Asthma Inhalers: A Comprehensive Guide

Asthma inhalers are portable medical equipment that deliver medication directly into the lungs and help with asthma symptoms. 

Inhalers fall under two main classes: “reliever inhalers” and “preventer inhalers.” Reliever inhalers, also known as bronchodilators or rescue inhalers open up the airways quickly during an asthma attack. The two main drugs in a reliever inhaler are usually Salbutamol or Terbutaline. 

On the other hand, long-term control (preventer) inhalers contain corticosteroids which reduce inflammation and prevent symptoms from occurring in the first place. These are used daily to prevent asthma symptoms. or other drugs. 

All these inhalers are designed to deliver a measured dose of medication in the lungs in the form of the mist or fine powder. This form of administration ensures that medication takes effect immediately and efficiently. 

Combination inhalers are sometimes used as part of an asthma management plan. These contain both a reliever and preventer medication. 

Targeted drug delivery in the form of an aerosol fine spray is delivered to the lungs via the correct breathing technique. The medication then deposits onto the inner surface of the lungs where it is absorbed.

Long-Acting Bronchodilators (LABAs)

Long-acting bronchodilators also known as long acting beta-2 agonists are a type of asthma inhaler used to provide long-term symptom management while improving airflow to the lungs and airways. They work in a similar way to short acting bronchodilators such as Salbutamol but their effects last for up to 12 hours, whereas short acting bronchodilators usually last up to four hours.  They are mainly prescribed with inhaled corticosteroids in combination inhalers but can be given on their own in some cases.

Asthma Inhalers Dosing Guidelines 

The dosing of asthma inhalers is dependent on the medication type and the patient’s age. For short-acting beta agonists (SABAs), such as salbutamol, the usual practice is to take them on an as-needed basis, with a common dose of 1-2 puffs during the symptoms or before exercise. 

Inhaled corticosteroids, which serve long-term maintenance of asthma, are taken daily at consistent doses to prevent inflammation and decrease the risk of asthma attacks. Regular use of a rescue inhaler signals inadequate asthma management, therefore you should see your GP or asthma nurse if this is the case. Uncontrolled asthma refers to symptoms which impact a persons daily life or restrict normal activities, as well as using a rescue inhaler on 3 or more days per week or night time wakening due to symptoms at least once a week.

The dose of the inhaler varies with children and adults, children need lower doses and spacers to ensure the accurate delivery of medication into the lungs. Stick to your doctor’s guidelines regarding dosage and administration to avoid side effects.

For medication to reach your lungs and work effectively, you must use your asthma inhaler correctly. Every type of inhaler – a Metered Dose Inhaler ( MDI ), Dry Powder Inhaler( DPI ), and nebulizer – demands certain techniques such as:

pMDIs (e.g., Ventolin):

• Shake the inhaler well.
• Exhale slowly and completely before use.
• Sit or stand upright with your chin tilted slightly upwards. This will help the medicine reach your lungs.
• Place your lips aroung the mouthpiece to make a tight seal.
• Start inhaling slowly and steadily while pressing on the canister once.
• Continue to inhale slowly and deeply (until your lungs feel full).
• Take the inhale out of your mouth and with your lips closed, hold your breath for 10 seconds or for as long as you can comfortably.
• If a second puff is prescribed, wait 30 seconds and repeat.

Complete a test spray into the air if it is the first time using your inhaler or you have not used it for more than 5 days.

DPIs (e.g., Accuhaler or Turbohaler):

• Sit or stand upright with your chin slightly tilted upwards as this helps the medicine reach your lungs. 
• Load your desired dose by twisting or sliding the mechanism (according to instructions).
• Breathe out completely, away from the device. Your lungs should feel empty and you feel ready to breathe in.
• Put your lips around the mouthpiece to make a tight seal. 
• Inhale deeply and quickly until your lungs feel full.
• Take the inhaler out of your mouth and hold your breath for 10 seconds.
• Then breathe out gently away from the inhaler.
• If you've been prescribed a second dose, slide the cover closed to reset the inhaler and repeat the steps. 

If you've used an inhaler that contains steroids, rinse your mouth with water and spit it out to reduce any chance of side effects. 

Nebulizers:

• Wash your hands before using the nebuliser.
• Make sure the nebuliser tubing or mask is fitted to the machine.
• Make sure there are no gaps if you use a mouthpiece or a facemask as the medication may escape and you will not get your full dose.
• While seated upright, attach the mask or mouthpiece, then turn the machine on.
• Keep breathing in and out in a relaxed and normal way (usually takes 10–15 minutes).

The medication in the nebulizer converts from a liquid to a fine mist which is delivered to your lungs via a facemask or mouthpiece.

Key tips
For children, always use a spacer with MDIs as per the guidelines to improve drug delivery. Avoid common mistakes such as inhaling too fast or too slowly with DPIs, not shaking the MDI, or not rinsing your mouth after using a steroid inhaler. Follow regular technique check-ups with your doctor to ensure the best results.

