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What should I know about using asthma inhalers?

Some of the differences between reliever and controller inhalers for asthma include the following:

  • Relievers like bronchodilators are muscle relaxers that work straightaway so people can breathe easier quickly.
  • Controller inhalers reduce inflammation in the airways and help prevent asthma attacks. Controller inhalers don't work straightaway so people might not notice any difference when they first take them. Controllers need to be taken every day to help prevent asthma attacks.
Stacy Wiegman, PharmD
Pharmacy Specialist

The following contains useful information about various oral inhalants often associated with Asthma treatment:

Alvesco
When you use Alvesco (ciclesonide), a medicine for preventing and reducing asthma symptoms, you still need to have a short-acting (rescue) inhaler handy at all times to manage sudden asthma attacks. 

If you take an oral corticosteroid, such as prednisone, you may be able to gradually taper off of it. This process can take months and should be carefully monitored by your doctor, because stopping oral corticosteroids too quickly can be dangerous. It can cause very low blood pressure, nausea, vomiting and other problems.

Beclomethasone

  • Do not use beclomethasone if you are having a sudden asthma attack. There are other medications that are faster acting to help you with sudden attacks. Talk to your doctor about having a fast-acting inhaler such as albuterol available for any issues you may have.
  • Beclomethasone does not cure asthma or other lung diseases, but it helps control the symptoms of lung illnesses.
  • Beclomethasone is used to prevent shortness of breath or wheezing caused by severe asthma or lung diseases.
  • You may begin to feel better and not have as much trouble breathing after using beclomethasone, but do not stop using this medication or your symptoms may return.

Talk to your doctor or healthcare provider if you have any questions about beclomethasone or your dosage instructions.

Your doctor or pharmacist can help you understand the importance of keeping a fast-acting inhaler readily available in case you have a sudden attack and need help to breathe.

Performerist
Perforomist (formoterol) is not approved as a treatment for asthma. It is a long-acting beta agonist (LABA) medication for the long-term treatment of chronic obstructive pulmonary disease (COPD). LABAs such as Perforomist can increase the risk of death for someone with asthma, especially if that person isn't already taking a long-term asthma control medication, such as an inhaled corticosteroid. LABAs should never be taken alone to treat asthma. Your doctor may suggest adding a LABA to your treatment regimen if your symptoms are not being adequately controlled by corticosteroids, but to be safe the added drug will need to contain both a LABA and another long-term asthma medicine -- which is not the case with Perforomist.

People with asthma often use inhalers. Inhaling medication through your mouth can cause a fungal infection called oral candidiasis. Sometimes called thrush, this infection appears as white spots in your mouth and can be painful. Rinsing your mouth after using your inhaler may prevent this infection.

Dr. Snehal R. Patel, MD
Emergency Medicine Specialist

Several different types of inhalers are being used in practice today for asthma, either as single (rescue) and/or in combination ( long-term prophylaxis). Their usage and dosing varies per severity and response of asthma patients. Nonetheless, each of them carries long-term side effects and must be used in proper dosage and frequency within prescribed limits.

  • Albuterol is the most frequently used inhalers as rescue treatment for any asthma patient. Long-term use of it can increase asthma-related death with increased severity of asthma exacerbations, cardiac arrhythmias and hypertension. With frequent usage for long periods it becomes ineffective and may lead to hyperinflation of the lungs.
  • Long-term effects of inhaled corticosteroid are mostly dose related. Osteoporosis, weakened immune system and decreased velocity of growth in children are well-documented side effects.
  • Formoterol and Salmeterol is the long acting b2 agonist (LABA) sometimes used for moderate and severe asthma control. Excessive and improper use of them leads to worsening bronchospasm, hypertensive crisis, cardiac arrhythmias and increased asthma-related deaths.
  • Long-term effects of Cromolyn-sodium Inhalers are rare and still it is unclear whether they are related to drug itself. Some of these are nephrosis, vasculitis, polymyositis, exfoliative dermatitis, anemia, pulmonary infiltrate with eosinophis and hemoptysis.
  • You may use a salt inhaler even with hypertension. For salt (sodium chloride) to affect blood pressure, systemic absorption is necessary. Respiratory mucosal lining cells are generally involved with mucus production as well as maintaining airway protection and immunity. Salt absorption is negligible by these cells. Inhaled salt gets dissolved with mucus present in airways and passively absorbs water and thus liquefies thickened mucus in an asthma patient, which eventually helps expectorate easily.

In general, patients should minimize use of rescue inhalers. Steroid inhalers in lowest effective dose are recommended for prophylaxis of asthma.

Intermountain Registered Dietitians
Nutrition & Dietetics Specialist

Many asthma medications come in small, hand-held devices called inhalers. There are two main types:

  • Metered dose inhalers, or MDI, deliver medication in fixed, measured amounts. Some inhalers have a pressurized canister that sprays out medication when you press down on it.
  • Dry-powder inhalers contain powdered medication that’s released when you breathe in through a mouthpiece. There are many different types of dry-powder inhaler devices. Always follow the instructions provided with your prescription.
Dr. Lawrence T. Chiaramonte, MD
Allergist & Immunologist

It is important to remember that the effectiveness of any medication is in part determined by proper use. When a metered-dose inhaler is used for asthma, the medication is released at a very high speed (60 to 80 miles per hour). This makes it difficult to coordinate the release of the puff at the same time as the inhalation of breath. Further, placing the inhaler in the mouth can produce greater side effects from the drug being absorbed through the mouth into the bloodstream. This is the case with the MDI pirbuterol (Maxair Autohaler), which is activated automatically by placing the device in the mouth and taking in a deep breath.

Thus, drug delivery to the airways is important. A device called a holding chamber greatly enhances proper use of most inhalers. As most rescue inhalers require two puffs, it is essential to wait a minimum of two minutes before the second puff. This allows time for the first puff to open up the airways so that the second puff gets down even further into the smaller airways.

Asthma Allergies Children: A Parent's Guide

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Metered dosed inhaler (MDI)
A metered dose inhaler (MDI) sends a measured dose of medicine in mist form directly into the person’s mouth. The person gently presses down the top of the inhaler.  This causes a small amount of pressurized gas to push the medicine out quickly. Sometimes a “spacer” is used to control the amount of medication that is inhaled.  The medicine goes into the spacer and then the person inhales the medication through the mouthpiece on the spacer.

Dry powder inhaler (DPI)
A dry powder inhaler (DPI) is a hand-held device that delivers a dry powder form of the medication. Some dry powders are tasteless. Others are mixed with lactose to give them a sweet taste. The DPI is administered by breathing in quickly to activate the inhaler. The person does not have to press down the top of the inhaler. DPIs may be difficult for some people to use because of the need to take in a quick, strong breath.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.