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How Was Asthma Treated Before Inhalers

What Are Common Asthma Attack Triggers

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An asthma attack happens when someone comes in contact with substances that irritate them. Healthcare providers call these substances triggers. Knowing what triggers your asthma makes it easier to avoid asthma attacks.

For some people, a trigger can bring on an attack right away. Sometimes, an attack may start hours or days later.

Triggers can be different for each person. But some common triggers include:

  • Air pollution: Many things outside can cause an asthma attack. Air pollution includes factory emissions, car exhaust, wildfire smoke and more.
  • Dust mites: You cant see these bugs, but they are in many homes. If you have a dust mite allergy, they can cause an asthma attack.
  • Exercise: For some people, exercising can cause an attack.
  • Mold: Damp places can spawn mold. It can cause problems for people with asthma. You dont even have to be allergic to mold to have an attack.
  • Pests: Cockroaches, mice and other household pests can cause asthma attacks.
  • Pets: Your pets can cause asthma attacks. If youre allergic to pet dander , breathing in the dander can irritate your airways.
  • Tobacco smoke: If you or someone in your home smokes, you have a higher risk of developing asthma. The best solution is to quit smoking.
  • Strong chemicals or smells.

With asthma, you may not have all of these symptoms. You may have different signs at different times. And symptoms can change between asthma attacks.

How To Take Asthma Medication Effectively

Taking medication regularly can be difficult. It can be easy to forget and many people dislike having to take medication, especially when they feel well and have no symptoms. But it is important to take your medication correctly and follow medical advice.Tips to help you take asthma medication include:

  • Ask your health professional for written instructions on the role of each medicine as part of your asthma action plan. Include details on how, when and how much to take, and what to do if symptoms get worse.
  • Know the side effects of your medication so that you know what is and isnt normal.
  • Ask your doctor if your medication can be simplified. Such as using one device for all your medications.
  • Ask for a device that you feel comfortable with. There are special aids for people who have trouble coordinating inhalers .
  • Make sure you know how to use your devices correctly. Ask your doctor or health professional to check your technique.
  • Create memory aids to remind yourself to take your asthma medication, such as before brushing your teeth in the morning and evening.

If you have any concerns, talk to your doctor, asthma educator or pharmacist.

Other Medication And Asthma Triggers

Some medication for other health conditions can make asthma symptoms worse and trigger an asthma flare-up or attack.

It is very important that you inform your doctor and pharmacist that you have asthma when a new medicine is prescribed to you or when you are buying over-the-counter medication or complementary therapies.

If you feel a particular medicine is making your asthma worse, treat your symptoms and contact your doctor immediately.Some medicines known to trigger asthma symptoms in some people include:

  • aspirin contained in some medication, such as pain relievers
  • non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen
  • beta-blocker tablets often used to control high blood pressure
  • beta-blocker eye drops to treat the eye condition glaucoma
  • ace inhibitors often used to control high blood pressure.

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A Typical Treatment Plan

A common treatment plan for a typical person with moderate asthma is:

  • A preventer inhaler , taken each morning and at bedtime. This usually prevents symptoms throughout the day and night.
  • A reliever inhaler may be needed now and then if breakthrough symptoms occur. For example, if symptoms flare up when you have a cough or cold.
  • If exercise or sport causes symptoms then a dose of a reliever inhaler just before the exercise usually prevents symptoms.
  • The dose of the preventer inhaler may need to be increased for a while if you have a cough or cold, or during the hay fever season.
  • Some people may need to add in an LTRA and/or a long-acting bronchodilator if symptoms are not controlled with the above.

At first, adjusting doses of inhalers is usually done on the advice of a doctor or nurse. In time, you may agree an asthma action plan with your doctor or nurse.

Do Asthma Medicines Have Side Effects

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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

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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.

The Inhaler A Profile

Born: 1956 in the US.

Career: On its introduction, replaced the cumbersome squeeze-bulb glass nebuliser. Initially held medicine used to relieve symptoms but later also used to issue preventive medicine.

They say: Dispensed for no good reason, and have become almost a fashion accessory . Inhaled steroids have absolutely revolutionised asthma care .

High point: Replacing steroid tablets, which had higher risk of serious side-effects such as growth suppression. With inhalers the medicine is breathed directly into the lungs, only a small proportion is absorbed into the blood and so there are fewer side-effects.

Low point: Shortly after their introduction, when they contained a medicine called isoprenaline, their use was linked to the asthma epidemic of the 1960s.

