ingredients can be found in some hay fever medications (e.g. Avamys).

Long-acting bronchodilators and long-acting muscarinics work similarly to their short-acting counterparts. However, the effects last longer (up to 12 hours).

They are used as a daily add-on treatment alongside your ICS for severe asthma or COPD. They should never be used instead of your reliever inhaler or ICS.

Your doctor will rarely prescribe you a LABA or LAMA on its own. It’s much safer to use them in a combination inhaler.

Depending on your asthma, you may require a combination inhaler.

These inhalers contain 2 or more ingredients to help you control your symptoms. However, you will still need your reliever inhaler.

The most common type of combination inhalers contain a steroid and a bronchodilator, usually formoterol. This type of treatment is known as MART - maintenance and reliever therapy. You use these inhalers daily but you can also use them when you have symptoms.

Not all combination inhalers are licensed for MART. If you don’t have a MART inhaler, you will still need to use your blue reliever inhaler.

The most common type of combination inhalers contain a steroid and a LABA.

*Treatments licensed for MART

Other types of inhalers may have up to 3 types of asthma medication. These are more suitable for people with COPD.

There are several types of inhaler devices. It means the devices look different and are used differently.

Your doctor will prescribe a device based on your preferences

Metered dose inhalers (pMDIs)

The most recognisable inhaler device is pressured metered dose inhalers or pMDIs. They are sometimes called “puffers”.

The medicine is stored in a pressurised canister. When you press the canister, a puff of medicine comes out through the mouthpiece. You breathe the puff in through the mouthpiece, so the medicine can get into your lungs. One puff is one dose.

There are several types of pMDIs.

There are also different variations of pMDIs.

For example, there are breath-actuated inhalers (BAIs) that deliver a dose of medicine as you breathe in. They are usually called Autohalers or Easi-Breathe inhalers.

In addition, there are soft mist inhalers (SMIs) that turn the liquid into a fine mist. These are known as Respimat inhalers.

Here are some examples of pMDIs:

• Ventolin
• Serevent
• Seretide Evohaler
• Atrovent
• Spiriva Respimat
• Qvar Inhaler / Autohaler / Easi-Breathe
• Clenil Modulite
• Salamol Inhaler / Easi-Breatheqva
• Flixotide Evohaler

Dry powder inhalers (DPIs)

Unlike pMDIs, dry powder inhalers (DPIs) store the medicine as a powder.

No propellant pushes the medicine. They are breath-activated. You activate the device and take a quick, deep breath to pull the medicine out of the inhaler.

DPIs are usually tube or disk-shaped. Some require you to load them with a capsule.

Some examples of DPIs include:

• Bricanyl Turbohaler
• Salbutamol Easyhaler
• Serevent Accuhaler
• Seretide Accuhaler
• Fostair NEXThaler
• Symbicort
• Flixotide Accuhaler
• Pulmicort Turbohaler

The devices all work and look different. What they do have in common is that they are generally easier to see than pMDIs.

Nebulisers

A nebuliser is a machine that can deliver high doses of asthma medication at one time. This is so it can deliver medicine to patients who have severe symptoms or are at risk of an asthma attack.

It is a machine that has a facemask or mouthpiece attached to it. It works by converting liquid medicine into a fine mist.

It is unlikely you will need a nebuliser at home. They are used in GP clinics and hospitals if your symptoms worsen or you’re at risk of an asthma attack.

You may need a nebuliser at home if you have severe asthma or are more at risk of an asthma attack.

If you use a pMDI inhaler, you may benefit from using a spacer.

A spacer is an empty plastic tube that you can attach to the mouthpiece of your inhaler. They help you get the best out of your inhaler.

There are 3 main benefits of using spacers.

1. You waste less medicine. This is because the medicine is more likely to get into your airways, instead of anywhere else.
2. It reduces the risk of side effects like oral thrush from your preventer. It stops the medicine from going into your mouth or throat.
3. It may be easier to take your medicine. The medicine collects in the chamber of the spacer so you can breathe it in without worrying about timing it perfectly.

You will need to replace your spacer yearly and clean it regularly. Different inhalers require different spacers, so always check with your doctor or asthma nurse.

Some people may need other treatments if inhalers alone can’t control their asthma symptoms. There are tablets, injections and surgery options.

Tablets

You may need to take tablets as well as your inhaler. Common asthma tablets include:

• Leukotriene receptor antagonists (LTRAs) like Montelukast - you take them daily to prevent symptoms.
• Theophylline - an oral bronchodilator.
• Steroid tablets - you take them short-term or long-term if your symptoms get worse or you have an asthma attack.

Biologic treatments

Biologic therapy is a treatment that targets the body processes that cause lung inflammation. They are delivered as injections. You can either have them injected at a clinic or you can inject them yourself.

Biologic treatments are reserved for people who have severe asthma or specific types of asthma. You will need to be referred to a specialist asthma clinic.

Surgery

Over time, severe asthma can damage the airways. So, your doctor may recommend a procedure to fix it.

Bronchial thermoplasty involves reducing the amount of thickened smooth muscle tissue on the inside walls of the airways. Thickened tissue narrows the airways, which makes it harder to breathe.

It is only offered to people with severe asthma that can’t be controlled with other medications. However, research into its long-term effects is ongoing. So, the procedure may only benefit a select group of people.

You will need to go to your doctor and get an asthma diagnosis. Once diagnosed, your doctor will decide an asthma treatment plan for you. Asthma medications are only available on prescription.