Asthma Inhalers

Most people with asthma experience some breathing difficulties at certain times, such as after exercising or because of common triggers, like pollen or common cold infection. People with severe asthma may experience asthma symptoms or breathing issues most of the time.

The most common asthma symptoms are:

• wheezing
• breathlessness
• chest tightness
• coughing

Symptoms of an asthma attack

An asthma attack is when your asthma symptoms get worse for a short time and can happen suddenly or over a few days.

The symptoms of a severe asthma attack include:

• wheezing, coughing, and chest tightness that become severe and constant
• being too breathless to eat, speak, or sleep
• faster breathing than normal
• faster heartbeat than normal
• drowsiness
• confusion
• exhaustion
• dizziness
• fainting
• blue lips or fingers

Symptoms of a silent asthma attack

Silent asthma affects your respiratory system but you may not have audible asthma symptoms like coughing or wheezing.

Silent asthma symptoms include:

• breathlessness
• chest tightness
• fatigue
• distress
• difficulty speaking, eating, or sleeping
• restlessness

People with asthma have inflamed and sensitive airways that can become narrow and blocked with sticky mucus when exposed to specific triggers.

Although the exact cause of asthma is unknown, several factors increase the risk of getting asthma, such as:

• family history
• allergy-related conditions (like eczema, hay fever, or food allergies)
• smoking
• air pollution
• premature birth

Asthma symptoms usually occur in response to specific triggers. Most of these triggers are either genetic or environmental and aggravate the airways. They include:

• allergens (such as pollen, dust mites, and pet dander)
• infections
• pollution
• medications
• mould or damp
• exercise
• emotions

Asthma isn’t curable but there are treatments available to help manage your symptoms so that your day to day life is not disrupted by them.

There are several different asthma treatment options, including:

• inhalers
• tablets
• injections

Inhalers

Inhalers are the main treatment available for asthma and are used to:

• prevent asthma symptoms occurring
• relieve asthma symptoms when they happen

Most people who are diagnosed with asthma will be given a reliever or blue inhaler to treat asthma symptoms when they occur and help them breathe easily. You may also be prescribed a preventer, or ‘brown inhaler’, especially if you need to regularly use your reliever inhaler, to stop asthma symptoms from happening.

Tablets

If an inhaler alone does not control your asthma symptoms, you may be prescribed tablets, such as:

• leukotriene receptor agonists (LTRAs)
• theophylline
• steroids

Injections

If your asthma is severe, injections can be given every few weeks to help control the symptoms. However, injections are usually only given in extreme cases.

A doctor will inject biologic medications, like omalizumab, mepolizumab, reslizumab, or benralizumab, into the body which disrupt the pathways that cause lung inflammation and reduce the risk of having an asthma attack.

Surgery

A surgical treatment called bronchial thermoplasty is performed to treat severe asthma. It is performed under general anaesthetic and involves a thin tube being inserted into your lungs. Heat is then used to stop the airway muscles from narrowing and causing asthma symptoms.

How to identify your asthma triggers

It may be obvious what triggers your asthma. For example, coming into contact with a pet or being around people who smoke may start your symptoms off.

However, some triggers are less visible, like pollen. Some triggers may cause a delayed reaction. So, it is helpful to keep a symptom diary detailing what symptoms you have experienced and the activities you have taken part in. Some people also find it useful to keep a record of their peak flow to help them identify any patterns.

Preventing and treating an asthma attack

Identifying your asthma triggers will help you avoid future asthma attacks because you will be able to avoid them.

You can also help to prevent asthma attacks by:

• following your personal asthma action plan and taking all medications exactly as they have been prescribed
• attending regular or yearly asthma reviews
• checking with your doctor or asthma nurse that you are taking your medication or using your inhaler properly

If you feel like you are having an asthma attack, you should:

1. Keep calm and sit up straight.
2. Use 1 puff of your reliever inhaler every 30 to 60 seconds – up to 10 puffs.
3. If after 10 puffs you do not feel better, or you feel worse at any time, call 999.
4. If an ambulance does not arrive within 10 minutes and your symptoms are not improving, repeat step 2.
5. If a further 10 puffs have still not improved your symptoms, call 999 again.

If you do not have your reliever inhaler with you, try to remain calm and:

• sit up straight
• steady your breathing and take slow deep breaths as much as possible
• call 999 for an ambulance
• if you know what has triggered your symptoms, try to move away from it if you can

There are 3 main types of asthma inhaler available:

• reliever inhalers
• preventer inhalers
• combination inhalers

Reliever inhalers

A reliever inhaler, sometimes known as a rescue inhaler, is a medical device that is used to relieve asthma symptoms during an asthma attack. Reliever inhalers are usually blue and include:

• Ventolin
• salbutamol

Reliever inhalers contain the active ingredient salbutamol, a bronchodilator that works to relax the smooth muscles in your airway, making it easier to breathe.