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The Standard Mdi Inhaler

A standard MDI is shown above. The MDI has been used for over 40 years and is used to deliver various types and brands of medicines. It contains a pressurised inactive gas that propels a dose of medicine in each ‘puff’. Each dose is released by pressing the top of the inhaler. This type of inhaler is quick to use, small, and convenient to carry. It needs good co-ordination to press the canister and breathe in fully at the same time. Sometimes these are known as evohalers .

The standard MDI is the most widely used inhaler. However, many people do not use it to its best effect. Common errors include:

  • Not shaking the inhaler before using it.
  • Inhaling too sharply or at the wrong time.
  • Not holding your breath long enough after breathing in the contents.

Until recently, the propellant gas in MDI inhalers has been a chlorofluorocarbon . However, CFCs damage the Earth’s ozone layer and so are being phased out. The newer CFC-free inhalers work just as well, but they use a different propellant gas that does not damage the ozone layer.

Aerosol Inhalers/metered Dose Inhalers

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These are likely the one you are most familiar with: Also known as a puffer, this inhaler, or pressurized metered dose inhaler , is a canister filled with asthma medication suspended in a propellant. When the canister is pushed down, a measured dose of the medication is pushed out as you breathe it in. Examples of MDIs are: Ventolin, Flovent, Advair, Alvesco, Airomir, and QVar.

This medication should be used with a spacer for increased delivery to the airways. When your inhaler is used alone, medicine often ends up in your mouth, throat, stomach and lungs. Medicine left in your mouth, throat and stomach may cause unpleasant taste and side effects. When you use a drug delivery system with your inhaler, more medicine is delivered to your lungs.

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Should I Be Using A Spacer

Asthma Canada recommends that anyone, of any age, who is using a puffer should consider using a spacer. A pharmacist, respiratory therapist, asthma educator, or doctor can assess how you use your puffer and will recommend the best device for you.

It is recommended that children use a spacer device with their puffer.

Spacers should not be used with dry powder inhalers only with puffer-style devices. Puffers with either a rectangular or a round mouthpiece should be able to fit into a spacer ask your healthcare provider for a demonstration if you are unsure how to set it up.

How Do You Monitor Asthma Symptoms

Monitoring your asthma symptoms is an essential piece of managing the disease. Your healthcare provider may have you use a peak flow meter. This device measures how fast you can blow air out of your lungs. It can help your provider make adjustments to your medication. It also tells you if your symptoms are getting worse.

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Assessment With A Peak Flow Meter

This is an alternative test. A peak flow meter is a small device that you blow into. A doctor or nurse will show you how. It measures the speed of air that you can blow out of your lungs. No matter how strong you are, if your airways are narrowed, your peak flow reading will be lower than expected for your age, size and sex. If you have untreated asthma then you will normally have low and variable peak flow readings. Also, peak flow readings in the morning are usually lower than in the evening if you have asthma.

You may be asked to keep a diary over two weeks or so of peak flow readings. Typically, a person with asthma will usually have low and variable peak flow readings over several days. Peak flow readings improve when the narrowed airways are opened up with treatment. Regular peak flow readings can be used to help assess how well treatment is working. See the separate leaflets called Asthma – Peak Flow Meter and Peak flow diary for more details.

Asthma Inhaler Type: Dry Powder Inhaler

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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.
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    How To Use A Cat Inhaler To Treat Feline Asthma

    This article is part of our Cat Asthma series. Download the full Guide To Cat Asthma here.

    To treat feline asthma, cats are prescribed corticosteroids to reduce inflammation and, in many cases, bronchodilators to open the airways during asthma attacks.

    Traditionally, these medications have been given as oral medications or injections. However, inhaled medications are a better option for treating cat asthma because the medication targets the airways directly, instead of needing to be processed by the body first. There are also fewer potential side effects when using inhaled medications compared to oral or injected medications, making it the preferred method of treatment for many veterinarians and pet owners.

    Just like inhalers are used to treat asthma in humans, inhalers can be used to treat asthma in cats. It’s important to be familiar with how to use a cat inhaler in order to make sure your cat gets the medication they need.

    For many, the thought of using a mask on their cat is terrifying. However, most cats, including the grumpy ones, are accepting and can learn and love to use an inhaler mask. It certainly can be easier than trying to give your cat a pill, especially when in distress .

    Reliever Medication For Asthma

    Reliever medication is used for an asthma flare-up or emergency. It opens the airways quickly and is taken as needed for immediate relief from asthma symptoms.

    Reliever medication is sometimes overused. Using too much, or too often, could lead to side effects, including tremors and a rapid heart rate.

    These side effects are not likely to cause harm. However, frequent use of reliever medication may be a sign that your asthma is not being well controlled. If you need to use a reliever more than twice a week for asthma symptoms , see your doctor to review your asthma and medication.

