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You are in: Home > Chest Information > Treatments > Inhalers

Inhalers

Inhalers allow drugs to be delivered directly to your lungs. There are different types including dry powdered and aerosol metered dose inhalers (MDIs).

The 3 main groups of inhalers used for chest conditions are 'relievers', 'long–acting relievers' and 'preventers'.

The drugs used in inhalers are also usually available in solution form to be used with a nebuliser.

• Relievers
• Long–acting relievers
• Preventers
• Using your inhaler
• Spacers
• Using your spacer
• Taking care of your spacer

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Relievers

Your doctor may suggest you use an inhaler that helps to open up your airways if your lung function tests show that they are narrowed. These drugs are called bronchodilators. They work by helping the muscles around your airways to relax and dilate, allowing the air to get into your lungs.

It is important to keep your reliever with you at all times as you never know what might trigger an attack of breathlessness / wheeziness.

Salbutamol inhalers are now available over the counter from supermarket pharmacies in Scotland for the treatment of asthma. Although this is an accessible way of picking up medicines, it is important to make sure that convenience does not substitute an appointment with your GP or practice nurse. There may be an important reason why you may have run out of your inhaler: perhaps you are not feeling well or perhaps you are not using it properly. Your GP or practice nurse can provide a full medication review to make sure that you are well and that you are on the appropriate treatment.

Example	Comments	Side effects
Salbutamol	Quick acting bronchodilators: usually prescribed on an 'as required' basis. Can also be used regularly.	Can cause a tremor especially noticeable on your hands. Some people may experience palpitations.
Terbutaline
Ipratropium bromide (Atrovent®)	Anticholinergic bronchodilator: works in a different way and takes longer to have an effect. It is taken regularly	Tends to have few side effects but can cause a dry mouth and very occasionally constipation and difficulty passing urine.
Salbutamol + Ipatroprium: known as Combivent®	Reliever combinations: allow you to take 2 different bronchodilators at the same time. Usually prescribed on a regular basis.	Combination of above: tremor, palpitations, dry mouth, constipation.
Fenoterol + Ipatroprium: known as Duovent®

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Long–acting relievers

These are long–acting bronchodilators which are used to keep your airways open and help control the symptoms of breathlessness.

• These inhalers must be taken regularly.

Example	Comments	Side effects
Salmeterol	Long–acting bronchodilators: taken twice a day, usually in the morning and at night. They take about 30 minutes to work but their effects last for 12 hours.	Similar to bronchodilators: fine muscle tremor in the hands, palpitations and cramps in hands and feet.
Formoterol
Tiotropium (Spiriva®)	Long–acting anticholinergic: only needs to be taken once every 24 hours. Cannot be taken with another anticholinergic inhaler (e.g. Atrovent® or Combivent®).	Can cause a dry mouth and very occasionally constipation and difficulty passing urine.

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Preventers

Preventer inhalers contain steroids. They are used to reduce the inflammation of your airways. It can take up to a week for preventer inhalers to take effect and up to 6 weeks to get maximum benefit.

• Preventer inhalers must be taken regularly. They will not help during a breathlessness attack.

Steroids can have quite serious side effects but, because inhalers deliver the drug directly to the part of the body that needs it, the side effects of steroid inhalers are usually minor and easy to control.

Example	Comments	Side effects
Beclomethasone	Steroid inhalers taken twice a day, usually in the morning and at night.	Voice hoarseness, sore mouth and / or oral thrush. Rinsing your mouth out after using these inhalers can minimise this.
Budesonide
Fluticasone + Salmeterol: known as Seretide®	Preventer combinations: combination of a preventer and a long–acting reliever.	As above plus fine muscle tremor in the hands, palpitations and cramps in hands and feet.
Budesonide + Formoterol: known as Symbicort®

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Using your inhaler

Inhalers are very effective but only if used correctly:

• Make sure you know how to use your inhaler and that you are comfortable using it even when you are very breathless. Different inhalers work in different ways. Most GP surgeries have practice nurses who will be happy to help you with your inhaler technique.
• It is important that you use your preventer and long–acting reliever inhalers regularly. If you stop taking them, or frequently forget, you will not get the full benefit from your treatment.
• If you are prescribed more than one inhaler and you have to take them together always use your reliever first.
• Always have a spare inhaler in case you lose it or it runs out.

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Spacers

• A spacer is a plastic dome with a mouthpiece at one end and a fitting for your inhaler at the other. They are only designed for use with aerosol inhalers.
• A spacer may be useful if you have difficulty with your inhaler technique or the physical handling of an inhaler.
• Your inhaler is triggered into the space delivering the dose required. You have more time and more than one chance of breathing it all in. The drug is delivered more effectively to your lungs, reducing some side effects, especially those caused by steroids.
• Using your spacer and inhaler correctly can be more effective than using a nebuliser.
• There are large and small volume spacers available. Large volume spacers are very helpful but tend to be cumbersome and not easy to carry around. Small volume spacers are available for carrying in your pocket and using if required with your inhaler when out and about.

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Using your spacer

• It is important that your inhaler fits onto your spacer properly. Ask your practice nurse if you are unsure.
• Make sure the valve in your spacer is working: some click open and shut when you breathe through them, and others make a whistling noise.
• Always shake your inhaler well before fixing it onto the spacer.
• Breathe out to empty your lungs.
• Seal your lips around your spacer mouthpiece.
• Holding your spacer level, activate your inhaler.
• Breathe in slowly and deeply.
• Hold your breath for a count of 10 or as long as you can. (This allows the medicine to reach the smaller airways of your lungs).
• If you are unable to take slow deep breaths or hold your breath, then breathe in and out as normal several times.
• Repeat if you take 2 puffs of your inhaler.

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Taking care of your spacer

• Take your spacer apart once a week, wash it in warm soapy water, rinse and drip dry.
• Never dry it with a towel or paper towel or tissue as fibres can interfere with its action.
• Your spacer should be replaced every 6 – 12 months.

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