Reliever inhalers usually work within 5 minutes to help relieve asthma symptoms and can last for 4 to 6 hours. You should only use your reliever inhaler when you are experiencing asthma attack symptoms.

Preventer inhalers

A preventer inhaler helps to stop the symptoms of asthma or chronic obstructive pulmonary disorder (COPD) from occurring. It does not stop an asthma attack, but stops the symptoms from developing in the first place.

If you need to treat asthma symptoms, you’ll need a reliever inhaler.

Preventer inhalers usually contain corticosteroids to reduce the inflammation and irritation in your airways. This stops an asthma attack from developing. It’s why you might hear a preventer inhaler being called a ‘steroid inhaler’. Some of the corticosteroids used in preventer inhalers include:

• beclometasone
• budesonide

Some preventer inhalers do not contain corticosteroids and instead contain long-acting bronchodilators like salmeterol or formoterol. These work to relax the muscles in the airways, making it easier to breathe.

When you first start using a preventer inhaler, it can take up to 10 days for the inflammation in your lungs to reduce and 6 weeks for you to feel the full benefit.

You’ll need to use your preventer inhaler every day. Your doctor will tell you how many puffs you will need to take but it is usually 1 or 2 puffs in the morning and 1 or 2 puffs in the evening.

Some of the preventer inhalers available from Superdrug Online Doctor are:

• Clenil Modulite
• Pulmicort Turbohaler
• Qvar Aerosol
• Qvar Autohaler
• Qvar Easi-Breathe

Combination inhalers

Combination inhalers contain 2 medications, a steroid to reduce inflammation and a long-acting bronchodilator to relax the muscles in the airways. These inhalers combine the effects of preventer and reliever inhalers to effectively manage asthma.

Preventer inhalers are usually used daily to prevent an asthma attack from developing. They can also be used as reliever inhalers. Your doctor will tell you how many puffs and how often you’ll need to use your preventer inhaler.

The combination inhalers available from Superdrug Online Doctor are:

• Symbicort Turbohaler
• Fostair
• Seretide

There are different types of inhalers available which require you to use them in different ways. For example:

• pressurised metered-dose inhaler
• turbohaler
• easi-breathe inhaler
• accuhaler
• autohaler

For instructions about how to use your specific inhaler, you should read the patient information leaflet that has been supplied with your medication. Your doctor or asthma nurse will tell you how many puffs you’ll need to take and when you need to use it.

Here, we’ll provide you with basic instructions about how to use each type of inhaler.

Pressurised metered-dose inhalers

A pressurised metered-dose inhaler (pMDI), also known as a ‘puffer’, delivers an exact amount of medication to the lungs to treat asthma and COPD. Examples include:

• Clenil Modulite
• Ventolin
• Fostair
• Seretide Evohaler

How to use a metered-dose inhaler:

1. Hold the inhaler upright and remove the cap covering the mouthpiece.
2. Check for any blockages or debris.
3. Shake the inhaler well.
4. Slowly breathe out, away from your inhaler, until your lungs feel empty.
5. Place your lips around the mouthpiece to make a tight seal and slowly begin to breathe in through your mouth.
6. Press the canister on the inhaler once to release the medication.
7. Keep breathing in slowly as far as you can.
8. Remove the inhaler from your mouth, keep your lips closed, and hold your breath for 10 seconds or as long as it feels comfortable.
9. Gently breathe out, away from your inhaler.
10. If you have been prescribed another puff, wait 30 seconds before shaking the inhaler again and repeating the steps.
11. When you have finished, replace the cap on your inhaler.
12. If your inhaler contains steroids, rinse your mouth with some water and spit out to reduce the risk of side effects.

Turbohaler

Turbohalers, like Symbicort and Pulmicort, are activated by breath and deliver your medication in dry powder form to your lungs.

