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How Do Inhalers Treat Asthma

Anyone Having Difficulty Using An Inhaler Can Try A Nebulizer

While not technically an inhaler, theres yet another option for inhaling medicine.

Nebulizer If you have severe asthma and are unable to use a regular inhaler, a nebulizer may be a better option.

This machine turns liquid medicine into a fine mist that you inhale through a mouthpiece, a mask that fits over your nose and mouth, or into your mouth alone.

What Are Common Types Of Asthma Medications

There are four basic types of asthma medications that each treat a different part of your asthma:

  • bronchodilators relax and open the airways to relieve asthma symptoms such as coughing, wheezing, chest tightness and shortness of breath
  • anti-inflammatory medications reduce and prevent lung inflammation
  • combination medications combine a bronchodilator and anti-inflammatory in one device
  • leukotriene modifiers block the action of leukotrienes, chemicals involved in immune system responses
  • biologics are medications that target the specific cells and pathways that cause inflammation related to severe asthma.

How Do Inhalers Help With Asthma

While you do your best each day to avoid the triggers that might kickstart your asthma symptoms, you cant always prepare for everything. For instance, you might engage in physical activity thats more vigorous than predicted. The air quality around you might suddenly and unexpectedly change due to smoke, or other irritants.

During those times, it helps to have an inhaler. Inhalers are a medical treatment that can treat your airways, so you can breathe and avoid a more serious asthmatic episode. If youre already having such an episode, an inhaler can get your breathing back on a more even level.

Not all inhalers are the same, and depending on your age, health and lifestyle, you will be prescribed one over another by your allergist. In this article, well discuss the various kinds of inhalers as well as how they help manage symptoms.

See related: Asthma Attacks: Triggers and Treatments

How Do I Know Which One I Should Use

Deciding on the best course of treatment is ideally a joint effort between both you and your health care team. At times, it may be a bit of a trial and error process. Most people with mild to moderate asthma respond well to inhaled steroids as controller medicines, with a short-acting bronchodilator inhaler to be used when symptoms still crop up. In cases where asthma proves harder to control, long-acting bronchodilators may be added to the mix.

How Is Asthma Treated

Overview of Medications for Asthma Treatment

Asthma medications play a central role in a treatment plan. Some medications prevent or reduce airway inflammation; others interrupt the allergic reaction that triggers symptoms; others relieve coughing and wheezing, making it easier to breathe.

Your doctor will work with you to find the right combination of medicines to manage your asthma and adjust the type and amount based on your symptoms and the type of asthma that you have. The goal of asthma treatment is to have you feel your best with the least amount of medicine.

Get to know your medications. Understand how and why they treat and soothe your lungs and airways. If youre prescribed an inhaler, ask for one with a dose counter. Learn when and how youre supposed to use your inhaler and follow your plan to better breathing.

When you hear the term steroids in asthma care, they are referring to NOT the anabolic steroids used illegally in body building.

Inhaled Corticosteroids As Asthma Treatment Options

Inhaled corticosteroids , also known as inhaled steroids, are the most potent anti-inflammatory controller medications available today for asthma control and are used to decrease the frequency and severity of asthma symptoms. They are the current mainstay of treatment once a person with asthma needs a higher level of care than a rescue inhaler .

Inhaled corticosteroids help prevent chronic asthma symptoms such as:

You and your physician may want to consider inhaled corticosteroids if any of the following apply:

  • You use rescue -agonist treatments, such as albuterol, more than two days per week.
  • You have asthma symptoms more than twice weekly.
  • You meet certain criteria on spirometry.
  • Your asthma interferes with your daily activities.
  • You have needed oral steroids two or more times in the last year.

Side Effects Of Asthma Medications

Many medications have side effects. For example, inhaled steroids can cause mild problems, such as thrush infections and a sore throat, or more serious ones including eye disorders and bone loss. Keep your doctor up to date with how well your treatment is working and whether you have side effects. TheyĆ¢ll work with you to keep your asthma under control with as little medicine as possible.

Classes Of Asthma Drugs

There are two main types of drugs doctors prescribe to control asthma. Its important to understand when and why to use each type. The first kind of medication is your long-term control medicine. You might call it your maintenance asthma medicine. You use these medicines on a regular basis to control asthma and prevent attacks. The other kind of medicine is your quick-relief, or rescue medicine. Should an asthma flare-up occur, you use rescue inhalers to relieve symptoms.

