Inhalers are the main treatment for asthma, a respiratory condition marked by spasms in the main passageway (bronchi) of the lungs, causing difficulty in breathing.
An asthma inhaler is a handheld device that delivers medication straight into the lungs, delivering the medication faster and with fewer side effects compared to oral or intravenous drugs.
Types of inhalers
There are three types of inhalers based on the way each type of device delivers asthma medications:
Metered dose inhalers (MDIs) deliver the drug through a small, handheld aerosol canister. MDIs work like a spray: you push the inhaler, it sprays out the medicine, and you breathe it in. A spacer can help kids or people with trouble breathing use an MDI more easily. A spacer is a tube that attaches to the inhaler and holds the medication until you can breathe it in. This makes the device easier to use and helps get the medication into your lungs.
Dry powder inhalers (DPIs) require you to breathe in quickly and deeply. That can make DPIs hard to use during an asthma attack when you will have difficulty taking a deep breath.
Nebulizers deliver medication through a mouthpiece or mask. They are easier to use because you can breathe normally. Nebulizers are ideal for children or people with severe asthma who may not be able to use an MDI or DPI properly.
Medications in inhalers
There are four types of inhalers based on the type of asthma medication the device delivers:
Reliever inhalers contain bronchodilator medications that relax and widen the muscles in the airways thereby easing acute asthma symptoms of breathlessness, wheezing and chest tightness. The two main reliever medicines are salbutamol and terbutaline.
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. 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 every day to prevent symptoms from developing. 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.
Long-acting bronchodilator inhalers function in a similar way to relievers, but work for up to 12 hours after taking each dose. They include salmeterol and formoterol. A long-acting bronchodilator may be advised in addition to a steroid inhaler if symptoms are not fully controlled by the steroid (preventer) inhaler alone.
Combination inhalers contain a steroid plus a long-acting bronchodilator for people who need both to control their symptoms.
How can I tell if there’s enough medicine in my inhaler?
It’s hard to tell if there’s still enough medicine in older-model inhalers because most of these make a puff sound long after the medication is gone. This could be a serious problem if you need the inhaler and it’s empty. Fortunately, many new inhalers include a dose counter to show how much medication is left.
The best way to tell how many doses remain is to mark the number of doses used on the inhaler and then discard the inhaler after you’ve used this number of puffs. You can find the total number of doses on the inhaler’s box or canister. Mark the date on your calendar when you expect to use all of the available puffs in the new inhaler, and replace it before then. Keep one or two extra reliever inhalers at home.
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