Which Asthma Inhaler To Use First

Who Can Use Steroid Inhalers

Most people can use steroid inhalers.

Tell your doctor before starting treatment if you:

• have had an allergic reaction to steroids in the past
• have tuberculosis or another infection of your lungs or airways
• are pregnant, breastfeeding or trying for a baby

Steroid inhalers are normally safe to use while breastfeeding and during pregnancy, but it’s a good idea to get medical advice first.

If you need to take a high dose during pregnancy, you may need regular check-ups to check for any side effects.

How Long Should You Wait To Repeat A Dose Of Your Inhaler

Knowing how long to wait between inhaler doses depends on the type of device and the amount of medicine required to manage your symptoms. You should always ask your doctor how often to repeat your medicine.

Controller inhalers are available as metered-dose , soft-mist, and dry-powder formulations. These medicines are used to prevent asthma complications. It is generally recommended to inhale 1 puff of your controller inhaler twice daily at the same time every day. Although there are multiple dosing variations, controller inhalers are not usually taken more than twice a day.6

Rescue inhalers are used to quickly restore your breathing during a flare-up. They are also given to prevent exercise-induced asthma. These inhalers are most commonly available as an MDI. Doses are usually repeated every 4 to 6 hours as needed. It is important to wait at least 60 seconds between puffs for the best results.10

Nebulizer machines allow you to breathe in your medicine through a face mask or a handheld tube. These machines are found in hospital settings, though many people also use them at home. Nebulizer treatments are usually repeated 3 to 4 times daily as directed.11

Types Of Preventer Inhaler

There are different types of corticosteroid preventer inhaler. They can be different colours, but most are brown.

• Metered dose inhalers give the medicine in a spray form . This is the one you can use with a spacer.
• Breath actuated inhalers release a spray of medicine when you begin to inhale.
• Dry powder inhalers give the medicine in a dry powder instead of a spray.

You can talk to your GP or asthma nurse about the best inhaler device for you.

If you find your inhaler difficult to use, you can see if there is another device you might find easier.

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Using Steroid Inhalers With Other Medicines Food Or Alcohol

Some medicines can interfere with the way steroid inhalers work, but this is uncommon if you’re only taking low doses for a short period.

Tell a doctor if you take any other medicines, including herbal remedies and supplements, before starting to use a steroid inhaler.

If you’re already using an inhaler, ask a doctor or pharmacist for advice before taking any other medicines, remedies or supplements.

You can usually drink alcohol while using a steroid inhaler and you should be able to eat most foods. Do not smoke though, as this can make your medicine less effective and make your symptoms worse.

Quick Relief: Rescue Inhaler

Rescue or relief inhalers quickly bring back normal breathing when you are:

• Short of breath

You should keep a rescue inhaler with you all the time. Use it:

• When you have a flare of symptoms
• Before you’re going to be around your asthma triggers
• When you run into unexpected triggers

A rescue inhaler is for short-term symptom relief, not to control your asthma in the long term. If you’re using yours 2 or more days a week, or more than 2 nights a month, talk to your doctor about a daily control inhaler.

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To Use Your Puffer With A Spacer:

How Steroid Inhalers Work

Steroids are a man-made version of hormones normally produced by the adrenal glands, which are 2 small glands found above the kidneys.

When they’re inhaled, steroids reduce swelling in your airways.

This can help reduce symptoms of asthma and COPD, such as wheezing and shortness of breath.

Steroid inhalers are different to the anabolic steroids that some people use illegally to increase their muscle mass.

Page last reviewed: 15 January 2020 Next review due: 15 January 2023

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How Do Preventers Help Asthma

Preventers are the mainstay of asthma treatment because they treat the underlying cause of the symptoms. They contain a corticosteroid which works by making the airways less sensitive, reduce redness and swelling and help to dry up mucus.

You need to take your preventer every day for it to work properly, to preventsymptomsand reduce the likelihood ofasthma attacks. It may take two to four weeks before they reach their full effect. Preventers have also been found to improve asthma-related quality of life.

Combination preventers contain two or more medicines in one inhaler. They are the next step up in asthma treatment. Read more here:Combination Preventers

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.

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What Do Asthma Management Guidelines Currently Say

The Australian Asthma Management Handbook recommends inhaled corticosteroids for patients with mild asthma characterised by occasional symptoms, exacerbations more than 6-8 weeks apart and a normal forced expiratory volume in one second when asymptomatic.10It also states that preventive treatment is indicated if patients require reliever medication 3-4 times a week or more.