The most common side effects of inhalers are:

• Oral thrush (fungal infection) occurs through the use of corticosteroid inhalers, especially if you do not rinse your mouth after use.
• Hoarseness or sore throat, linked with the use of steroid inhalers, due to the medication hitting the back of the throat by inhaling too quickly.
• Coughing or dry mouth, possible with MDIs and DPIs, if the inhalation technique is poor.
• Increased heart rate or palpitations, especially when bronchodilators are overused.

While the majority of side effects are mild and do not pose great concern, they can be alleviated with proper use and good inhaler hygiene. However, if they persist or get worse, speak to your healthcare professional.

Cleaning and maintenance of your inhaler is necessary to make sure that it operates accurately and provides the right dose every time. With time, moisture or dust clogs the device or medication buildup, leading to poor performance and poor asthma control.

For Cleaning 

MDIs (Metered Dose Inhalers): Only wash the plastic parts of your metered dose inhaler. Never let the metal canister get wet. Take out the metal canister and remove the cap. Rinse the plastic case with warm water for 30 seconds. Dry the plastic case inside and outside before putting the canister back in.  

DPIs (Dry Powder Inhalers): Water is strictly prohibited with dry powder inhalers, If the powder gets wet, it can stop your inhaler from working properly. So, gently wipe the mouthpiece with a dry tissue or cloth to remove residual powder. 

Nebulizers: You must wash the mask/mouthpiece and the medication chamber with warm, soapy water after each use. Rinse thoroughly and let it air dry. Disinfect it regularly according to the manufacturer's protocol, generally by boiling or using a sterile solution.  

For Maintenance

• Place the mouthpiece cap on when not in use to prevent debris and dust from entering. 
• Keep your inhaler in a cool, dry place, away from heat, moisture, or direct sunlight.
• Replace your inhaler once its expiry date has passed.
• Store your inhaler at room temperature.
• Avoid leaving your inhaler in direct sunlight or in cold temperatures. This can stop your inhaler from working properly.
• Keep your inhaler dry as moisture can affect how well it works. For example, avoid storing in a bathroom which can get hot and damp. 

Are inhalers safe during pregnancy?

Most inhalers are deemed safe during pregnancy, especially when utilized as prescribed. Effectively managing asthma in pregnant people is important for both maternal and fetal health. The benefits of controlled breathing often overshadow its potential risks.

What if I forget a dose of my preventer inhaler?

If you miss a dose of a preventer inhaler, take it as soon as you remember, but not if it is the time of your next dose. Do not take double doses to compensate for missed doses. Adhere to your regular schedule and consult a doctor if you have missed multiple doses in a row.

What inhalers are used for asthma?

The inhalers that are used for asthma may include; quick-relief inhalers such as Salbutamol and Terbutaline, LABA-ICS combinations like Fostair and Symbicort, and long-term control inhalers containing inhaled corticosteroids. The selection depends on the frequency and severity of symptoms.

Shapes and Sizes of Asthma Inhalers

Asthma inhalers have different designs to meet different needs and preferences. As an example, Ventolin is a compact metered dose inhaler (MDI) which is small and portable, making it ideal for on-the-go use. DPIs (breath-actuated dry powder inhalers), such as the Spiriva HandiHaler, are bulkier but lack the need for hand-breath coordination. 

DPIs do require a strong, deep breath for dose activation, which may pose challenges for certain users, like young children or elderly individuals. Soft mist inhalers (SMIs) and nebulizers are better suited for home use, as they provide relief to patients who have coordination or breathing difficulties by delivering medicine in the form of a mist or slow, steady aerosol over time. 

The design and shape of the inhaler may have a significant impact on its ease of use, medicine delivery, and the overall management of asthma. So, for effective control, select the right type based on your condition and preferences.

Who Needs to Use an Inhaler?

A person suffering from asthma, chronic obstructive pulmonary disease (COPD), or other respiratory conditions that affect breathing use inhalers. This device delivers medication directly to the lungs for quick relief or long-term asthma control. Also, doctors prescribe inhalers to those patients who often experience wheezing, shortness of breath, or tightness in the chest.

What is the Difference Between an Inhaler and a Nebulizer?

Both nebulizers and inhalers serve the same purpose in delivering medication to the lungs; however, the deviceswork differently. An inhaler is a compact, portable device that releases a measured dose of medicine, which the patient inhales quickly, usually in the form of a dry powder or spray.

On the other hand, nebulizers turn liquid medicines into fine mists which can be inhaled via a mask or mouthpiece over several minutes, making them easier to use for young children and those suffering from severe respiratory issues. While nebulisers are best for those who want longer, gentler delivery of medicine, inhalers are often more convenient and fast-acting.

Can I Use Someone Else’s Inhaler in an Emergency?

Using someone else’s inhaler is inadvisable because it may contain medication that is not suitable for your condition or can lead to adverse effects.