Inhalers are a useful tool to make sure medicine can be delivered directly, targetting the lungs. There are many different ways to differentiate between asthma inhalers. Here is a comprehensive guide to inhaler types, colours, names, escalation of treatment and the inhalers right for each group of patients.

3 Main Types of Inhaler

There are three main types of inhaler used for asthma. 

Reliever Inhalers – These inhalers are used to relieve asthma symptoms when they occur. Reliever inhalers are generally used as required.

Prevent Inhalers – These inhalers contain steroids, and they are used to prevent asthma symptoms from occurring. Preventer inhalers must be used every day to be effective.

Combination Inhalers – These inhalers combine the effects of both reliever and preventer inhalers. Combination inhalers are taken every day. 

What do the Different Inhaler Colours Mean?

Colours generally correspond to the three main types of inhaler. Reliever inhalers tend to be blue, preventer inhalers tend to be brown, and purple inhalers tend to be a combination of the two. Here we outline how inhaler colours relate to different inhaler types and brands.

Colour Type Active Ingredient(s) Brands
Blue Reliever Salbutamol sulfate Ventolin
Salamol
Bluish-Green / Teal Reliever Salmeterol Serevent    
Brown Preventer (steroid)    Beclometasone dipropionate Clenil
Reddish-Brown Preventer (steroid) Beclometasone dipropionate Qvar
Orangey-Brown Preventer (steroid) Fluticasone propionate Flixotide
Brown and white Preventer (steroid) Budesonide Pulmicort
Purple Combination Fluticasone propionate and salmeterol Seretide
Red Combination Budesonide and formeterol fumarate dihydrate   Symbicort  

 

Inhalation Methods

Inhalers have different names, based on the substances that you inhale. For example, ‘Ventolin Evohaler’ is a common inhaler. ‘Ventolin’ is the GSK brand name of the active ingredient salbutamol sulphate and ‘Evohaler’ refers to the fact that a propellant that carries the medicine. The propellant is in a liquid form in the canister. When you press on your inhaler, the liquid propellant escapes as a gas/aerosol due to a fall in pressure, and the medicine reaches your lungs when you breathe in. Alternatively, the medicine can be carried in a dry powder form instead. Here we summarise which type of inhalers are aerosols and which are powder inhalers. 

Aerosol Inhalers Dry Powder Inhalers
Aerosol
Autohaler
Easi-breathe
Evohaler
MDI (metered-dose inhaler)		 Accuhaler
Clickhaler
Diskhaler
Easyhaler
Turbohaler

The same active substance can be in an aerosol inhaler or a dry powder inhaler e.g. ‘Flixotide Accuhaler’ and ‘Flixotide Evohaler’. However, manufacturers may make each with a different dose. Therefore, you should not assume that two different types of inhalers from the same brand will have the same dose. Your doctor will take this into account when prescribing your inhalers, so always ensure that you read the prescribing information and patient information leaflet every time you get a new inhaler. 

Escalation of Treatment

If your asthma is poorly controlled and getting in the way of your life, you should discuss this with your doctor. Signs that your asthma is poorly controlled may include:

  • Daily symptoms including chest tightness, shortness of breath, wheezing and coughing
  • Frequently having to use your reliever inhaler (3 times a week or more)
  • Nighttime flare-ups
  • Needing to visit the hospital because of asthma attacks

  • Steps of asthma management can roughly be simplified into the following:
  • At each stage, a blue inhaler can be used for relief
  • Newly diagnosed asthma sufferers may get a blue inhaler
    • Next, a brown inhaler may be used as a preventer
    • After that, a purple inhaler may be used
  • Additional add-on therapies may be considered, and doses will be further adjusted
  • Next, steroid doses may be further increased, and a fourth drug may be needed which will be discussed by a specialist
  • A specialist may finally consider options like oral steroids

Which Inhaler is Right For Me?

In addition to considering the severity of your asthma, a doctor will also take into account any other illnesses that you suffer from, so that you have an inhaler that is easy to use. 

Metered-Dose Inhalers 

Pros: Smaller, cheaper and quick to use. 

Cons: Pressing down for a puff may be difficult for those that have arthritis. Coordinating breathing can also be hard if someone has a cognitive impairment.


Dry Powder Inhalers 

Pros: It works when you choose to breathe in, so coordination is less of an issue.

Better for the environment. This is because they do not use propellants like HFA, which are greenhouse gases.

Cons: It may still be challenging for arthritis patients to load the drug by pressing a lever or pushing a button before inhalation. COPD patients may also have difficulty because a deep breath is needed. 

These inhalers tend to be more expensive than metered-dose inhalers


Ellipta Dry Powder Inhalers 

Pros: More suitable for those with poor grip strength or dexterity as the inhalers are preloaded.

Cons: The dose counter may be difficult if you have a visual impairment.


Mist Inhalers

Pros: The mist is slow-moving so you can breathe slower and easier.

Cons: The canister may be challenging to turn and the dose counter could be hard to read with a visual impairment. 


Summary

Controlling your asthma is very important, and various inhalers can enable you to do this. Your doctor will take into consideration your symptoms, the severity of your asthma and your own unique needs when prescribing an inhaler to you. Make sure you use your inhaler correctly and as directed. If you wish to switch to an alternative inhaler such as an inhaler that is more environmentally friendly talk to your doctor. Remember to seek medical attention promptly if you are having severe respiratory problems.

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