How to use a turbohaler:

1. Holding your inhaler upright with the coloured base at the bottom, twist off the top cover.
2. Check there is nothing inside the mouthpiece.
3. Make sure the inhaler isn’t empty by checking the dose counter.
4. Turn the coloured base as far to the right as it will go and then to the left until you hear a ‘click’.
5. Sit or stand up straight, slightly tilting your head back.
6. Slowly breathe out, away from your inhaler, until your lungs feel empty.
7. Hold the inhaler horizontally, but don’t tip it upside down because the powder will fall out.
8. Place your lips around the mouthpiece to make a tight seal.
9. Breathe in quickly and deeply until your lungs feel full.
10. Remove the inhaler out of your mouth and with your lips closed, hold your breath for 10 seconds or for as long as you comfortably can.
11. Gently breathe out, away from your inhaler.
12. If you’ve been prescribed a second dose, you’ll need to repeat these steps.
13. When you have finished, twist the protective cover back on.
14. If your inhaler contains steroids, rinse your mouth with some water and spit out to reduce the risk of side effects.

Easi-breathe inhalers

Easi-breathe inhalers, like the Qvar Easi-Breathe, release the medication automatically when you breathe in and are designed for people who find standard inhalers difficult to use.

How to use an Easi-breathe inhaler:

1. Hold the inhaler upright and shake well.
2. Open the cap and check there is nothing inside the mouthpiece.
3. Make sure your fingers are not covering the air holes on the top of the inhaler.
4. Sit or stand up straight and slightly tilt your chin up to help the medication reach your lungs.
5. Slowly breathe out, away from your inhaler, until your lungs feel empty.
6. Put your lips around the mouthpiece to make a tight seal.
7. Breathe in slowly and steadily.
8. Keep breathing in when you feel the inhaler puff in your mouth, until you have taken a full, deep breath in.
9. Remove the inhaler from your mouth and hold your breath for up to 10 seconds or as long as you comfortably can.
10. Breathe out gently away from the inhaler.
11. If you’ve been prescribed a second dose, close the cap, wait 1 minute and then shake the inhaler again.
12. Repeat the steps.
13. When you have finished, close the cap.
14. If your inhaler contains steroids, rinse your mouth with some water and spit out to reduce the risk of side effects.

Accuhaler

Seretide accuhaler is an example of an accuhaler. It is a circular inhaler which releases dry powder into your lungs.

How to use an accuhaler

1. Slide open the cover.
2. Check the mouthpiece is clear of any blockages.
3. Check the dose counter to make sure the inhaler is not empty.
4. Hold the inhaler horizontally, but don’t tip it upside down because the powder may fall out.
5. Push the lever back with your thumb until it clicks to load the inhaler.
6. Sit or stand up straight and slightly tilt your chin upwards to help the medication reach your lungs.
7. Breathe out slowly and gently away from the inhaler, until your lungs feel empty.
8. Put your lips around the mouthpiece to create a tight seal.
9. Breathe in quickly and deeply until your lungs feel full.
10. Remove the inhaler from your mouth and with your lips closed, hold your breath for up to 10 seconds or for as long as you feel comfortable doing so.
11. Gently breathe out away from your inhaler.
12. If you have been prescribed a second puff, slide the cover closed to reset the inhaler.
13. Repeat the steps.
14. When you’ve finished, close the cover.
15. If your inhaler contains steroids, rinse your mouth with some water and spit out to reduce the risk of side effects.

Autohaler

If you have been prescribed an autohaler, like the Qvar autohaler, you’ll need to follow these steps to use it:

1. Remove the cover by pulling the lip down at the back.
2. Check there is nothing inside the mouthpiece.
3. Hold the inhaler upright, making sure you’re not covering the air vents at the bottom.
4. Shake the inhaler well.
5. Flip the red lever on top of the inhaler until it clicks into place.
6. Sit or stand up straight and slightly tilt your chin up to help the medication reach your lungs.
7. Breathe out slowly and gently away from the inhaler until your lungs feel empty.
8. Put your lips around the mouthpiece to make a tight seal.
9. Breathe in slowly and steadily.
10. Continue breathing in when you hear a click and feel a puff of medication in your mouth.
11. Remove the inhaler from your mouth and hold your breath for up to 10 seconds or as long as you comfortably can.
12. Breathe out gently away from your inhaler.
13. If you have been prescribed a second puff, wait 30 seconds to 1 minute and shake the inhaler again.
14. Then repeat the steps.
15. When you have finished, replace the cover, and make sure the red lever is down.
16. If your inhaler contains steroids, rinse your mouth with some water and spit out to reduce the risk of side effects.

“It is important that you use your inhaler properly to make sure the medication reaches your airways. If you do not, your symptoms may persist or get worse. If you are not sure how to use your inhaler and have read the patient leaflet, contact your doctor or nurse for advice. You can also use a device called a spacer to help. ” – Dr Brenda Ikeji, Medical Editor.

