Using a Bronchodilator vs. a Steroid Inhaler

First dilate your airways, then reduce inflammation

Man about to use asthma inhaler
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If you have chronic obstructive pulmonary disease (COPD) or asthma, you may be prescribed both an bronchodilator and a steroid inhaler. They may seem similar, but they are meant to help you manage different aspects of your condition. Short-acting bronchodilators are typically used for acute instances, while steroid inhalers are generally used for long-term maintenance.

It's important to know how each one works and when it's appropriate to reach for one versus the other.

Uses

Most inhalers can be divided into two categories: short-acting and long-acting. The medications are typically delivered through the mouth via an inhaler device, which may include one of several formats: Hydrofluoroalkane inhalers (HFAs), dry powder inhalers (DPIs), or soft mist inhalers (SMIs).

Bronchodilator Inhaler Facts

  • Open and relax airways

  • Works within minutes

  • Appropriate for use during attacks

  • Risks associated with long-term use

Steroid Inhaler Facts

  • Reduce airway inflammation and swelling

  • Effects can take hours to a day

  • Not for use as rescue medication

  • Used for ongoing condition management

Short-Acting Bronchodilators

A bronchodilator is used to open up (dilate) and relax constricted airways, making it easier to breathe. They come in both short-acting (lasting four to six hours) and long-acting (lasting 12 or more hours) versions.

If you're feeling short of breath, your bronchodilator inhaler is going to relieve your symptoms fast—and should be your first choice. In fact, within seconds of using your bronchodilator, your airways will start to dilate and you will (hopefully) note relief from your wheezing and shortness of breath.

The main reason to use your bronchodilator inhaler first is so that your steroid inhaler can get to where it's needed.

Brands of short-acting, beta-agonist bronchodilators include:

These rescue inhalers help remove mucus from your airways, allowing you to cough it up, and let more air into and out of your lungs.

Overuse of your rescue inhaler is a sign that your condition is not well-controlled. If you find yourself using your short-acting inhaler more than two or three times per week, call your doctor and work to find another maintenance method that may be better for you.

Long-Acting Bronchodilators

In contrast, long-acting bronchodilators are used to offer longer-term control and maintain open airways. They're generally taken twice per day (every 12 hours).

Brands of long-acting, beta-agonist bronchodilators include:

  • Advair (fluticasone and salmeterol)
  • Symbicort (budesonide and formoterol)
  • Serevent (salmeterol)
  • Foradil (formoterol)

Long-acting bronchodilators should only be used in specific cases, as they have been shown to increase the risk of death from asthma. The safer long-term option is generally a steroid inhaler.

Steroid Inhalers 

Steroid inhalers deliver corticosteroids to your airways, which reduce inflammation and swelling. Corticosteroids mimic the hormone cortisol, which is naturally produced by the body.

But it may take several hours or even a day for the steroid to do its job, so these shouldn't be used as rescue inhalers in acute situations. In fact, it can take weeks of regularly using a daily steroid inhaler before you start to notice effects.

In contrast to working through the nervous system as with a bronchodilator, a steroid inhaler needs to work on the inflammatory cells in your airways, and this can take time.

As with bronchodilators, there are several brand and generic names, and it's not uncommon for people to get confused and end up using two different brands thinking they are getting different medicines. Your doctor will give you instructions to use your steroid inhaler once per day or more, at regularly spaced intervals.

Some examples of steroid inhalers include:

  • Qvar (beclomethasone)
  • Pulmicort (budesonide)
  • Flovent (fluticasone)
  • Azmacort (triamcinolone)
  • Aerobid (flunisolide)

Contraindications

There are certain people for whom use of these inhalers poses added risk, so it's important that you're upfront with your doctor about your complete medical history.

For example, anyone with a severe milk protein allergy or sensitivity to albuterol should not use bronchodilators. If you have diabetes, glaucoma, high blood pressure, cardiovascular disease, low potassium (hypokalemia), or hyperthyroidism, talk to your doctor about whether bronchodilators are right for you.

Generally speaking, people with any of the following conditions should not use steroid inhalers, as corticosteroids may exacerbate these conditions or symptoms:

  • Impaired liver function
  • Weakened immune system
  • Current infections (viral, bacterial, fungal, or parasitic)
  • Eye issues such as glaucoma or cataracts
  • Weakened bone density

Dosage

The precise dosage of your bronchodilator or steroid inhaler will vary depending on the severity of your condition, the type of condition (whether COPD or asthma), whether the drug is short-acting or long-acting, and what other medications you're taking.

Bronchodilators are usually taken multiple times per day, and steroids can be taken one or more times per day, but be careful not to exceed the maximum dosage.

Make sure you are using your bronchodilator properly. If the medicine doesn't get where it's supposed to go, it won't do much good.

Steroid inhalers should be used every day, whether you're experiencing a flare-up or not. Ask your doctor about using a spacer with your inhaler device to minimize medication loss. Be sure also to rinse your mouth with water after using your inhaler to minimize the risk of contracting oral thrush. Be sure to not swallow the water—simply spit it out.

How to Take and Store

You can learn to use a bronchodilator, but you will probably need some instruction. Generally, there should be staff in your doctor's office or pharmacy who are ready to teach you. This should take a few minutes, and you might demonstrate (typically with an empty inhaler) that you know how to use it.

Depending on the specific medication, you might need to shake the container right before use. You would then take a few deep breaths, tilt your head back a little, and exhale. With each dose, you will inhale as you use the device. Most devices have a plastic piece that you will press to release the medication as you inhale.

Be sure to store your inhaler at the recommended temperature. These medications may have a shelf life of less than than a few months, so it isn't generally a good idea to 'stock up." It is important that you learn to know when the medication is getting low and when it is empty. Your pharmacist can show you how to gauge the amount of medication left in your specific inhaler brand.

Side Effects

There are several side effects of using both bronchodilators and steroid inhalers, and most are fairly mild.

Side Effects of Bronchodilators

  • Nervousness

  • Shakiness

  • Rapid heartbeat or palpitations

  • Nausea

  • Insomnia

  • Muscle aches or cramps

Side Effects of Steroid Inhalers

  • Hoarseness

  • Cough and sore throat

  • Oral thrush

  • Weight gain

  • Increased risk of pneumonia

A Word From Verywell

Bronchodilators and steroid inhalers save millions of lives every year, but they must be used responsibly and as intended. Make sure you know the warning signs of an attack and that you have an asthma emergency plan or COPD emergency plan in place. If your bronchodilator is not working, it's time to call your doctor or 911 if your symptoms are severe. One of the reasons cited for the death rate from asthma despite advances in medicine is that people treat their symptoms themselves too long before seeking emergency care.

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Article Sources

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