Inhaled Asthma Medications


This article has been reviewed by Thanai Pongdee, MD, FAAAAI

If you suffer from asthma, you know what it feels like to gasp for air or feel tightness in your chest. The goal of asthma medications is to prevent symptoms like these from happening.

There are two general classes of asthma medications: quick-relief and long-term control medications. Many inhaled asthma medications are meant to be used daily to keep your airways healthy, even if you are not experiencing symptoms.

With inhaled medications, the medicine is delivered directly to your bronchial tubes, helping to open your airways. Also, these medicines have fewer side effects compared to others that are taken by mouth or by injection.

Inhaled Medications
There are several asthma medications available in inhaled form. Your allergist / immunologist, often referred to as an allergist, is the best qualified to determine which is right for you.

Inhaled corticosteroids, also referred to as topical corticosteroids or glucocorticosteroids, are anti-inflammatory medications that have been used successfully to treat asthma for over 50 years. These types of steroids are very different from the ones misused by some athletes to help their performance. These asthma medications reduce many forms of airway inflammation, which helps normalize how much mucus you produce, airway hypersensitivity, swelling and tightening of your bronchial tubes.

Your asthma management plan may include taking inhaled corticosteroids even when you feel well. This is because the medications can prevent you from having an asthma flare-up or prevent your symptoms from becoming worse.

Examples of inhaled corticosteroids are beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone and triamcinolone. It is important to rinse with water and spit after each dose of inhaled steroids.

Bronchodilators are non-steroid medications that help open up your airways by relaxing small muscles that tighten them. Some bronchodilators are rapid-acting, and some are long-acting. The rapid-acting bronchodilators are used as "rescue" or quick – relief medications to immediately relieve your asthma symptoms, and include albuterol, levalbuterol, terbutaline and ipratropium. Although they make you feel better and breathe easier in the short – term, these drugs commonly do not solve the underlying problems that lead your asthma symptoms to appear.

If you regularly need these rescue medications more than two times per week, your asthma isn't being properly controlled or there is something else going on that is causing your airways to be blocked. See your allergist to change your treatment.

Bronchodilators are non-steroidal medications that help open up your airways by relaxing small muscles that can tighten the airways in asthma. Some bronchodilators are short-acting, and some are long-acting. The short-acting bronchodilators are used as "rescue" or quick – relief medications to immediately relieve your asthma symptoms, and these include albuterol, levalbuterol, terbutaline and ipratropium. Short-acting bronchodilators are also used before exercise to prevent exercise-induced asthma. Although these medications help relieve asthma symptoms and help you breathe easier in the short – term, these drugs do not treat the underlying inflammation that causes your asthma symptoms to appear. Long-acting bronchodilators are used to provide asthma control instead of quick relief of asthma symptoms. They should only be used in conjunction with inhaled steroids for long-term control of asthma symptoms. These medications include salmeterol and formoterol.

Salmeterol and formoterol are long-acting beta 2-agonist bronchodilators with an anti-inflammatory medication on a regular (daily), rather than as-needed, basis. Each of these long-acting bronchodilators is available in combination with a corticosteroid within one inhaler.

Types of Inhalation Devices - Asthma Inhalers
There are three basic types of devices that deliver inhaled medications. The most common is the metered – dose inhaler (MDI), which uses a chemical propellant to push the medication out of the inhaler. Nebulizers deliver fine liquid mists of medication through a tube or a "mask" that fits over the nose and mouth, using air or oxygen under pressure. Dry powder inhalers (DPIs) deliver medication without using chemical propellants, but they require a strong and fast inhalation.

No matter which you use, getting the medication to your lower airways is essential for the medication to work. For all devices, education and training on how to correctly use them is very important.

A device called a spacer may be prescribed if you're having trouble getting the medicine to your airways with an MDI. Spacers help you coordinate your inhaled breath with the release of the medication from the MDI canister. With many MDIs, the spacer also makes the medication droplets smaller, so they can more easily get into your lower airways where they are needed. There are also MDIs with built-in spacers.

Using a dry powder inhaler is very different than an MDI. A lever may need to be pressed, a button squeezed, a cap removed or a dial twisted before inhalation. Dry powder inhalers need a stronger, faster inhalation and are not used with spacers.

Nebulizers
Nebulizers deliver asthma medications in a fine mist through mouthpieces or masks. You can breathe normally and there is no special coordination required. Nebulizers are useful for young children and some patients with more severe or acute asthma who are unable to use an MDI or DPI. Using a nebulizer can be more time-consuming, and may take five to 15 minutes for a treatment.

Healthy Tips
• Many inhaled asthma medications are meant to be used daily to keep your airways healthy, even if you are not experiencing symptoms.
• There are several types of inhaled asthma medications and your allergist can prescribe the right one for you.
• Metered – dose inhalers, dry powder inhalers and nebulizers are all types of devices that are used to dispense inhaled medicines. Each is used in a different way.
• No matter which device you use, make sure you know how to use it correctly, so that the medicine works and your asthma is under control.

The AAAAI's Find an Allergist / Immunologist service is a trusted resource to help you find a specialist close to home.

Find out more about asthma.

AAAAI - American Academy of Allergy Asthma & Immunology