Asthma Inhalers

Asthma is a long-term lung condition that affects the tubes that carry air into and out of the lungs (airways), causing them to become inflamed and swollen. If this happens, your airways become narrower, which reduces the amount of air that can enter and leave your lungs.

Asthma symptoms can be triggered by things like:

• allergens, like pet hair, dust, and pollen
• smoke
• cold air or weather
• some infections
• exercise

What are the symptoms of asthma?

The main asthma symptoms are:

• coughing
• wheezing
• chest tightness
• shortness of breath

During an asthma attack, you may have these symptoms as well as:

• difficulty speaking in full sentences
• breathing faster and more rapidly
• blue lips, nails, or ear lobes
• exhaustion
• extreme distress

Asthma is treated with inhalers. Asthma inhalers contain medication that can prevent asthma symptoms, relieve them, or a combination of both, depending on the type. Your doctor will tell you which type of inhaler for asthma you have.

Preventer inhalers

A preventer inhaler for asthma, also known as a brown inhaler, contains corticosteroids and are used every day to prevent asthma attacks. They work by relaxing the immune system to lower the inflammation in the airways, opening them up, and stopping symptoms, like coughing and wheezing, from happening. Common examples of preventer inhalers include Clenil Modulite, Qvar, and Pulmicort Turbohaler.

Reliever inhalers

A reliever asthma inhaler contains a bronchodilator that relaxes the smooth muscles in your airways, quickly opening them, and making it easier to breathe. A reliever inhaler, also known as a blue puffer, is used as and when you have asthma symptoms. Common reliever inhalers include Ventolin and generic salbutamol inhalers.

Current UK asthma guidelines state that everyone with asthma must receive an inhaled steroid as part of their treatment plan, so no one with asthma can be prescribed only a reliever inhaler. If you only have a blue inhaler, make an appointment with your GP to discuss your asthma medication.

Combination inhalers

Combination inhalers for asthma contain both an inhaled steroid to prevent asthma symptoms and a long-acting bronchodilator to widen your airways.

Depending on the type of combination inhaler you have, you may need a separate blue reliever inhaler. That’s because some combination inhalers contain slower acting long-acting bronchodilators that may not work quick enough during an asthma attack. An example of this is Seretide Accuhaler or Evohaler. Although it contains the bronchodilator, salmeterol, you will need a separate blue inhaler that contains the faster acting salbutamol. You should always follow your doctor’s instructions to make sure you are using your combination correctly.

Combination inhalers containing the long-acting bronchodilator formoterol can be used as a preventer inhaler, but can also be used in 2 other ways depending on your symptoms:

1. Anti-inflammatory reliever (AIR) therapy – If you are on an AIR plan, then you use your combination inhaler similarly to a blue reliever inhaler – as and when needed. However, a combination inhaler is safer than a reliever on its own because it also contains a low dose of steroids to treat the inflammation causing your asthma, reducing your chance of having an asthma attack. Common types of asthma inhalers that can be used for AIR therapy are Symbicort Turbohaler 200/6, Duoresp Spiromax 160/4.5, Fobumix 160/4.5, and WockAIR 160/4.5.
2. Maintenance and reliever therapy (MART) – Combination asthma inhalers used for MART are used daily to prevent symptoms and when you need them to relieve them, just like a separate preventer and reliever inhaler is used. AIR inhalers can also be used for MART, but common MART combination inhalers include Fostair, Luforbec, Proxor, Vivaire and Bibecfo.

If you have a formoterol-containing combination inhaler and are using it as AIR or MART therapy, you should not need a separate reliever inhaler.

How you use your asthma inhaler will depend on which type of device you have. Some use pressurised gases to propel the medication into your airways, while others are activated by taking a sharp, deep breath. Whichever device you have, using the right technique will mean you get the best results from your medication.

Pressurised metered dose inhaler (pMDI)

A pMDI is a common type of asthma inhaler that contains a metal canister with the medication inside, a metering valve, and a plastic mouthpiece. It uses a pressurised gas to deliver an exact amount of medication to your lungs. To use a pMDI you should:

1. Remove the mouthpiece cap and check it is free from debris.
2. Shake the inhaler well.
3. Sit or stand upright.
4. Breathe out gently and slowly away from the inhaler as far as you comfortably can.
5. Place your lips around the mouthpiece, making sure you avoid biting down.
6. Begin breathing in slowly through your mouth and at the same time press down on the metal canister to release the medication. Keep breathing in until your lungs feel full.
7. Remove the inhaler from your mouth and hold your breath for up to 10 seconds.
8. Then breathe out away from your inhaler.
9. If you have been prescribed a second puff, wait 30 seconds and repeat steps 2 to 8.
10. Replace the mouthpiece cover when you have finished with the inhaler.

Some people may need to use a spacer with this type of inhaler. A spacer is a plastic tube that attaches to the pMDI and one end and the other end has a mouthpiece or mask where you breathe the medication in. A spacer can make the inhaler easier to use and ensure you get the correct amount of medication.

Dry powder inhalers (DPIs)

Dry powder inhalers contain fine powder rather than a spray and are breath-activated. This means you need to take a deep strong breath in to release the powder. To use a DPI, you need to:

1. Twist off the cover and hold the inhaler so the coloured base is at the bottom.
2. Turn the coloured base as far as it will go in one direction, then all the way back again. You should hear a click.
3. Repeat this once more.
4. Check there is nothing inside the mouthpiece.
5. Hold the inhaler upright and sit or stand up to use it.
6. Breathe out gently and slowly away from the inhaler, until you feel like you are ready to breathe in.
7. Hold the inhaler horizontally but do not tip it upside down as the medication may fall out.
8. Place your lips around the mouthpiece to create a tight seal and breathe in quickly and deeply through your mouth until your lungs feel full.
9. Remove the inhaler from your mouth and hold your breath for up to 10 seconds.
10. Away from the inhaler, breathe out gently.
11. If you have been prescribed a second puff, repeat steps 2 to 10.
12. Twist the cover back on once you have finished.

When you have used all of the doses in your inhaler or it has passed its expiry date, you will need to dispose of it properly. Asthma inhalers should not be thrown away in your household rubbish. Instead, you should take your used or unwanted inhalers for asthma to your local pharmacy for safe disposal.

If you throw your inhalers in the bin, they can release gases, which can impact the environment, so taking them to a pharmacy is the safest and most environmentally friendly option.