If you or your child has symptoms of asthma your doctor is likely to have prescribed a reliever inhaler to use whenever symptoms appear, and possibly a preventer inhaler, which will make future asthma attacks less likely. It is very important to use these inhalers as your doctor has instructed. If these inhalers are being used as they should, but the asthma is still not under control, your doctor may decide “add-on” treatments are necessary.
Reliever inhalers
What are they and how do they work?
These are usually blue in colour and are intended for immediate relief of symptoms. If you or your child feels tight-chested, starts wheezing or experiences any other symptoms of asthma the reliever inhaler should used straight away and will almost always help. Examples of these are salbutamol (called albuterol in the USA) which is sold under the brand names Terbutaline (Brycanyl), Ventolin, Proventil, procaterol which is sold under the brand name ProAir, and pirbuterol, sold under the brand name MaxAir. These work by relaxing the muscles around the airways and therefore making it easier to breathe. Sufferers of asthma should carry their reliever inhalers with them at all times. If your child has been prescribed a reliever make sure that teachers and carers always know where to find it and how to use it. Most relievers are effective in alleviating symptoms for about 4 hours.
The reliever inhaler will not cure asthma or reduce the number of future attacks; they just alleviate the symptoms of an attack. If the reliever is needed more than 3 times a week you should contact your doctor or asthma clinic for a review of the medication.
Side effects of reliever inhalers
Reliever inhalers are extremely safe to use and usually do not have side effects. However, in some cases they can cause feelings of shakiness, hand tremors, headaches and muscle cramps. However these usually only last for a short time and are unlikely to be present unless you have had a very high dose.
Preventer inhalers
What are they and how do they work?
If symptoms are present more than three times a week or if you have experienced a severe attack you will probably be given a preventer inhaler. These are often brown in colour, or sometimes red or orange. Examples include beclomethasone (Quar), budesonide (Pulmicort), ciclesonide (Alvesco), flunisolide (Aerospan), fluticasone (Arnuity Ellipta), fluticasone (Flovent) and mometasone (Asmanex). They usually contain corticosteroids, a safe form of steroids, very similar to those produced naturally by the body. Unlike the blue reliever inhalers, these preventers actually help reduce the inflammation in the patient’s airways and therefore reduce the likelihood of attacks occurring.
Preventer inhalers must be used as regularly as your doctor has prescribed, usually twice a day. It takes time for the effects to build up in the body so you might not see the full benefit of these drugs for several weeks. Do not stop taking these just because you have not had an asthma attack for a long time. That just means that the preventer is working.
Side effects of preventer inhalers
Your doctor will have decided on corticosteroids because the benefits of taking these outweigh the risks. The advantage of taking medication in inhaler rather than tablet form is that the inhaler delivers the medication straight to your lungs, so this actually reduces the chances of side-effects.
Side effects are usually mild, and might include thrush (a common yeast infection in the mouth which is easily treatable), and occasionally hoarseness or a sore throat. You can help avoid this by brushing your teeth and rinsing immediately after taking the preventer. Some people find that using a spacer to administer the medication helps make a thrush infection less likely.
Parents sometimes worry that corticosteroids might be harmful to their children, or affect growth. However, it is important to emphasize that these corticosteroids are not the same as the dangerous anabolic steroids sometimes taken by bodybuilders. Whilst studies have shown that corticosteroids can sometimes slightly reduce growth, uncontrolled asthma can do the same as well as potentially being life threatening.
If you are worried about side effects, you should speak to your doctor.
Using your inhaler correctly
Incorrect use
Reliever and preventer inhalers come in various different forms. The majority come in pressured canisters; some come in the form of dry powder in a container. Whichever form your medication takes it is crucial to be sure that you are using the inhaler correctly, otherwise the medication might not be reaching your lungs. It is estimated that as many as one-third of asthma sufferers are not using their inhaler correctly.
Correct use
If you are not sure whether you are using your inhaler correctly speak to your doctor or asthma nurse. Your local pharmacist might also be able to help.
With most devices, the correct way of administering the medication is to:
- shake the canister
- breathe out to empty the lungs
- put the mouth-end of the canister in your mouth and press the canister
- then breathe in
- hold the breath for up to 10 seconds
Different devices require different techniques. There are useful demo recordings on the Asthma UK website at http://www.asthma.org.uk/advice-using-inhalers
Using a spacer
A spacer might be used to help ensure that the medicine from your inhaler goes straight to the lungs. It is particularly useful for administering preventer and reliever medication to babies and children, but can be useful for adults too. As well as reducing the likelihood of a thrush infection, the spacer makes it easier for those who find it hard to co-ordinate pressing the canister and breathing in at the right moment.
The spacer is a hollow container, usually made out of plastic, with a hole at one end for the inhaler canister and a mouthpiece (or mask for infants) at the other.
Add-on treatments
If a preventer inhaler does not help treat your asthma, it is important to make an appointment with your doctor or asthma clinic to review your medication. The doctor might decide that it is necessary to increase your dosage or to prescribe a longer-acting reliever, such as Seretide, Symbiort, Fostair or Flutiform. These usually alleviate symptoms for up to 12 hours rather than the usual 4 hours. Use of longer acting relievers should always be combined with a preventer, and these often come in a combination inhaler which includes both reliever and preventer medication in one dose.
Other add-on treatments might include Leukotriene receptor Antagonists (LTRAs), an alternative type of preventer, suitable for some forms of asthma but not others, and Theophylline, which usually comes in tablet form and can help relax the muscles around the airways to make breathing easier.
You may be tempted to try alternative/ complimentary medicine to help with your asthma. Speak to your doctor before trying any alternative treatment. Some can actually make your asthma worse. You should never use complimentary medicine as a substitute for your conventional inhalers. Your doctor may recommend practitioners who can help you with breathing exercises.