Doctors follow expert guidelines when choosing which medicines to use in treating asthma. Classes of asthma drugs include:

After starting treatment, your doctor will regularly monitor your asthma control. Your doctor will want to know how often you experience symptoms, if you have symptoms at night, and how often you use your rescue medicine. You will also need to regularly take peak flow measurements and record them. Your doctor will use all this information to decide whether your current treatment is working.

Are There Any Side Effects

Reliever inhalers are a safe and essential treatment for asthma symptoms when they suddenly flare up. They have very few side effects.

Some people notice that they feel a bit shaky or their heart beats faster than normal.

Youre more likely to notice these side effects if you have needed to use more puffs than recommended of your reliever inhaler. They’ll usually pass quickly and are not dangerous. See your GP or asthma nurse if youre worried.

The best way to avoid side effects is to have a regular asthma review. This means your GP or asthma nurse can make sure youre doing all you can to prevent asthma symptoms, like taking your preventer inhaler regularly as prescribed. 

Your preventer inhaler works away in the background to prevent symptoms from coming on in the first place. If you use it every day, even when youre well, you won’t need to use your reliever inhaler so much.

What Are The Forms Of Bronchodilators

There are two forms of bronchodilators:

  • Short-acting bronchodilators relieve or stop asthma symptoms. You use your rescue inhaler to stop an asthma attack.
  • Long-acting bronchodilators help control asthma symptoms by keeping the airways open for 12 hours. You use these inhalers every day to prevent asthma attacks.

John Thinks Generally Speaking People Understand If They See Someone Using An Inhaler It Might Be Seen As A Bit Geeky Or Not Cool By Some People But Once People Know You They Dont Judge You

Oh thats interesting because lots of people have talked about whether they do or not. You still dont?So why would you not now?Because thats something thats typical. I was just thinking do you think that generally enough is known about asthma, I mean because some people have said to me that they dont take their inhaler public. So general public may not see you using inhalers behind that kind of consciousness?

Asthma Inhaler Type: Dry Powder Inhaler

Dry powder inhalers are used for control medications such as long-acting beta-agonists and inhaled corticosteroids .2 These inhalers cannot be used with a valved holding chamber or spacer. To use these inhalers, you must be able to breathe in forcefully enough to draw the medication into the lungs.

Figure 4. Dry powder inhalers

Instructions for dry powder inhalers vary by device, so reading the instructions for your inhaler is especially important. Some product websites also have videos with a demonstration. General guidelines for using a dry powdered inhaler are:2,3

  • Do not shake your inhaler.
  • Load a dose according to the instructions for your device. You may need twist the inhaler or slide the cover. Each device is different.
  • Turn away from the inhaler and exhale.
  • Put your mouth around the mouthpiece.
  • Breathe in rapidly and deeply for 1 to 2 seconds.
  • Hold your breath for 10 seconds.
  • Rinse out your mouth with water and spit it out, especially if you are taking an inhaled corticosteroid. Rinsing helps to prevent thrush . It also reduces the amount of medication you swallow.
  • The Right Inhaler Technique

    The Chemistry of Asthma Inhalers

    If your inhaler technique isn’t good, you may not be getting much of the medicine into your lungs at all. Problems often arise with the metered dose inhalers, where you have to co-ordinate pressing down to get the dose at the same time as you breathe it in.

    If you press before you breathe, most of the dose ends up on the back of your throat rather than in your lungs. Press after you breathe in and you’ll leave it all in your mouth where it will promptly get breathed out again!

    If you’ve been given a spacer to use with your metered dose inhaler and don’t use it, you’ll get up to 30% less medicine going into your lungs but more going into your body because it’s deposited in your mouth and throat. That makes you more prone to side effects, such as trembling and palpitations from large doses of reliever medication.

    If you’re in any doubt, take your inhaler with you when you get your next check-up with the doctor or nurse and get them to look at how you take it. Alternatively, many pharmacists now have training in checking inhaler technique.

    Tried And True Oral And Inhaled Options

    The two medications most widely recommended for controlling equine asthma are corticosteroids and bronchodilators .1,5

    While systemic anti-inflammatory drugs such as oral prednisolone and injectable dexamethasone can effectively reduce airway inflammation, veterinarians typically try to reserve their use for flare-ups . For daily control to prevent exacerbations, look to inhaled corticosteroids. These medications include fluticasone, budesonide, and beclomethasone that come as inhalants delivered via an aerosol chamber placed over one nostril through which the horse breathes. Inhaled steroids rapidly and effectively improve clinical signs associated with asthma. However, glucocorticoids should be used with caution in horses with a history of laminitis, or at a higher risk for laminitis.

