Inhalers

What are inhalers? Inhalers are small, hand-held devices that are used to deliver medication(s) directly to your lungs. Inhalers are used for a number of lung conditions, including (most commonly) asthma and Chronic Obstructive Pulmonary Disease (COPD).

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What are the different ways inhalers deliver medicine? The two main systems are Metered-Dose inhaler (MDI) and Dry Powder inhaler (DPI). The MDI has a pressurized canister with medicine inside, fitted to a boot-shaped plastic holder. Typically, the medicine is released when you actuate the canister by pushing down on it. Some actuate automatically when you inhale. Dry Powder inhalers release the medicine when you take a deep, fast breath, rather than using a gas propellant like the MDI.

What are the commonly prescribed medicines used in inhalers? Inhalers usually contain bronchodilators (medicines that relax and open the airways), corticosteroids (medicines that reduce the airway inflammation), or some combination.

Bronchodilators: “airway openers”

  • Short-Acting Beta Agonist (SABA)- These work rapidly (seconds) to open the airways, but typically only last 4-6 hours. Commonly prescribed SABAs include albuterol (Proair, Proventil, Ventolin), levalbuterol (Xopenex), and pirbuterol (Maxair).
  • Long-Acting Beta Agonist (LABA)- These keep the airway relaxed and open for about 12 hours, but do not begin rapidly like SABAs. LABAs are better for maintenance therapy and should not be used for “rescue” or acute asthma symptoms. In the US, commonly prescribed LABAs include salmeterol (Serevent), formoterol (Foradil) and aformoterol (Brovana).
  • Anticholinergic- These also open the airways, but by a different mechanism than the beta agonists. The main short-acting drug is ipratropium bromide (Atrovent) and long-acting drug is tiotropium bromide (Spiriva).

Inhaled Corticosteroid (ICS): These medicines have no significant effect on relaxing smooth muscle like bronchodilators, but instead work to reduce airway swelling and mucus production. Commonly prescribed ICS inhalers include beclamethasone (Qvar), fluticasone (Flovent), budesonide (Pulmicort), mometasone (Asmanex), flunisolide (Aerobid), and triamcinolone (Azmacort).

Combination inhalers: In the US, the most commonly prescribed combination of bronchodilator (LABA) and corticosteroid are Advair (fluticasone and salmeterol) and Symbicort (budesonide and formoterol). The combination of beta agonist (albuterol) and anticholinergic (ipratropium bromide) is called Combivent.

How can I be sure there is medicine remaining in my inhaler? Many newer inhaler brands include a counter but for others the best way is to keep track of the number of inhalations used and discard when you have reached the total number indicated on the box and/or inhaler. People using MDIs may mistakenly keep using an inhaler with only propellant inside (no drug). In other words, inhalers can still generate a “puff” sound or “feel” like there is something inside, but the drug has been completely used up. This is a serious problem if you depend upon the inhaled medication. Be sure to get a new inhaler before you used all the doses of the old inhaler.

How do I properly use my Metered-Dose inhaler?

  • Closed Mouth Technique:

 

  • Open Mouth Technique:

How do I use my Dry Powder inhaler?


  • Aerolizer
  • Diskus:
  • Flexihaler
  • HandiHaler
  • Twisthaler

Where can I learn more?

American College of Chest Physicians (pdf instructions in English and Spanish)

National Institutes of Health (closed mouth technique)

National Institutes of Health (with a spacer)