An Overview of Asthma Inhalers

Asthma inhalers contain prescription medications that are breathed directly into the lungs to relieve or prevent asthma symptoms. If you have asthma, your doctor may prescribe a long-acting inhaler to use regularly for overall asthma control and/or a short-acting (rescue) inhaler to use as needed for asthma attacks.

Pediatrician explaining inhaler to patient and mother
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Inhalers may contain a steroid medication that reduces airway inflammation or a bronchodilator medication that opens the airways. Some asthma inhalers contain both.

Long-Acting Inhalers

The medications in long-acting inhalers are used to prevent asthma symptoms on an ongoing basis and so often are described as controllers (although not all controllers come as inhalers). They work by counteracting the underlying causes of asthma.

There are two types of long-acting asthma inhalers: those containing long-acting bronchodilators and those containing corticosteroids (sometimes simply called steroids). Your doctor may prescribe one or both—or an all-in-one combination inhaler—to help you breathe comfortably and prevent asthma attacks.

If you are given a prescription for a long-acting inhaler, you may need to use it on a regular schedule, even when you don't have symptoms. Long-acting inhalers take hours or even days to take effect and so they should not be relied on in emergency situations to treat an asthma attack. Long-acting inhalers last for several days before wearing off.

People with asthma who've been prescribed long-acting inhalers typically have been advised to use them daily. However, according to updated recommendations for asthma management by the National Institutes of Health (NIH) issued in December 2020, this no longer is regarded as necessary for those with mild to moderate persistent asthma. If you use an inhaler daily to manage asthma, ask your doctor if the new guidelines might affect your treatment.

Steroid Inhalers

Long-acting inhalers containing corticosteroids target inflammation, which contributes to asthma symptoms by narrowing the airways. Asthma attacks often occur when inhaled particles or an infection trigger excessive inflammation and spasm of the bronchi (airways).

Taking a steroid on a regular schedule can help prevent acute inflammation. Steroid inhalers commonly used for asthma include:

Bronchodilator Inhalers

Some asthma controller inhalers contain a long-acting bronchodilator, which widens the airways to help you breathe.

Many long-acting bronchodilators are long-acting beta-agonists (LABAs), which act directly on beta receptors in the airway muscles to control the size of the airway opening. Others are anticholinergics, which also relax the airway muscles.

Bronchodilator asthma controllers include:

  • Atrovent (ipratropium), an anticholinergic bronchodilator, relaxes the muscles of the airways to widen them. It is used several times per day because it is not as long-acting as many controllers (though it still cannot be used in an emergency situation).
  • Spiriva (tiotropium), an anticholinergic bronchodilator, is more commonly used for chronic obstructive pulmonary disease (COPD) than for asthma, but it is considered an option for asthma treatment, especially when the goal is to reduce the steroid dose.
  • Elixophyllin (theophylline) is in a class of drugs called methylxanthines. This asthma drug is a muscle relaxant that opens up constricted airways and may have mild anti-inflammatory properties. With the advent of newer asthma medicines, the use of theophylline has fallen off, but it is available as an option that works for some people.

Combination Inhalers

Some experts suggest using a single combination inhaler instead of multiple inhalers may reduce hospitalizations for asthma attacks, and this may be due to the ease of using just one device instead of multiple devices.

Combination inhalers used for asthma include:

  • Advair, a controller asthma medicine that combines fluticasone propionate (an inhaled steroid) and salmeterol (a LABA)
  • Symbicort, which combines the steroid budesonide with formoterol, a LABA.

Short-Acting Inhalers

Short-acting inhalers are often bronchodilators containing short-acting beta-agonists (SABAs). Because they counteract the sudden bronchoconstriction (narrowing of the airways) that causes acute shortness of breath, they often are prescribed for people who have sudden asthma symptoms.

Sudden asthma symptoms may be the sign of an impending asthma attack, and it is important that you learn to recognize asthma symptoms that require immediate treatment with an inhaler.

Sudden asthma symptoms may be the sign of an impending asthma attack, and it is important that you learn to recognize asthma symptoms that require immediate treatment with an inhaler.

Short-acting inhalers used for the treatment of acute asthma symptoms include:

  • Ventolin (albuterol) is a bronchodilator used in quick-relief rescue inhalers to relieve acute asthma symptoms.
  • Xopenex (levalbuterol) is a rescue inhaler medication used to relieve acute asthma symptoms. It is similar to albuterol.

Both can cause side effects such as jitteriness and palpitations.

If you use a rescue inhaler often—for instance, more than twice per week and without an obvious trigger—this could be a sign that you need a change in your long-acting asthma medication (or to start on such a drug, if you haven't already).

A Word From Verywell

Keep in mind that skipping your long-acting asthma medication because you have a "backup"—a rescue inhaler—in case of an emergency is not safe. An asthma attack can be life-threatening, and recurrent asthma attacks (even if they are mild) can worsen your conidition by causing stiffness and scarring of your lungs.

It's important that you understand the intended use of each inhaler you use. In addition, avoiding your triggers (e.g., dust, pollen, certain foods) may have even more of a beneficial effect than medication.

Asthma Doctor Discussion Guide

Get our printable guide for your next appointment with your doctor to help you ask the right questions.

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