Types of Inhalers Explained: Relievers, Preventers, Combination Inhalers and Technique

Many people with asthma or COPD use inhalers every day without being sure what each one does. Knowing the difference between a reliever and a preventer, and using good technique, can transform symptom control.

Imagine relying on your blue inhaler several times a day while your brown one sits in a drawer because it “does not seem to do anything”. Your asthma keeps flaring. A five-minute review shows you have had it the wrong way round.

Reliever inhalers

Reliever inhalers, often blue, contain a fast-acting medicine such as salbutamol (albuterol) that relaxes the muscles around the airways within minutes. They are used to relieve symptoms such as wheeze, cough and breathlessness.,Needing a reliever more than two or three times a week usually means asthma is not well controlled. Current international guidance, including from the Global Initiative for Asthma (GINA), no longer recommends treating adults and adolescents with asthma using a short-acting reliever alone, without an anti-inflammatory preventer.

Preventer inhalers

Preventer inhalers, often brown, orange or purple, contain an inhaled corticosteroid such as beclometasone, budesonide or fluticasone. They reduce inflammation in the airways over time, making attacks less likely.,They need to be taken every day, even when you feel well, and take a few weeks to work fully. They do not relieve sudden symptoms.

Combination inhalers

Combination inhalers contain a preventer steroid and a long-acting reliever medicine (a LABA), such as budesonide with formoterol or fluticasone with salmeterol or vilanterol.,Some combinations containing formoterol can be used both as daily maintenance and as reliever therapy. This is called MART (maintenance and reliever therapy) or, when used only as needed, anti-inflammatory reliever (AIR) therapy. Your healthcare provider will explain which approach is right for you; only use your inhaler this way if you have a written plan saying so.

Inhalers for COPD

In COPD, inhalers often include long-acting bronchodilators: LAMAs such as tiotropium or umeclidinium, and LABAs such as salmeterol or formoterol. Some people also use an inhaled steroid, depending on their symptoms, flare-ups and blood eosinophil count. Triple inhalers combine all three.

Types of inhaler device

• Pressurised metered-dose inhalers (pMDIs): spray the medicine; need coordination of pressing and breathing in slowly, and work best with a spacer
• Dry powder inhalers (DPIs): require a quick, deep breath in; do not need a spacer
• Soft mist inhalers: release a slow-moving mist
• The right device depends on your breathing strength, coordination and preference

Good technique with a metered-dose inhaler and spacer

1. Shake the inhaler and attach it to the spacer
2. Breathe out gently, away from the spacer
3. Seal your lips around the mouthpiece
4. Press the inhaler once
5. Breathe in slowly and deeply, or take several normal breaths through the spacer
6. Hold your breath for up to 10 seconds if you can
7. Wait about 30 seconds before a second puff, shaking again

Side effects of steroid inhalers

• Oral thrush (white patches in the mouth)
• Hoarse voice
• Rinse your mouth and spit after using a steroid inhaler, and use a spacer with metered-dose inhalers to reduce these effects
• At high doses for long periods, other effects are possible, which is why the lowest effective dose is used

Inhalers and the environment

Some metered-dose inhalers contain propellant gases that are powerful greenhouse gases. Dry powder inhalers and soft mist inhalers have a much lower carbon footprint. If you are interested, ask whether a lower-carbon inhaler would suit you, but do not switch without advice. Return used inhalers to a pharmacy for safe disposal.

When to seek urgent help

• Your reliever is not helping or you need it more than every four hours
• You are too breathless to speak, eat or sleep
• Your lips or fingers look blue or grey
• Follow your asthma action plan, and call emergency services if symptoms are severe

Frequently asked questions

How do I know if my inhaler is empty?

Many have dose counters. For those that do not, keep track of puffs used or ask your pharmacist.

Should children use spacers?

Yes. Spacers with a mask or mouthpiece help children get much more medicine into their lungs.

Can I stop my preventer when I feel well?

Not without advice. Feeling well usually means it is working.

But my inhaler technique is fine, isn’t it?

Studies show many people use their inhalers incorrectly. Ask a nurse or pharmacist to watch you; small changes can make a big difference.

Related: Asthma attack: what to do · Inhalers and spacers in children

Sources: Global Initiative for Asthma (GINA), Global Initiative for Chronic Obstructive Lung Disease (GOLD), Asthma + Lung UK, National Institute for Health and Care Excellence (NG245).