Asthma inhalers are prescription-only medications, so you will need a doctor’s approval to obtain one. You can request asthma inhalers from online services, like Superdrug Online Doctor or get them on the NHS.

Can you buy asthma inhalers online?

Yes, you can request preventer, reliever, and combination inhalers online from Superdrug Online Doctor. The ordering process is quick and you won’t need to wait for a face-to-face appointment with a doctor.

1. Complete a short online questionnaire about your health and lifestyle.
2. Order your preferred treatment and make payment.
3. One of our doctors will review your answers to the questionnaire and your order to see if it is suitable for you.
4. If approved, your order will be delivered to your address in plain packaging or to a Superdrug Pharmacy for collection, based on what you choose during the order process.
5. If our doctors do not feel the inhaler you selected is right for you, they will contact you via your account with other suitable treatment options.

Can you buy asthma inhalers over the counter?

No, you must have a prescription from a doctor to get an asthma inhaler.

Can you get asthma inhalers through the NHS?

Yes, you can obtain an asthma inhaler on the NHS, but you will need to make an appointment with your GP to get a prescription.

Like all medications, asthma inhalers can cause side effects, but not everyone will get them. Using your inhaler properly can help to minimise the risk of side effects. The side effects you may experience can depend on the type of inhaler you are using.

Steroid inhaler common side effects:

• sore throat or mouth
• hoarse or croaky voice
• coughing
• oral thrush

Rare side effects affecting up to 1 in 10,000 people include:

• swollen face, eyes, lips, and throat
• thinning and weakened bones
• cataracts and glaucoma

Reliever inhaler common side effects:

• feeling shaky
• headaches

Rare side effects of reliever inhalers affecting up to 1 in 1000 people are:

• low blood potassium levels
• increased blood flow to your fingers and toes

What to do if you get side effects

If you experience any side effects while taking your inhaler, you should let your doctor know straight away. Do not stop taking your medication unless your doctor tells you to.

If you experience any signs of an allergic reaction whilst using your inhaler, call 999 or go to A&E immediately. Signs of an allergic reaction include:

• swollen face, lips, mouth, tongue, or throat
• difficulty swallowing or breathing
• itchy skin rash
• feeling faint or lightheaded
• collapse

For more information on the specific side effects of your asthma inhaler, read the patient information leaflet that comes with your treatment.

How should I dispose of my asthma inhaler?

Never throw your inhaler away in your household rubbish. Ask your pharmacist how you should discard your used inhalers. This will ensure your medication is disposed of safely and in an environmentally friendly way.

How should I care for my asthma inhaler?

Generally, you should:

• store your inhaler below 30 degrees Celsius
• protect it from frost and direct sunlight
• if your inhaler contains a metal canister and it gets very cold, remove the canister from the plastic case and warm it up in your hands for a few minutes before use
• always check the expiry date and never use the inhaler if it has expired
• clean your inhaler once a week by following the instructions in the patient leaflet

Check the patient information leaflet that came with your inhaler to find out how you should care for your specific inhaler.

What inhaler is best for severe asthma?

Most people with asthma control their symptoms with a daily preventer inhaler and a reliever inhaler when they get asthma symptoms.

For people who have asthma that is difficult to manage, they may need extra treatments or a combined inhaler, like Fostair.

What is cough-variant asthma?

Cough-variant asthma is a type of asthma where a dry, chronic cough is the only symptom. You don’t experience other asthma symptoms like wheezing or breathlessness. It is usually treated with a steroid inhaler.

What is seasonal asthma?

Seasonal asthma is when you only get asthma symptoms at certain times of the year, such as during hay fever season or when the weather is cold.

What is brittle asthma?

A rare and serious type of asthma that is difficult to control, brittle asthma can cause unpredictable and life-threatening asthma attacks.

How is asthma diagnosed?

You will need to see your GP for an asthma diagnosis which is usually made based on your symptoms and some simple tests. A GP will usually ask:

• what symptoms you have
• when your symptoms happen and how often
• if there are any triggers that cause your asthma symptoms
• if you have any allergies

Your GP may also run some simple tests to diagnose asthma, such as:

• FeNO test – a machine that measures how much nitric oxide is in your breath, which is a sign of lung inflammation
• spirometry – you’ll need to blow into a machine to measure how fast you can breathe out and how much air you can hold in your lungs
• peak flow test – a device that measures how quickly you can breathe out

What is the difference between asthma and COPD?

Asthma and COPD are chronic respiratory conditions that cause similar symptoms. However, with asthma, the narrowing of your airways comes and goes, usually when you are exposed to a trigger, whereas in COPD, they narrow permanently.