Mahendra P. Dadhania, MD     Shailen R. Shah, MD     Adele M. Guernica, DO

Board Certified by American Board of Allergy & Immunology
Office locations in South Jersey, NJ Shore and Montgomery County in Pennsylvania

Use of Inhaled Medications

Tips to Remember:

People with asthma have inflamed airways that become narrowed, making it more difficult to breathe. Anti-inflammatory asthma medications lessen symptoms by treating the inflammation.

Bronchodilators are medicines that help relieve the constriction of smooth muscle within the inflamed airways. Inhalation is usually the most effective way to deliver medications to treat asthma. The major advantages of inhaled medications are their direct delivery to the area of difficulty - the large and small bronchial tubes - and their decreased side effects compared to many medications taken by mouth or by injection.

Classes of inhaled medication
Primary asthma medications available in inhaled form include:

  • Inhaled corticosteroids, also referred to as topical corticosteroids or glucocorticosteroids, are effective anti-inflammatory medications used successfully to treat asthma for more than 50 years. These types of steroids are different from the anabolic steroids misused by some athletes to increase performance. These inhaled steroid medications decrease airway inflammation, mucus production, oversensitivity, swelling and constriction of the bronchial tubes.
    It is important to continue to take inhaled corticosteroids as prescribed even if you feel well, because the inflammation is constant even when you do not feel it and the medication helps to prevent asthma exacerbations. Examples of inhaled corticosteroids are beclomethasone, budesonide, flunisolide, fluticasone and triamcinolone. It is important to rinse, gargle and spit with water after each dose of inhaled steroids.
  • Bronchodilators, also called beta2agonists, are non-steroid medications related to adrenalin and used as "rescue" medications to immediately relieve asthma symptoms. These include albuterol and levalbuterol, pirbuterol, and terbutaline. Sometimes these inhaled medications are overutilized. Using more than one canister per month or needing it more than three to four times a day is cause for concern. It indicates that underlying inflammation is not adequately controlled, and that you should see your physician for adjustment of your treatment. Salmeterol and formoterol are long-acting beta2agonist bronchodilators that are ordinarily intended to be used together with anti-inflammatory medication on a regular (daily) rather than an as-needed basis.
  • Non-steroid 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
There are three basic types of devices used to 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. Chlorofluorocarbon (CFCs), are used in many MDIs but are being replaced gradually by other propellants. 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. Rotary inhalers and other dry powder inhalers deliver medication without using chemical propellants.

Regardless of the type of inhalation device, effective delivery of medication to the lower airways is critical for the medication to work. For all devices, education and training of patients, and family or professional caregivers who administer these medications to patients, for the proper and effective use of these devices is an essential component of inhalation therapy. It is so important, in fact, that proper inhalation technique should be constantly ensured, demonstrated at routine physician visits, for example, with re-education and re-training as necessary.

Coordination of inhalation from inhalational devices varies from extremely easy with some devices (for example, nebulizers) to extremely difficult for some patients (for example, MDIs) and poor response to therapy can be due simply to such poor coordination with inhalational delivery that little or no drug reaches the airways. A device called a spacer can improve delivery of inhaled medication from MDIs.

Spacers help deliver a greater amount of medication directly into the lower airways, where it is intended to go, rather than into the throat. Many spacers fit on the end of an inhaler; for some, the canister of medication fits into the device. Some devices come with built-in spacers. Many people with asthma, especially young children, may have difficulties coordinating inhalation with using a metered dose inhaler. For these patients the use of a spacer is particularly recommended.

MDIs from which drug is dispensed automatically when the patient breathes in from the inhaler also are available. Technique for inhalation from dry powder inhalers is different and may feel more "natural" than with MDIs. Spacers are not needed for dry powder devices.

Nebulizer use
Nebulizers effectively deliver asthma medications in a fine mist through mouthpieces, through masks sized differently to fit infants through adults, or through T-tubes. Their use tends to be particularly easy, requiring only usual inspiration and expiration through the connection to the nebulizer. Nebulized asthma medication is especially useful for infants, young children and some elderly patients who are unable to use an MDI. Use of a nebulizer can be more time-consuming and is much less effective if an infant or child is crying.

Appropriate medication use
Your physician will prescribe inhaled medication that is most appropriate for you. If you have any questions about your prescribed inhaled medications or their proper use, make sure to contact your doctor. Many inhaled asthma medications are intended to be used on a daily basis to keep your airways open, even if you are not experiencing symptoms. It is important to follow your physician's instructions to ensure that you are optimally managing your asthma.

Your allergist/immunologist can provide you with more information on using inhaled asthma medications.

Tips to Remember are created by the Public Education Committee of the American Academy of Allergy, Asthma and Immunology. This brochure was updated in 2003.

The content of this brochure is for informational purposes only. It is not intended to replace evaluation by a physician. If you have questions or medical concerns, please contact your allergist/immunologist.

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