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
- 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
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.
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
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
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.
American Academy of Allergy,
Asthma and Immunology
555 East Wells Street
Milwaukee, WI 53202-3823
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