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    How Do Asthma Treatments Work

    Asthma treatments work in these ways:

  • They relax the muscles that tighten around the airways. They relieve the squeeze. They can be short- or long-acting. By opening the airways, they help remove and reduce mucus. These medicines are bronchodilators or beta agonists.
  • They reduce the swelling and mucus inside the airways. These medicines are anti-inflammatories .
  • Bronchodilators

    Bronchodilators can be short- or long-acting. If you use short-acting bronchodilators more than two days a week, talk with your doctor about your asthma control. You may need to make changes to your treatment plan to better control your asthma.


    Anti-inflammatories come in many different forms. They are also called controllers because they help to control or prevent asthma symptoms. They reduce swelling and extra mucus inside the airways. They will not relieve sudden symptoms.

    Other Types of Medicines and Treatments

    Single Maintenance and Reliever Therapy

    The 2020 Focused Updates to the Asthma Management Guidelines recommends single maintenance and reliever therapy, also known as SMART. SMART uses one inhaler that has two medicines as a quick-relief and controller medicine. When on SMART, you can either take your medicine only as needed to relieve sudden symptoms, or you can take it daily as a controller and as needed for quick relief. This is based on your age and the severity of your asthma.

    Tests Of Bronchial Hyperreactivity

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    When spirometry is normal, but symptoms and the clinical history are suggestive of asthma, measurement of airway responsiveness using direct airway challenges to inhaled bronchoconstrictor stimuli or indirect challenges may help confirm a diagnosis of asthma.

    Tests of bronchial hyperreactivity should be conducted in accordance with standardized protocols in a pulmonary function laboratory or other facility equipped to manage acute bronchospasm. Bronchopovocation testing involves the patient inhaling increasing doses or concentrations of an inert stimulus until a given level of bronchoconstriction is achieved, typically a 20% fall in FEV1. An inhaled rapid-acting bronchodilator is then provided to reverse the obstruction. Test results are usually expressed as the provocative dose or provocative concentration of the provoking agent that causes the FEV1 to drop by 20% . For methacholine, most pulmonary function laboratories use a PC20 value less than 4-8 mg/mL as the threshold for a positive result indicative of airway hyperreactivity, supporting a diagnosis of asthma. However, positive challenge tests are not specific to asthma and may occur with other conditions such as allergic rhinitis and chronic obstructive pulmonary disease . Therefore, tests of bronchial hyperreactivity may be most useful for ruling out asthma among individuals who are symptomatic. A negative test result in a symptomatic patient not receiving anti-inflammatory therapy is highly sensitive .

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    Inhalers Nebulizers And Pills As Asthma Medicine

    There are a few ways to take asthma medications. Some are inhaled, using a metered dose inhaler, dry powder inhaler, or a nebulizer . Others are taken by mouth, either in pill or liquid form. They can also be given by injection.

    Some asthma drugs can be taken together. And some inhalers mix two different medications to get the drugs to your airways quicker.

    Is A Brown Inhaler Always A Preventer

    Preventer inhalers are sometimes brown, but again, this can vary.

    Preventers contain an active ingredient known as a corticosteroid. A regular, low dose of this medication builds up in your system over time to keep asthma symptoms at bay, by reducing trigger sensitivity and inflammation.

    You should use your preventer inhaler as prescribed by your doctor, even if you feel well. This is usually twice a day to reduce the chances of having an asthma attack.

    A preventer inhaler should not be used in the event of an asthma attack, as the active ingredient will not act fast enough to alleviate your symptoms.

    Some examples of preventer inhalers are:

    Not all asthma patients require a preventer inhaler, but if your doctor prescribes one then you should use it as directed.

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    How To Use An Mdi Inhaler Without A Spacer

    Take off the mouthpiece cover, then:

    • Shake it for 5 seconds.
    • Hold the inhaler up with your index finger on top and your thumb underneath to support it. Use the other hand to hold the spacer if you need to.
    • Breathe out.
    • Put the mouthpiece between your teeth, and close your lips tightly around it.
    • You can also hold the mouthpiece about the width of two fingers away from your mouth.
    • Press the top down, and breathe in until your lungs fill completely — about 4-6 seconds.
    • Hold the medicine in your lungs as long as you can , then breathe out.
    • If you donĂ¢t get enough air in the first breath, wait 15-30 seconds and try again. Shake the canister again before the next puff.
    • Recap the mouthpiece.
    • If your medicine has a steroid in it, rinse your mouth and gargle with water after you use the inhaler. Spit out the water.


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