    ASERVO EQUIHALER is not for use in humans and is licensed for intranasal inhalation in horses only. It may be used as part of the overall management of severe equine asthma in addition to other appropriate strategies to control clinical signs, such as environmental changes/modifications and bronchodilator therapy, as needed.6

    Clear Breathing Aheadnovel Treatments In Development

    No single solution for equine asthma exists. Lack of perfection, however, doesnt stop progress, and many equine researchers continue to explore novel paths to make breathing second nature again.

    Stem cell therapy. Because stem cells have potent anti-inflammatory and immunomodulatory properties, scientists are looking to harness those properties for diseases like asthma. To date, researchers have only conducted studies in mice, cats, and humans. This technique shows promise, but dosing, frequency of administration, and treatment timing need to be explored further.9

    Inhaled microscopic immunomodulatory particles. This technology uses small inert, biodegradable particles to alter the immune systems function to decrease airway inflammation. These particles work like allergy shots but dont need to be custom-made for each patient. When researchers tested the particles in horses, they noted significant improvements in respiratory parameters that persisted for eight weeks.4   

    Azithromycin, an immunomodulatory antibiotic. Azithromycin can do far more than just fight infections. This antibiotic also has immunomodulatory properties. When studied in asthmatic horses, levels of proinflammatory interleukins-1b and -8 decreased following treatment. This medication has not yet been studied in enough detail, however, to warrant use in actual patients.10

    Understanding The Different Types Of Inhaled Medication Devices:

    According to the American Academy of Allergy, Asthma & Immunology or AAAI, inhalers are identified by three categories or types. These include dry powder inhalers or DPIs, nebulizers and metered dose inhalers or MDIs.

    • Metered Dose Inhalers: When you think of a standard inhaler, youre imagining an MDI. This inhaler has two parts, the mouthpiece and the pressurized medication canister. You put the mouthpiece into your mouth and then press down. When you breathe, the medication is propelled into your lungs. Again, you must breathe quickly and deeply for the medication to be effective. Holding your breath after dosing will help it be absorbed by your airways.
    • Nebulizers: Nebulizer aerosolize asthma medications which are then inhaled using a mask or mouthpiece.  You wear them over your face, specifically your mouth and nose. They require less coordination than inhalers.  If youre ill, an older adult or a young child, a nebulizer may be prescribed instead of a DPI or MDI.
    • Dry Powder Inhalers: This type of inhaler delivers medications to your lungs in a powder form. Breathing in will pull the medication out of the inhaler into your lungs. To use a DPI, you must inhale slowly and deeply so that the medication can reach your lungs. Again holding your breath after dosing helps the medicine be the most effective.

    Why Is This Important In Asthma

    When you have asthma, actions take place in the airways that can make it hard to breathe. Most often, this happens in reaction to coming into contact with an allergen, such as , pet dander, , or mold. But it can also occur if you are sensitive to certain irritating substances in the environment, such as wood or tobacco , chemical odors, , and air pollution.2

    When an asthma attack occurs, your airway muscles tighten, causing the airways to narrow. In addition, the lining of your airways swells and may produce excess mucus.3 All of these effects make it harder to breathe, causing the hallmark symptoms of asthma:3

    • Wheezing
    • Coughing
    • Chest tightness

    So, anything that would prevent or counteract the effects of an asthma attack will lessen the symptoms of asthma.

    Do Asthma Medicines Have Side Effects

    Yes. All medicines have side effects. Tell your doctor how you are responding to the treatment and if you have any side effects. Follow up often with your doctor so you can control your asthma with the least amount of medicines and with the fewest side effects. 


    Medical Review: June 2021 by S. Allan Bock, MD; Maureen George, PhD, RN, AEC, FAAN; and Sumita Khatri, MD, MS

    References1. Bonds, R., Asawa, A. and Ghazi, A. . Misuse of medical devices: a persistent problem in self-management of asthma and allergic disease. Annals of Allergy, Asthma & Immunology, 114, pp.74-76.e2.

