Reliever Inhalers for Asthma

A reliever inhaler is a puffer used to stop asthma or COPD (chronic obstructive pulmonary disease) symptoms as they happen. You use it to manage coughing, wheezing, shortness of breath and tightness in the chest.

You need a prescription to get a reliever inhaler and should follow your doctor’s advice on how to use it.

A reliever inhaler helps to manage breathing difficulties as they happen, whereas a preventer inhaler is used to stop symptoms occurring in the first place.

Reliever inhalers are usually blue. Other inhalers can also be blue, so always check the label carefully.

The drug used in reliever inhalers is called salbutamol. It can be bought unbranded, or under the brand name of Ventolin.

You can get 3 different types of reliever inhalers.

• Pressurised metered-dose (pMDIs): sprays the medicine, can be used with a spacer
• Breath-actuated inhalers (BAIs): releases a spray of medicine when you begin to inhale
• Dry powder inhalers (DPIs): gives the medicine in a dry powder

The most common type is the pMDI.

Reliever inhalers work by relaxing the bronchial muscles in your airways in your lungs, making it easier for you to breathe.

What is in a reliever inhaler?

Reliever inhalers contain bronchodilator medicines, usually salbutamol or terbutaline. Both work in the same way to relax the muscles in your lungs.

How long does it take for a reliever inhaler to work?

Your symptoms should start to improve within a few minutes of taking your reliever inhaler.

Always follow these steps when using your reliever inhaler:

1. Stand straight or sit upright.
2. Take off the mouthpiece cover and check it is clean before you use it.
3. Shake the inhaler several times.
4. If it is a new inhaler or you haven’t used it for 5 days, make sure it is still working by pressing the canister for 1 or 2 puffs. If you cannot see a puff of the medicine in the air, it may be empty.
5. Hold the inhaler upright with your thumb at the base just below the mouthpiece.
6. Breathe out.
7. Put your lips around the mouthpiece to make a tight seal. It should rest between your teeth.
8. Breathe in and press down on the top of the inhaler. Continue breathing in steadily and deeply as the inhaler releases a puff of medicine.
9. Hold your breath for as long as you can to allow the medication to get into your airways.
10. If you have been advised to take 2 puffs, wait 30 seconds before repeating the process.
11. Always replace the mouthpiece cover immediately after use.

If you have difficulty breathing while using the inhaler, talk to your doctor about using a ‘spacer’. This will help you inhale the medication more easily.

When should I use a reliever inhaler?

You should use your reliever inhaler when you start to have symptoms.

If you know you are going to be in an environment with substances (such as animal hair, dust or pollen) that trigger your asthma or you have exercise-induced asthma, you can use your reliever inhaler 10 to 15 minutes before to help stop symptoms from starting.

Should I use a preventer or reliever inhaler first?

If you have been prescribed a preventer inhaler and a reliever inhaler, you should use both of them as directed by your doctor. If you are having an asthma attack, you should use your reliever inhaler.

Generally, a preventer inhaler is used daily to help prevent symptoms from starting, and you use the reliever inhaler when you need to stop symptoms as they happen.

How many puffs should I take?

Your doctor will advise you on how many puffs you should take.

For most relievers, you can take 2 puffs up to a maximum of 4 times in any 24 hours. If you need to take more than this amount, you should seek urgent medical advice.

For some people, 1 puff every 4 hours may be enough to relieve the symptoms. Whether you take 1 puff or 2 puffs, you should only use your inhaler 4 times in any 24 hours.

How often should you use a reliever inhaler?

You should use your reliever inhaler to help when you are having symptoms of asthma. Your doctor will advise you on how many puffs you should take. This is usually 1 or 2 each time, with a maximum of 8 puffs in a day.

If you have severe symptoms such as an asthma attack, you can safely take up to 10 puffs, with 30 seconds between each puff. You can then repeat this 10 minutes later. Always shake the inhaler between each session of 10 puffs. If you are needing to take 10 puffs in this way, you must also seek medical advice, as your asthma may suddenly get worse.

Talk to your doctor if you find you need to take more puffs than the recommended dose.

What should I do if I take too much?

If you use your reliever inhaler too much, you can feel shaky or as though your heart is beating too fast. This usually goes away within 30 minutes or a few hours at most. If you also have chest pain, seek urgent medical advice.

What should I do if my reliever inhaler doesn’t work?

You can check if your inhaler is working properly by releasing a puff into the air and checking you can see the medicine. If you cannot, it may be empty or clogged. Clean your inhaler every week to stop it from getting blocked.

If your inhaler is working properly, but it is not helping to alleviate your symptoms, you must seek urgent medical advice. It is likely your asthma attack is severe and not being controlled by medication, which means it might quickly get worse.

How to look after your reliever inhaler

Clean your inhaler every week to stop it blocking when you need to use it:

1. Take the metal canister from the casing and remove the mouthpiece.
2. Do not put the metal canister in water.
3. Hold the plastic casing under the tap and run warm water through it.
4. Make sure the casing is completely dry before putting the metal canister and mouthpiece on again.
5. Shake the inhaler and spray it into the air once to make sure it works.

Reliever inhalers are safe to use if used in the right way, as prescribed by your doctor. As with all medicines, some people have side effects that vary in type and severity from person to person.

Talk to your doctor as soon as possible if you:

• have an allergic reaction (symptoms include swelling of the face, lips, mouth, tongue or throat, which may cause difficulty in breathing or swallowing, itchy rashes, feeling light headed, and collapse)
• feel your heart beating faster (tachycardia) or stronger than usual (palpitations)
• feel that the side effects are impacting your life

Common side effects (may affect 1 in 10 people) include:

• feeling shaky
• increased or uneven heart rate

Uncommon side effects that may affect 1 in 100 people include:

• Headaches

Rare side effects (may affect 1 in 1000 people) include:

• a low level of potassium in your blood
• increased blood flow to your fingers and toes
• mouth and throat irritation
• muscle cramps

Very rare side effects (may affect up to 1 in 10,000 people) include:

• chest pain
• heart attack

For more information on side effects, please read the patient leaflet provided with your inhaler. This will provide information on the specific inhaler you are using.

You should not use a reliever inhaler if you are allergic to any of the ingredients.

Tell the doctor prescribing your inhaler if you have:

• a disease affecting the heart or blood vessels
• infection in your lungs
• overactive thyroid
• low levels of potassium in your blood
• diabetes
• hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption

Tell the doctor prescribing your inhaler if you are taking:

• theophylline or aminophylline (xanthines) for breathing problems
• beta-blockers for your blood pressure, e.g. propranolol
• water tablets (diuretics) and other medicines for heart problems
• medications to manage depression