What should I know about using asthma inhalers?

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.

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.

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.

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.