    Asthma Action Plan

    How To Help Someone With An Asthma Attack Without An Inhaler

    Asthma is a very common condition with around one in 13 of us affected. It’s been increasing since the 1980s and affects people of all ages and backgrounds. There’s currently no cure for asthma, but typically with the right treatment plan and lifestyle changes, most people diagnosed with asthma are able to live normally without severe symptoms. 

    However, very occasionally, a person with asthma may be caught off guard. They might find themselves facing an attack without an inhaler to help them. Fortunately, this doesn’t need to be as bad as it might sound. With the right assistance, they could get through an attack using some simple coping techniques. 

    If you know someone with asthma, learning more about their condition, as well as what you can do to help them, can be valuable. 

    Different Kinds Of Inhalers

    There are three basic types of inhalers that deliver medications. The most common is the metered-dose inhaler which uses pressure to push the medication out of the inhaler. Nebulizers use air or oxygen and deliver a mist of the medication through a tube or mask that fits over your nose and mouth. Dry powder inhalers deliver medication, but they require a strong and fast inhalation.

    Short-acting bronchodilators are used as quick-relief, reliever, or rescue inhalers. These bronchodilators open the airways and help stop or relieve acute asthma attacks very quickly. While theyre best known for working on sudden attacks, theyre also great to use before exercise to help stop asthma during your workout. 

    While many people use short-acting bronchodilators, the overuse of an inhaler, tablet, or liquid/nebulizer, is a sign of uncontrolled asthma that needs better treatment. If you are using short-acting bronchodilators more than twice a week, call Charleston Allergy & Asthma about improving your asthma control therapy.

    Long-acting bronchodilators provide control, not quick relief, of asthma. Your board-certified allergist will prescribe the medication, which is usually taken twice a day along with inhaled steroids for long-term monitoring of symptoms. 

    Unlike short-acting inhalers, long-acting inhalers do not work on muscle inflammation directly. Instead, they help the airways relax, allowing more air to pass through.


    When Will Your Doctor Prescribe Steroids For Your Asthma

    Compound Interest

    Your doctor will prescribe steroids for your asthma if you need extra help with symptoms. Theyll prescribe the lowest dose of steroid medicines you need to treat your asthma symptoms and keep you well.

    For example, your GP will prescribe steroid medicine if:  

    • youre taking your reliever inhaler three or more times a week. Most people with asthma are prescribed a steroid preventer inhaler to use every day. It stops inflammation building up in your airways and cuts your risk of symptoms. So, if youve only been given a reliever inhaler, and youre using it three or more times a week, see your GP.
    • youve had an asthma attack. You might be given a short course of steroid tablets to take until your symptoms are fully under control. These can quickly get the swelling in your airways back down again if you have an asthma attack.
    • youre getting asthma symptoms even when youre taking your preventer inhaler as prescribed. This is when a course of steroid tablets may be what you need to get your asthma back under control.

    If your asthma is still not well controlled in spite of high dose inhaled steroids, keep taking them until you can discuss your treatment with your GP. Use our severe asthma tool to find out if you need a referral to a severe asthma specialist.

    Why Are Inhaled Steroids Used To Treat Asthma And Copd

    Inhaled corticosteroids are used extensively in the treatment of asthma and chronic obstructive pulmonary disease due to their broad antiinflammatory effects. They improve lung function, symptoms, and quality of life and reduce exacerbations in both conditions but do not alter the progression of disease.

    Will Medicine Help Me Breathe Better When I Exercise

    Yes. Exercising, particularly in cold air, may cause airway swelling or exercise-induced bronchoconstriction . Quick-relief asthma medicines, taken before exercise, usually control this. If you need repeated doses of quick-relief medicine during and after exercise talk with your doctor. Your medicines may need to be adjusted. Thanks to these medicines, many Olympic and professional athletes have successful sports careers even with their asthma. 

    It is important for everyone, including people with asthma, to be as active as possible for good health. Talk with your doctor about how you can be physically active while keeping your asthma well-controlled. 

    Asthma Medications And Treatment

    When it comes to understanding all of the asthma treatments available, its natural to feel a little bit confused.

    The important thing to remember is that asthma is a variable disease. In other words, asthma symptoms, severity and treatment plans can vary from person to person, and even the same persons condition may fluctuate throughout the year.

    The two most common types of asthma medications are which treat the long-term, underlying inflammation in your airways and which act as your rescue inhaler and provide fast but short-term relief of symptoms. You should speak with your healthcare professionalabout finding a treatment plan that is right for you.

