Hi everyone! Hope you are well and staying safe! This is more an infomercial for newbies to asthma than anything else! I know starting out it can be quite confusing as to what to take when, especially when it’s not been explained why, so thought I’d do a (hopefully) short post about it!
INHALER DESIGN
First off a note about the different style of inhalers. There are the typically thought of metered-dose inhaler (MDI) which squirts a puff when you use it, and there’s the dry powder inhaler (DPI) that you typically have to suck. There is also the breath actuated inhaler (BAI), which is similar to an MDI but activates as you breathe in, and may be used with those who have difficulty using the normal inhaler.
With MDIs it’s recommended that you use a spacer as that can help reduce a lot of the side effects (thrush, bad taste, tremors etc) and can make you up to 80% more effective at breathing in the drug. Spacers you can use 2 different methods - tidal or deep breath and hold (descriptions and links to videos can be seen here: asthma.org.uk/advice/inhale... ). Also make sure to remember it’s one puff at a time, and shake it before each spray (so that you get the medicine, and not just the propellant!). With all inhaler types it is recommended that you rinse your mouth after use, again to help prevent thrush/sore throats etc.
Which inhaler style you use is personal. Some people get issues with the propellant in MDIs so prefer DPIs, some people struggle with DPIs and get more side effects so prefer MDIs. People who may have physical difficulties using a pump may prefer the BAI. Most people can use either with no real issues, but if you find you always cough and have issues using one type of inhaler it’s worth asking to try a different style! AUK have created videos you can use to check how to best use your inhaler (dpi versions are inhaler specific as the require different methods), so check that out here; asthma.org.uk/advice/inhale...
Now on to what the inhalers do!
RELIEVER INHALERS
This is usually the typical blue inhaler that people think of and is normally a form of salbutamol. Most people are initially started on an MDI version of this. 2 puffs for MDI (1 at a time with a minute or 2 between puffs!) or (usually) 1 suck of a DPI is a dose. This is for when you’re feeling symptomatic; coughing, wheezing, tightness or short of breath (SoB). If you’re a dropper and not a feeler you should also take it if you’ve hit yellow zone on your peak flow/asthma action plan (PF/AAP). You do not have to be in yellow zone to take your reliever, if you have symptoms!
In an attack (very symptomatic, not relieved by 2 puffs, red PF or according to your AAP) it’s usually up to 10 puffs (separate) of an MDI or 5 sucks if the DPI. If this calms things down you should then speak to your GP within 48hrs if possible. If this doesn’t resolve things you should call 999.
The salbutamol can take up to 15 minutes to fully kick in, but then should last 4hrs. Most people see some improvement/feel some relief in the first 5 minutes however, so if there’s no improvement or you feel worse you need to think about escalating treatment (2puffs goes up to 10 puffs, if you’ve done 10 puffs call ambo). If 2 puffs are not lasting 4 hours you need to contact your GP ASAP as it’s a sign that an attack may be on the way. If 10 puffs does not last 4 hours then you should be taking yourself into hospital. Also if you find you are frequently requiring 3+ doses a week, speak to your GP/AN - this indicates you are not controlled and may need more help!
Salbutamol works by treating the symptoms. It’s a bronchodilator, so temporarily widens your airways if they have become narrow. What it doesn’t do it treat the underlying cause of why your airways have narrowed!
This is what the preventer inhaler does!
For more information on your reliever inhaler visit the AUK website here; asthma.org.uk/advice/inhale...
PREVENTER INHALERS
Does what it says on the tin 😉. These try to prevent irritation from building up. They are typically steroid based, although a lot are combined with a long acting reliever (LABA), which are (shockingly 😉) often called combination inhalers. Preventer inhalers you have to take every day, and can take up to 6 weeks to fully build up in your system. The majority of the inhalers you take twice a day, but some of the newer ones are now just once a day!
There are 4 main different steroid bases so if you find you have an issue with one steroid base, it’s worth asking to try a different base. Equally if you are on a combination inhaler and know you cope with the steroid component you can ask about having a different LABA element!
Unlike with oral tablets of steroids, long term side effects of steroid inhalers are a lot less likely and extreme! Certain inhalers come with steroid cards, but that’s usually just a precautionary issue - it is possible, but it is very rare and usually happens only with longer courses of oral steroids (I’ve never known of anyone with adrenal issues caused just by a steroid inhaler, tho know a couple with them from long term oral steroid use) If you are concerned about it speak to your doctor, but try not to worry too much - bigger side effects for steroid inhalers are a lot rarer than bigger side effects to asthmatics who don’t take them!
Remember if you switch inhalers (for whatever reason!) it will still take up to 6 weeks to become fully effective, and a lot of the initial side effects can calm as your body adjusts to the new drug. Unless things are worsening or completely unbearable, it’s worth trying to wait out the initial 6 weeks to see what goes, what stays and how much help it is!
For more info; asthma.org.uk/advice/inhale...
MART REGIME
To make things more complicated... some people on certain combined preventers (symbicort/fostair/duoresp/fobumix) are told to use them as a reliever (Maintenance And Reliever Therapy). This means that some people may not have the blue reliever inhaler. If you’re instructed to follow this regime you should be given guidance of when to seek more help as instructions are different. It’s also important to double check your inhaler is licensed for this use if you’re instructed to do it by a GP - it’s not always best understood, and so you may be told to use MART on the wrong inhaler (I was 🤦♀️). There is also a cap of how many doses you can take a day of these inhalers. If you’re being transitioned on to MART I would suggest making sure you have a ‘normal’ reliever for just in case, until you know for sure that MART works for you (it’s another thing that can be personal), and that it works during asthma attacks. It’s also important to remind the doctor that they may to increase the number of inhalers you have a month - if you only have enough to cover daily use each month you don’t have any spare to cover reliever usage!
To see what AUK says about MART: asthma.org.uk/advice/inhale...
Another thing to note is that some people are told to increase their preventer dose in certain situations. If you have allergies and hay fever you may be told to double your dose in the summer, if you are strongly affected by cold weather, or always catch winter colds it may be suggested to could dose over winter etc.
As I said in the beginning, this is just a short explanation on what inhalers do and when to use them for anyone who is unsure. I know I have mentioned peak flow in this so here’s a link for anyone who wants more information on that! healthunlocked.com/asthmauk...
In the future I’ll probably do a page covering the common add on therapies (montelukast, spiriva, intal, theophylline etc etc) but that’s for another day and another post - this post is long enough! 😳🙈😂😂 If anyone has anything else to add please fire away!!!
Edit - Common GP prescription drugs: healthunlocked.com/asthmauk...
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