The British Thoracic Society guidelines advise starting inhaled corticosteroids when a reliever is taken three or more times a week, exacerbations of asthma have occurred in the last two years, symptoms are occurring three or more times a week, or are causing night waking one night a week.11Although the British guidelines state that a threshold for introducing inhaled steroids has never been firmly established, in recent years several large studies and meta-analyses have been published. These enable firmer recommendations and an assessment of the strength of evidence supporting the guidelines.

Preventer Inhaler Top Tips

1. Get into a good routine

Keep your preventer inhaler somewhere that reminds you to take it for example, next to something else you do every day. Or try a reminder app on your phone. Sticking to a good routine makes taking your inhaler an everyday habit like brushing your teeth.

2. Dont run out of preventer medicine

Make sure you contact your GP for a new prescription before your preventer inhaler runs out. Some inhaler devices have a counter to show how many doses are left. When the numbers on the counter turn red, its time to contact your GP for a new prescription.

You can arrange repeat prescriptions with your local pharmacy to make things easier.

3. Take old inhalers back to the pharmacy

You can return your used inhalers to any pharmacy. This means they can be disposed of in a safe and environmentally friendly way.

If you have concerns about the environmental impact of inhalers, its good to know that alongside considering the best device for you and your asthma, your GP can also look at the carbon footprint of different inhalers.

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Controller And Reliever Medicines Work Together

There are two main kinds of asthma medicines: preventer medicine and rescue medicine. Each medicine is important, and each medicine does a different thing for your lungs.For most people with asthma, the doctor will prescribe both kinds of medicine:

Some people think they can skip the preventer medicine and only use the rescue medicine. This is dangerous. If you’ve been prescribed a preventer medicine, use it. The rescue medicine by itself will not control your asthma over the long term. To make sure you get all your medicine into your lungs, be sure you know how to use your inhalation device.

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 donât 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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When Will I Start To See An Improvement

If you’re taking your combination inhaler as prescribed, and using the right inhaler technique, you should start to see improvements quickly.

You might notice:

• you dont need your blue reliever inhaler as much
• youre less wheezy and breathless
• youre coughing less during the day and at night
• youre sleeping better – this is because the long-acting bronchodilator in your combined inhaler lasts for 12 hours which means you should see an improvement in night-time symptoms.

The preventer part of your combination inhaler builds up protection over time. You should notice things starting to improve after a few days.

And after a few weeks, once your preventer medicine has cut down the inflammation in your airways, you’ll really start to get the full benefit of taking it regularly.

For example, you probably won’t react as badly to your asthma triggers, you may sleep better, or find you can do things like climb stairs without asthma symptoms.

Steroid Inhalers Manage Inflammation

Inhaled corticosteroids help with asthma and COPD management by treating airway inflammation. Steroid inhalers deliver medicine directly to your lungs to reduce inflammation and swelling and ease breathing.

Unlike a bronchodilator, which works through the nervous system, steroids work on the inflammatory cells in your airways. Corticosteroids mimic the hormone cortisol, an anti-inflammatory hormone naturally produced by the body.

Steroid inhalers are not rescue inhalers and should not be used for quick relief of symptoms. It can take weeks of daily steroid inhaler use before you notice improvement. Thereafter, it may take several hours or even a day for a steroid to do its job.

Inhaled corticosteroids are delivered as a dry powder. Common steroid inhalers include:

• Aerobid

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How To Clean Your Metered

Clean your MDI once a week, or as directed, to make sure it doesnt become blocked. Start by removing the cap and canister. Do not put the canister in water. Rinse the plastic mouthpiece and cap in warm water for about 30 seconds, if this is recommended for your particular MDI. Some recommend cleaning with a dry cloth or tissue only. Shake the mouthpiece and cap to remove excess water and leave out to air dry. Once dry, replace the metal canister and cap and its ready to use.

What Is A Preventer Inhaler

A preventer inhaler is the main way to treat asthma. It contains a low dose of steroid medicine to keep down inflammation and swelling in your airways.

Giving the medicine through an inhaler means it can get to your airways more easily.

The steroids in your preventer inhaler are called corticosteroids, says Dr Andy Whittamore, Asthma UKs in-house GP. They are a copy of the steroids our bodies produce naturally. They are not the same as steroids used by bodybuilders.

