Most people diagnosed with asthma can manage their condition with medication.

The most common types of treatment are reliever and preventer inhalers. However, in some cases long-acting, combination or non-steroidal inhalers may be prescribed instead.

We’ve created a brief guide to help you gain a better understanding of the different treatments available and how they work.

What are reliever inhalers?

All asthmatics are prescribed a reliever inhaler in order to ease chest tightness, breathlessness and wheezing symptoms.

Reliever inhalers tend to be blue in colour and are used to quickly relax airway muscles to offer immediate respite to the user. The two main medicines are salbutamol and terbutaline and are known as bronchodilators.

Reliever inhalers are available in various branded forms such as airomir, salamol, salbutamol, ventolin and bricanyl. This type of inhaler should be kept with you at all times in case of an emergency.

Using your reliever inhaler more than three times in one week indicates that your asthma is not well managed. You should contact your doctor who may need to prescribe a preventer inhaler too.

What are preventer inhalers?

Preventer inhalers tend to be brown in colour and are used on a regular basis (usually twice a day) to stop an asthma attack from happening. Not all asthmatics require one.

Preventer inhalers allow a dose of corticosteroid medication to be breathed in directly through the airways and into the lungs to reduce inflammation.

The preventative abilities of this medicine build up over time so it can take up to two weeks before you notice the full benefit. It is important to continue taking your medication as directed by your doctor, even if you are feeling well.

You should try and get into a routine of using your preventer inhaler at the same time of day so that it becomes a habit which you are less likely to forget.

What are long-acting reliever inhalers?

Long-acting reliever inhalers are usually prescribed as an ‘add-on’ alongside a daily preventer inhaler.

There are two medications used in this type of inhaler, which are long-acting beta agonists (LABA) and long-acting muscarinic receptor antagonists (LAMA).

These inhalers work by relaxing the muscles surrounding the airways and opening them up to allow more air into the lungs. LAMA inhalers also reduce the amount of mucus in the airways.

It can be dangerous to use this type of inhaler without using a steroid preventer inhaler. It is important to remember that short-acting reliever inhalers should also be used to respond to emergencies.

What are combination inhalers?

This type of inhaler contains a combination of long-acting reliever medication, known as long-acting beta-agonists (LABAs), and a corticosteroid preventer medication.

Typically prescribed versions of this medication include brands such as Seretide and Symbicort. These inhalers are used to help ease breathlessness and tight chest symptoms whilst also preventing airway inflammation in the long-term.

This type of inhaler is usually prescribed to those who do not have their asthma under control and are regularly reacting to their asthma triggers. Asthmatics who are prescribed a combination inhaler also need a reliever inhaler for faster acting assistance in an emergency situation.

What are non-steroidal inhalers?

They are a type of long-term preventer inhaler that does not contain steroids.

There are two non-steroidal inhalers available: intal, which contains sodium cromoglicate and is often used for those with exercise-induced asthma; and tilade, which contains nedocromil sodium. They both work by opening up the airways and calming inflammation.

They are used as an alternative treatment for people who are not able to tolerate the use of steroids.

What is maintenance and reliever therapy (MART)?

This type of medication is only prescribed to those over the age of 18 years who are experiencing particularly bad asthma control.

MARTs help to reduce airway inflammation and relieve on-going and sudden symptoms. This type of treatment does not require a separate reliever inhaler to be prescribed, as the MART inhaler can also be used in emergency situations.

When symptoms are bad the user can increase their dosage to their maximum, after discussion with their doctor. 

The two available brands are Symbicort SMART and Fostair MART Regime. 

What different inhaler devices are there?

Asthma inhalers are available in a variety of types. The devices have been manufactured to get the correct dose of medication in contact with the airways as efficiently as possible. You might not be well-suited to every type of device and so it is important to attend regular asthma check-ups so that your doctor can assess your technique.

  • Metered Dose Inhaler (MDI):

One of the most commonly prescribed types of asthma inhaler is the metered dose inhaler (MDI) also known as the ‘puffer’.

It provides a single dose of medication via an inhaled spray or aerosol which is propelled into your airways by a safe pressurised gas.

The medication is expelled from the aerosol chamber by pressing down the top of the inhaler device. In order to successfully inhale the correct dosage you must coordinate your breathing and the pressing of the canister. This can prove difficult for some people, in which case your doctor may be able to prescribe a different type of inhaler or provide you with a spacing device (see below for further information).

  • Breath-actuated Inhaler (BAI):

An alternative type of device is known as the breath-activated inhaler.

As the name suggests this type of inhaler relies on the user to breathe in for the device to automatically release a spray of medication.

Breath-activated inhalers are available in metered dose form, requiring the user to breathe in as normal; and dry powder (DPI) form which usually require a little more breathing effort in order for the full dosage to be inhaled.

  • Spacer devices:

Spacer devices are used in conjunction with metered dose inhalers to help the user successfully receive the correct amount of medication.

It can be difficult for some MDI users to coordinate their breathing whilst pressing down the top of the canister, meaning that they do not receive a sufficient dosage.

A spacer is an empty plastic container which attaches to the MDI at one end and has a mouth piece on the other end. A spacer allows for the medicine to gather in the empty space allowing the user to breathe more normally.

The timing and speed of the user’s breathing is not as important when using a spacer which makes them particularly useful for children. The spacer allows the medication to be fully inhaled into the lungs with less hitting the back of the throat and being absorbed by other parts of the body.

It has been noted that the use of a spacer can also reduce the likelihood of unwanted side effects such as oral thrush.

  • Nebulisers:

A nebuliser is a machine which turns liquid medication into a breathable mist.

They are mostly used in hospitals to deliver a high dose of medicine to someone who has suffered an asthma attack, is fatigued and struggling to breathe. Nebulisers can be used in conjunction with a face mask so that the user does not need to be coordinated and only has to breathe in and out.

They are not used as often as they used to be as research has shown that normal inhalers fitted with a spacer device are just as effective.

As with all forms of medication it is important to use those listed above as prescribed by your doctor and to use the correct technique.

Adhering to your doctor’s directions should help you feel the full benefits of the medication and reduce the chances of experiencing side effects.

By using the most suitable medication, perfecting your inhaler technique and attending regular check ups you should be able to manage your asthma to a level where it does not impinge on your daily life.

Page last reviewed:  03/02/2021