Medication and treatment - inhalers

Although there’s no cure for asthma, there are many treatments available which should enable most people to control their symptoms well and live a normal life. Treatment is based on two important goals
  • relief of symptoms
  • preventing future symptoms and attacks from developing

Treatments are most commonly given as an inhaler (puffer) or sometimes in tablet form. In this summary we focus on inhalers. Some inhalers are for relief of symptoms (relievers) and there are others, usually inhaled steroids, which are taken every day whether or not the person is experiencing symptoms (preventers). While some people may manage their symptoms well with only a reliever or only a preventer inhaler, it is quite common for people to use a combination of treatments. A regular asthma review with a health professional can ensure that the best combination of medication is being used. Asthma can change over time so it’s important to keep a regular check on things.
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Reliever inhalers are the ones that are taken immediately to relieve asthma symptoms. They are bronchodilators, which means they relax the muscles surrounding the narrowed airways (bronchi), making it easier to breathe. Some of these are short acting, their effects last 3-5 hours. They have a variety of different names – most commonly Ventolin (salbutamol) and Bricanyl (terbutaline), although very often people referred to them by their colour (blue). People who have very mild asthma, or whose asthma is only triggered infrequently, sometimes only need to use a reliever inhaler for either immediate relief, or to prevent symptoms in the short term such as before doing some exercise. They work quickly - within about 15 minutes breathing should feel easier. Susan said, ‘When it works it usually works quite quickly.., like it’ll usually start improving within a few minutes.’

Charles and John have relatively mild asthma and use a minimal amount of medication.
People may use the blue reliever inhaler in conjunction with a preventer inhaler, which is an inhaled steroid. The idea of steroids can worry people who associate them with banned substances taken by athletes. As Julie commented, “I did at first wonder about whether they were the same thing as these anabolic steroids that sports people take and was I sort of going to balloon into a great muscly being because I didn’t fancy that very much.” In fact they are very different, although there can be some side effects (see below). There are a range of different steroid inhalers, including Pulmicort (budesonide) and Clenil Modulite (beclometasone). They are often brown or orange. With these inhalers the protective effect builds up over a period of time so they need to be taken every day even when people are feeling well. Steroids work to control the swelling and inflammation in the airways and also to make the airways less responsive to asthma triggers. The GP will work with the patient to get them onto the lowest possible steroid dose, but it can sometimes take some time to work out the best combination of treatments for each individual.
As well as short acting relievers (e.g. salbutamol) and long acting preventers (steroids) there are also long acting relievers which, like salbutamol, work to relax the muscles in the airways but work for longer so they only need to be used twice a day. Examples of these are Serevent (salmeterol) and Oxis (formoterol). They are usually used with steroids, and sometimes in a combination inhaler so they are delivered together.

Other inhalers used for asthma include Atrovent (ipratropium bromide) which is another kind of short acting muscle relaxant (it takes longer to work than salbutamol and isn’t used as much) and Intal (sodium cromoglycate) which works against allergic reactions.

Many of the people we interviewed needed several types of inhaler. People described the number of times they used their inhalers each day, usually morning and evening for the preventer inhaler, and as and when needed for the reliever. Often people had tried a few different types until they found ones which suited them.
Inhalers are effective partly because inhaling the medication takes it straight to the lungs. Some people find it relatively straightforward to use an inhaler, but others may experience problems. Both Margaret and Dee said that they only realised some time after they had been diagnosed that they had not been using the correct technique to begin with and so their asthma was less well controlled. There are some types of inhaler devices that are easier to use for people who have difficulty holding the regular inhaler for example people with arthritis. The Haleraid or Turboaid device fits onto some spray-type inhalers and helps the release of the medicine. There are also breath- activated inhalers such as the Accuhaler which some people find easier to use, where the measured dose is triggered by breathing in at the mouthpiece, so you don’t have to push the canister to release the medication.
Sometimes people use a spacer with their inhaler. A spacer is a large plastic or metal container, with a mouthpiece at one end and a hole for the aerosol inhaler at the other. They can help make inhalers easier to use and more effective.

They can also reduce side effects of preventer inhalers by reducing the amount of medicine that is swallowed and absorbed into the body. Margaret explains … "So with the spacer you’re meant to kind of breathe out and then take a puff to five counts of breathing in and out and then wait maybe 20 seconds to a minute or something before you take the next one, and the next one….. but there is a real technique to using them".
Spacers can be effective, but in practical terms they are sometimes quite large and can be difficult to accommodate in a handbag or pocket. Most people using a spacer keep it at home for use with their preventer inhalers, but it can be a problem when travelling and away from home.
People had different attitudes about using their inhalers in front of other people. Often people said they would prefer to use the inhaler privately so that nobody saw them, but others said that it was important for it to be seen as something ‘normal’ rather than something to be embarrassed about. Catherine was adamant that it should not be something to hide "I don’t slink off out of the room to take it, I just sit there in front of everybody, take it…. If they’re looking at me I just smile and say ‘I’m an asthmatic…"
Sometimes there can be side effects from using inhalers. The most common one that people talked about with the reliever type inhalers was a temporary feeling of dizziness, shakiness or increased heartbeat. Susan got her first Ventolin inhaler when she was at school. ‘I only really had to use it when I doing sport at school. And the reliever they gave me the first time, it worked but it made me dizzy at the same time.’Some people found their inhaler made them feel out of sorts for a while but usually most people get used to knowing how many puffs to take and how it makes them feel. The preventer inhalers contain corticosteroids, which can have a number of different side effects, the most common are irritation of the throat and occasionally they cause oral thrush. Esther said it’s important to have a drink of water after using the inhaler to ensure that there’s no residue left in the mouth and Peter explained "You’re supposed to gargle and sort of get rid of anything that hasn’t gone straight into the airways". Using a spacer can also help to reduce these types of effects. On balance most people said that they felt the benefits of the medication in keeping them fit and well outweighed the side effects and that the priority was to be able to breathe easily.(Also see ‘Treatment and medication – other treatments’, ’Managing asthma – reviews and action plans’ and ‘Changing symptoms over time’).



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