    Talking To Your Doctor

    You should meet regularly with your doctor if you have asthma. During your appointment, youll get to discuss your symptoms and determine whether your treatment plan is effective. Share the records you keep of your symptoms with your doctor so they can get a clear idea of how your management plan is working.

    Your doctor may recommend a few in-office tests to measure your airways. One of these is called a spirometry test. This test measures the amount of air your lungs can let out and how fast the air is let out after a deep breath.

    How Do Immunomodulators Work To Improve Asthma Control

    is a biologic therapy that has been found to control the blood cells that often trigger asthma. Nucala targets Interluken-5 which regulates the levels of blood eosinophils . Genetically engineered, Nucala keeps IL-5 from binding to eosinophils and, thereby, lowers the risk of a severe asthma attack.

    Nucala is administered by injection once every 4 weeks and is meant to be used in conjunction with other asthma treatments as a maintenance medication. By using Nucala, patients have been found to not only experience fewer asthma incidents, but they are able to reduce the amount of their other asthma medications. Side effects include headache and a hypersensitivity reaction that can cause swelling of the face and tongue, dizziness, hives, and breathing problems.

    , an immunomodulator, works differently from other anti-inflammatoryƂ medications for asthma . Xolair blocks the activity of IgE before it can lead to asthma attacks. Immunomodulator treatment has been shown to help reduce the number of asthma attacks in people with moderate to severe allergic asthma whose symptoms are not controlled with inhaled steroids.

    How To Take And Store

    A member of your healthcare team and/or your pharmacist should go over the proper way to use your inhaler when it is first prescribed. Using your inhaler correctly is essential to ensuring you get a full dose of medication.

    Albuterol inhalers are relatively easy to operate. A spacer is recommended as it ensures the medication goes deeper into the throat rather than being dispersed in the mouth.

    If you’re using the inhaler for the first time or have not used it in the past 14 days, you will need to prime it by shaking the canister and pressing it down four times to clear the opening.

    Then, follow these five steps:

  • Exhale completely through your mouth.
  • Place the end of the mouthpiece into your mouth and close your lips tightly around the opening.
  • Inhale deeply as you press the canister down to expel one puff.
  • Hold your breath for 10 seconds, remove the inhaler, and exhale slowly.
  • If you require more than one puff, wait for one minute before repeating these steps.
  • Be sure to clean your inhaler at least once a week to prevent clogs and contamination. Just remove the canister from its holder, rinse the holder under warm water for 30 seconds, and then allow it to dry overnight.

    • Visual changes
    • Worsened breathing

    If used excessively or for long periods of time, albuterol can lead to low potassium levels , which may be serious in people with kidney failure.

    Working With A New Treatment Plan

    You likely have questions or concerns about starting a new treatment plan. They may be about managing numerous medications, budgeting for the costs of the treatment plan, or preparing for an asthma attack. Make sure to discuss them with your doctor at your appointment.

    Write down the details of your new treatment plan to make it easier to follow. Your treatment plan may involve a few different medications, so its important to use them correctly.

    Contact your doctor if you feel confused about the new treatment plan. Your doctor can review what you need to do and answer any questions that come up once you begin.

    Top Home Remedies For Asthma

    Why does asthma make it difficult to breathe?  How It Works

    August 2, 2018

    Roughly 34 million Americans now have asthma, about 7 million to 8 million of which are children. Asthma is behind 12.8 million missed school days and 10.1 million missed work days in the U.S every single year. In addition, asthma costs the U.S. about $14.7 billion a year in medical costs, prescription drugs and lost productivity leading many people to search for home remedies for asthma.

    Heres something that might surprise you: Although asthma medications can help control symptoms in the case of an emergency attack, they can actually sometimes make asthma symptomseven worse long term. Most asthma medications also have a host of side effects due to how they affect the endocrine system and the immune system. Research shows some asthma drugs might contribute to problems including mood changes, acne, yeast growth and weight gain plus over time they might hinder normal immune functions that make allergic and asthmatic reactions more frequent.

    What are some effective, holistic ways of treating asthma that can help prevent attacks instead? Home remedies for asthma that dont require taking prescription medications or even using inhalers include limiting irritant exposure, reducing food allergies, improving gut health, supplementing with vitamin D or getting more naturally from the sun, and maintaining a healthy weight.


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