Inhalers are designed for you to breathe in medication that reaches the lungs and targets inflammation. They come in a wide range of devices and modes of delivery. Your doctor will select the right one for you, and consider alternatives if it doesn’t suit you, but it helps to be informed of the different options out there. Our medical team will talk you through it. First things first, let’s get to grips with terminology. A spacer device is a plastic tube that fits to your inhaler at one end and your mouth at the other, allowing you to administer a dose of medicine from your inhaler and breathe freely. Medicine via a spacer gets to the lungs more easily. Inhalers differ in how they deliver medicine to your lungs. Most inhalers are metered-dose inhalers (MDIs), which give a spray of medicine once you’ve pressed on the canister at the top, and these can be used with a spacer. Breath activated inhalers (BAIs) release a spray of medicine when you start to inhale, rather than pressing on the canister. Dry powder inhalers (DPIs) come as a powder rather than a spray, and you need to breathe in fairly hard to activate the inhaler.
Certain factors may influence which inhaler is right for you. Age is one factor – those less than 12 years should use a spacer with their inhaler, which means they are restricted to certain MDIs. However, MDIs may be difficult for elderly people or those with a disability or coordination difficulty, so BAIs may be a better choice. BAIs needs a certain strength of respiratory muscle to forcefully breathe in. Convenience and ease of portability may be a high priority, such as putting your inhaler in your pocket, handbag or sports bag, therefore MDIs can be less bulky than some BAIs. Side effects may be important – higher dose steroids can cause thrush in the mouth, but the chance of this is reduced by using a spacer, which limits you to MDIs. Your doctor's surgery may have demonstration inhalers for you to have a look at.
Everyone with asthma will be prescribed a reliever inhaler. It’s usually blue and contains a medicine called salbutamol, which is a short-acting bronchodilator. It works to relax and widen the airways, relieving chest tightness, wheeze and shortness of breath. Ventolin is a common brand of salbutamol. It’s a temporary relief when you need it, and for those with very occasional asthma, this may be all that’s needed. For most with asthma, your preventer inhaler provides ongoing treatment to keep symptoms at bay in the long term. Terbutaline is an alternative short-acting bronchodilator to salbutamol and is often blue, but may be a different colour. Bricanyl is a popular brand and is blue and white.
Your preventer inhaler has medication to reduce swelling in your airways, but takes one to two weeks to reach full benefit. This is your long-term treatment to keep symptoms and flare-ups at bay. The name of your inhaler will indicate if it contains a steroid: these include budesonide, mometasone, beclometasone, fluticasone and ciclesonide. They come in any colour, but the most common brands are Clenil and Qvar, containing beclometasone, and these inhalers are brown.
Long-acting bronchodilators may be added alongside or instead of a steroid inhaler, and they vary in colour. They work in a similar way to your reliever inhaler, but last for up to 12 hours. They can come in any colour and contain either salmeterol, where Serevent is a common brand, or formeterol. If you need these for the long-term alongside your steroid inhaler, your doctor may switch to an inhaler combining steroids with long-acting bronchodilators. Common brands include Fostair, Symbicort and Seretide. Whichever inhaler you use, make sure you have learned the correct technique to get the required medication to the right place, and use your inhaler as prescribed on your personalised asthma plan. If this isn’t getting on top of your symptoms, your doctor can make an assessment and tweak the dose or change the type of inhaler.