Your preventer inhaler is not for asthma attacks

You need to use your reliever inhaler when symptoms come on. Your reliever inhaler acts quickly when you have an asthma attack, so keep it with you at all times.

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Knowing When To Refill With Dose Counters

If you have asthma, its essential to monitor your medication to take care of your health.

In an effort to help patients know when their inhaler has exceeded or is nearing the last available dose, GlaxoSmithKline Pharmaceuticals developed the first MDI with an integrated dose counter in 2004.

All new MDIs are now recommended to have dose counters or dose indicators. Counters show how many sprays the inhaler has left, while indicators turn a different color when the medications running low. This means you know exactly when you need to refill, so youre not caught short when your symptoms flare.

If Your Asthma Is Not Controlled Using Only Inhaled Corticosteroids Your Doctor May Add On Another Controller Medication Other Controller Also Need To Be Taken Regularly These Include:

Combined inhalers: corticosteroids and Long-Acting Beta2-Agonists

Doctors usually prescribe an inhaler that has a combined medicine of Long-Acting Beta2-Agonists and corticosteroid and is for people whose asthma is not controlled by their usual medicine. Long-Acting Beta2-Agonists are inhaled medicines help the airways relax, allowing more air to pass through. They have to be used in combination with an corticosteroid. A combined inhaler ensures you get both.

Examples of combination asthma medicines:

• Advair®: Made of a corticosteroid plus a Long-Acting Beta2-Agonists
• Breo®: Made of corticosteroid plus a Long-Acting Beta2-Agonists
• Symbicort®: Made of a corticosteroid plus a Long-Acting Beta2-Agonists
• Zenhale®: Made of a corticosteroid plus a Long-Acting Beta2-Agonists

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Asthma Inhaler Type: Metered

Metered-dose inhalers are used for rescue medications and control medications such as long-acting beta-agonists and inhaled corticosteroids .2

Figure 1. Metered dose inhaler

General guidelines for using a metered-dose inhaler are:2,3

Metered-dose inhalers can be difficult to use. It is hard to coordinate releasing the medication and breathing in. This is particularly hard for young children and elderly adults.2 If you use a valved holding chamber, you do not need to coordinate the puffing and breathing.2

Rules For Asthma Inhaler Colours

While blue and brown are commonly used colours, inhalers are manufactured by many different pharmaceutical brands and are used by patients across the globe. There are no rules to restrict what colours are chosen by the manufacturers for the different types of inhaler they are free to use whichever colour they see fit.

Over the years the two main types of inhaler have, for the most part, stuck to the convention of brown and blue.

There have been calls from groups of asthma specialists and healthcare professionals for a regulated colour-coded system to be implemented and particularly so for relievers as these need to be identified quickly when used in an emergency.

The UK Inhaler Group carried out a recent survey which found that 95 percent of surveyed healthcare professionals felt that the blue colour convention was important when referring to reliever inhalers.

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What Is Inhaler Priming

Priming is spraying empty puffs into the air before you inhale your first puff. When you prime your inhaler, no medicine is wasted. In fact, if you do not prime your inhaler, you may not get a full dose of medicine, even though you feel a burst of air in your mouth.3

Priming allows the ingredients to be mixed together well so that when you inhale your first puff, the active drug successfully makes it into your lungs. This is especially important for devices that are not used daily.4,5

How To Use A Dry Powder Inhaler

• Prime your inhaler. Read the instructions for use that come with your inhaler to find out how to load a dose of medication. Some DPIs require a powder-filled capsule to be loaded for each use, while others have pre-loaded doses of powder. DPIs with pre-loaded powder will have an indicator to show how many doses are left.Do not load a dose until you are ready to use it or shake your inhaler. Do not try to inhale the contents of a capsule without the appropriate device.
• For regular use, stand or sit up straight and empty all the air out of your lungs by breathing out completely.
• Put the mouthpiece up to your mouth and form a tight seal around it with your lips. The mouthpiece should be pointed up or held horizontally. Do not use a spacer with a DPI.
• Breathe in quickly and forcefully through the mouthpiece, then remove the inhaler from your mouth and hold your breath for 10 seconds before slowly exhaling.
• If using a capsule device check that there is no powder left in the capsule. If powder is still visible then close the device and repeat the steps above to inhale the remainder of the powder.
• If a second dose is required, load a new dose and repeat the steps above.
• Close the device and store in a dry place.
• Rinse your mouth out if instructed to do so.

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