What is the difference between blue and brown inhalers?

Simply put, asthma is inflammation of the airways. This is the result of many different things and is not always the same for two different people. Common triggers include pollen, dust, pet dander and tobacco smoke. Once you have figured out your trigger, it becomes easier to avoid and prevent future attacks.

When an asthma sufferer is exposed to a trigger, a number of physical reactions occur due to inflammation, all making breathing harder. The muscles surrounding your lungs and airways contract - this limits how much your respiratory organs can expand. The walls of the lungs will swell, further limiting the volume of air they can hold. Lastly, the membranes of your airways will overproduce mucus - they do this naturally, but too much can also make breathing harder.

Inhalers help you to breathe. Depending on the types of inhaler, they relieve or prevent attacks, combating asthma symptoms like shortness of breath, wheezing and chest pain.

You should never use an inhaler without first consulting your doctor. Using any medication without the advice of a healthcare professional is potentially dangerous. If you are struggling to breathe and cannot determine the cause, you should seek immediate medical attention.

Inhalers are a very efficient way of introducing substances into your respiratory system. They deliver drugs, usually bronchodilator or steroids, as sprays, aerosols and powders. The different methods of delivery include:

• Metered-dose inhalers (MDIs) - they release a spray when a button is pressed.
• Breath actuated inhalers (BAIs) - they activate when you breathe in, so that you inhale the active ingredient
• Dry powder inhalers (DPIs) - release a powder that you should breathe in

There is no set colour code for inhalers, and many manufacturers and countries will label devices differently. However, you can usually expect to find blue, brown, green and purple/pink options available. As the system of colouring inhalers is not completely universal, you should always consult with your doctor before using a new device. You should also check with the pharmacist when purchasing an inhaler from a new vendor (especially, if abroad).

What is in a blue inhaler?

Blue inhalers usually contain salbutamol. Salbutamol is a bronchodilator and is prescribed to treat asthma and chronic obstructive pulmonary disorder (COPD).

These inhalers are relievers, which means they are used to relieve symptoms when they occur and reduce the severity of attacks. You should take one or two puffs when you are exposed to a trigger. It is not recommended to exceed 4 puffs in 24 hours.

There are many different branded versions of salbutamol inhalers, including Ventolin, Salamol, and Salbulin. As they contain the same active ingredient, they will all work in very similar ways.

How does a blue inhaler work?

Most reliever inhalers contain an active ingredient belonging to a class of medications called beta-2 agonists.* These target the beta-2 receptor in your lung airways. In turn, this relaxes the smooth muscles in the bronchioles - these are tubes that air runs through. By relaxing, the space inside them increases so more air can pass through. The wider airways also means mucus build-up is not as restricting.

As beta-2 agonists act only on the muscles of your respiratory system, relievers will not improve your overall condition - they offer temporary and immediate relief from symptoms.

*Some will also contain long-acting anticholinergics.

What is in a brown inhaler?

Brown inhalers contain corticosteroids. These are synthetic versions of chemicals naturally produced by your body in the adrenal gland. They work to suppress your immune system so that you are less susceptible to asthma triggers.

You should use a brown inhaler on a regular basis to prevent attacks - this is why they are referred to as preventers.

Examples of steroid inhalers include Flixotide and Clenil Modulite.

How does a brown inhaler work?

When your immune system interprets threats to the body, it responds with inflammation, rushing blood to the source of the “threat”. In a normal scenario, this is a beneficial reaction. However, if you have asthma, these threats are exaggerated, and your airways become inflamed as they “fight” triggers like pollen.

Your body produces a hormone called cortisol to recover from immune reactions. The corticosteroids brown inhalers contain, replicate the effects of cortisol. By calming your immune response, inflammation is reduced, which means wider, mucus-free airways.

Green inhalers

These inhalers are used in a similar way to relievers and also work by opening your airways. They are called controllers and usually work for around 12-24 hours after a dose, making them particularly useful if you will be exposed to a trigger repeatedly over a short period.

You will usually be prescribed a conventional reliever first, like Ventolin. If you find you have regular attacks, a doctor may consider prescribing a controller alongside a preventer, as a combination. That way, the chance of attacks is minimised, but you have a potent backup in case of more serious flare-ups.

Examples of controllers include Salmeterol, Pulmicort, and Serevent.

Red, purple and pink

The last form of inhaler to discuss is combination inhalers. As the name suggests, these combine two different active ingredients, a steroid and a long-acting beta-agonist. These are usually red, purple, pink or white, but again, there is no definite colour.

Combination inhalers relieve ongoing attacks, opening your airways (as reliever inhalers do), whilst also offering long-term protection against triggers (as preventer inhalers do).

Well-known brands of combination inhalers include Seretide, Symbicort.

Deciding what inhaler is right for you is a decision best left to your doctor. You should visit your GP and be prepared to tell them about the frequency and severity of asthma attacks, known triggers, as well as any inhalers or other medications you are currently using.

You can get an inhaler from the NHS if you have been prescribed it by a GP. However, you can also buy one online from euroClinix (if previously prescribed) once a quick consultation has been completed.