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What You Should Know About Inhaled Asthma Medications

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If you have 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.

Inhaled Medications
There are several asthma medications available in inhaled form. Your doctor can help you 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 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, gargle, and spit with water after each dose of inhaled steroids.

Bronchodilators are nonsteroid medications that help open up your airways by relaxing small muscles that tighten them. Some bronchodilators are rapidacting, and some are long-acting. The rapid-acting bronchodilators are used as “rescue” medications to immediately relieve your asthma symptoms; these include albuterol, levalbuterol, pirbuterol, 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 cause your asthma symptoms to appear.

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.

If you regularly need these “rescue” medications more than two times per week, your asthma isn’t being properly controlled, or something else is causing your airways to be blocked. See your doctor to change your treatment.

Salmeterol and formoterol are long-acting beta2-agonist bronchodilators that are ordinarily meant to be used together 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.

Nonsteroid anti-inflammatory medications, such as cromolyn or nedocromil, reduce inflammation and can help prevent asthma symptoms. These drugs are extremely safe but are less effective than inhaled corticosteroids.

Types of Inhalation Devices
Three basic types of devices deliver inhaled medications. The most common is the metered-dose inhaler, 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 deliver medication without using chemical propellants, but they require a strong and fast inhalation.

No matter which one 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 use them correctly is important.

A device called a spacer may be prescribed if you’re having trouble getting the medicine to your airways with a metered-dose inhaler. Spacers help you coordinate your inhaled breath with the release of the medication from the metered-dose inhaler canister. With many metered-dose inhalers, 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 metered-dose inhalers where the medicine is released automatically when you breathe in from the inhaler, and there are metered-dose inhalers with built-in spacers.

Using a dry-powder inhaler is different from using a metered-dose inhaler. 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 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 people with more severe or acute asthma who are unable to use a metered-dose inhaler or a dry-powder inhaler. Using a nebulizer can be more time-consuming and may take five to fifteen minutes for a treatment.


Excerpted with permission from Tips to Remember: Inhaled Asthma Medications, copyright © 2009 by the American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2010.