Inhaled Asthma treatments can often be confusing with so many options and brands available.
In this article you will learn:
Types of Inhaler devices
Inhaled treatments for Asthma come in three main device options. There are constantly newly emerging devices with slight differences in their administration, but these are what patients typically use:
- Pressurised Inhaler or pressurised metered dose inhaler (PMDI)
- Dry powder inhaler (DPI)
1. Pressurised inhaler
Pressurised inhalers store the medicinal contents in a pressurised aerosol canister. To administer, you need to press the trigger to release; and simultaneously breathe in the medicinal particle spray.
If you find this technique difficult, a spacer device can be used. This is a hollow bottle-like or tube with one end that fits on the inhaler mouthpiece, and the other end which fits in your mouth. It allows you to breathe the inhaler contents gradually with multiple inhalations, so you don’t have to worry about inhaling in one go.
2. Dry powder inhaler
This is a non-pressurised device that holds the medicine in a powder form. To use, activate the trigger to release the powder, then simply put your mouth over the mouthpiece and sharply inhale.
Dry powder inhalers are preferred over pressurised inhalers by patients with poor dexterity. However, the dry powder properties can often cause a sore throat, so gargle after use.
These are often referred to as ‘breathing treatment’. Nebulisers turn liquid into a mist so they can be absorbed by the lungs. It requires a machine and mask for a method of delivery. Nebulisers are used by patients whose asthma is very poorly managed and require a lot of aid in breathing.
The most important aspect of using inhalers is making sure you have the correct technique. This allows a healthy quantity of medicinal compound to reach the lungs; and only then will it produce a therapeutic effect. With a poor technique, symptoms may show a lack of improvement.
This will also often decide which device type is best suited for you to manage your asthma appropriately. You should get your technique regularly checked by a pharmacist or prescriber.
Brands often have slight variations in how their devices operate. It is important to be aware of how to use individual devices properly.
Types of inhaler treatments
Your medical prescriber will issue a combination of two or more of the following treatment options.
- Long-acting relievers
- Non- Steroidal Inhalers
Patients are typically prescribed a reliever inhaler and a preventer inhaler to manage their asthma symptoms. If further management is needed, the other options are explored.
The medical term for relievers is short-acting beta agonists. They are commonly known as ‘blue’ inhalers and are used for short term relief of asthma exacerbations.
They work by binding to receptors in the lining of the airway. This results in relaxing and dilating the airway muscle for improved breathing capacity. Thus, breathing will become easier.
They are not for regular use, only for sudden onset of breathing difficulties. They take approximately 15 mins to start working and their effects can last up to 4 hours.
If you are using relievers more than four times a day on a daily basis, you should contact your prescriber to review your therapy.
Examples of relievers are salbutamol and terbutaline.
The medical term for preventers is inhaled corticosteroids. They are commonly known as ‘brown’ inhalers and are used regularly on a daily basis.
They work overtime by preventing swelling and inflammation in the airways. This helps keep the airways clear for optimal breathing. You should use this inhaler every day even when you are feeling well. Consequently, it should keep your asthma managed long term.
Please note if you feel an asthma attack coming on, you should always use blue inhaler (reliever) to relieve your symptoms and not this one.
3. Long-acting relievers
Long-acting relievers are add-on therapies if you need extra help to manage your asthma. Your prescriber may mix and match your therapy to see which works best for you. But they should always be used alongside a reliever and a preventer.
Effects of long-acting relievers can last 12-24 hours and come in two types:
- Long-acting beta antagonists- for example, salmeterol and formoterol. They relax the muscles in the airways and keep them dilated for longer to improve breathing. These sometimes come as a combination with a preventer inhaler, for example, Seretide and Symbicort.
- Long-acting muscarinic agents-for example ipratropium bromide. This reduces mucous for improved breathing.
4. Non-steroidal inhalers
Examples of these are nedocromil sodium and sodium cromoglicate. These are only available as pressured inhalers.
They are not as strong as inhaled corticosteroids but are used when steroid inhalers are not appropriate for a patient.
They are particularly helpful for patients whose asthma is triggered by exercise or allergens.
It is quite easy to become confused at the vast amount of inhaler brands that are available.
An example of this is salbutamol. The generic brand for the salbutamol inhaler Salamol and another brand is Ventolin. Both do the same thing. The main difference is the company brand name and the price. You will notice that they each will also have a pressurised device and a dry powder device.
The Salamol pressurised device is called Salamol CFC-Free and its dry powder device is called Salamol Easi-Breathe.
The Ventolin pressurised device is called Ventolin Evohaler and its dry powder device is called Ventolin Accuhaler.
The variations in brand names and device options are why it can often be overwhelming. But you don’t need to worry. Your regular pharmacist will be aware which brand you use and if you have a preference. The most important thing is to identify which is your reliever and preventer and stick to the inhaler that works best for you.
Key points to remember
- Only use your reliever (blue inhaler) to manage a sudden onset of breathlessness or an asthma attack.
- Keep your reliever (blue inhaler) on hand at all times.
- Your preventer (brown inhaler) is used every day as maintenance even when you are feeling well. Do not use your reliever (blue inhaler) as maintenance therapy.
- Your therapy will be a combination of a reliever (blue inhaler) and a preventer (brown inhaler). Any add-on therapies will be used alongside these two (unless it is a combination preparation).
- Get your technique regularly checked so you can get the best possible management and relief.
- If you struggle with your device you can ask to switch to another type or utilise a spacer device