Asthma inhalers

The main treatment for asthma is medication that you breathe in via an inhaler. There are several types of inhalers available to help manage or prevent symptoms, such as:

• reliever inhalers, which are used when you get symptoms (you should not be given a blue reliever on its own) and contain a bronchodilator, like salbutamol.
• preventer inhalers that are taken every day to prevent asthma symptoms and contain a corticosteroid.
• combination inhalers that contain both a steroid and a reliever medication. There are different types of combination inhalers, some that can be used to treat asthma symptoms as well as prevent them, and some that are only used as preventers.

Combination inhalers

Combination inhalers contain both an inhaled steroid to prevent asthma symptoms and a long-acting bronchodilator to open your airways. Some long-acting bronchodilators act quickly and can be used when you have symptoms, as a reliever. Others contain a slower-acting, long-acting bronchodilator so you may need to also have a separate blue reliever inhaler for when you have symptoms. You should always follow your doctor's advice to ensure you are using your combination inhaler in the correct way.

Combination inhalers containing formoterol can be used in 2 different ways, depending on your symptoms. They are:

1. Anti-inflammatory reliever (AIR) therapy – This is when you use a combination inhaler only when you have symptoms, in a similar way to how a blue inhaler was used. However, because a combination inhaler also includes a low dose of steroids, it can help treat airway inflammation, open your airways, and reduce the chance of an asthma attack. Common examples of combination inhalers used for AIR therapy include Symbicort Turbohaler 200/6, Duoresp Spiromax 160/4.5, Fobumix 160/4.5, and WockAIR 160/4.5.
2. Maintenance and reliever therapy (MART) – MART combination inhalers are used every day to prevent symptoms, and relieve symptoms when you get them, similar to how a separate preventer and reliever inhalers were used. AIR inhalers can also be used for MART, but there is a wider range of MART combination inhalers available, including Fostair, Luforbec, Proxor, Vivaire and Bibecfo.

You should not need a separate reliever or blue inhaler if you have this type of combination inhaler.

Preventer inhalers

Preventer inhalers contain corticosteroids and are used daily to prevent asthma attacks. They work by reducing inflammation in the airways, widening them, and stopping symptoms like wheezing. Preventer inhalers, also known as brown inhalers, include Clenil Modulite and Pulmicort.

Reliever inhalers

Reliever inhalers contain a bronchodilator that opens your airway quickly, helping you breathe more easily. This type of inhaler is used when you get asthma symptoms, and is often blue in colour. Reliever asthma inhaler brands include Ventolin or salbutamol inhalers.

“In the past, you may have been prescribed a blue inhaler to take when you got symptoms, like wheezing, breathlessness, and chest tightness, alongside a preventer or combination inhaler, which you would use regularly to prevent asthma symptoms from happening. However, this has now changed, and everyone with asthma should have inhaled steroids as part of their treatment plan, and no one should only be prescribed a blue inhaler. If you have not yet changed to an AIR or MART treatment plan, you may be using a combination of a reliever inhaler with a separate preventer inhaler to control your asthma.” – Dr Kathryn Basford, Online Doctor.

It is essential to attend your yearly asthma check-ups, so your doctor can make sure you are getting the correct treatment.

In addition to the different asthma inhaler types, there are several inhaler devices available. Different people find different devices more suitable. For example, some inhalers use pressurised gas to deliver medication to your airways, while your breath activates others. The way each device is used can vary and will require a good technique for the best results.

Metered-dose inhalers (MDIs)

A pressurised metered-dose inhaler (pMDI) is a common inhaler type that contains a metal canister with the active medication inside, a metering valve, and a plastic mouthpiece. It uses a pressurised but inactive gas to deliver a precise amount of the medication to your airways.

Spacers

A spacer is a plastic, empty tube that you attach a pMDI to one end and breathe the medication through the other. A spacer helps to make sure that the right amount of medication reaches your lungs and makes it easier for you to use your inhaler.

Spacers are only for use with pMDIs. If you use a dry-powder or soft-mist inhaler, you do not need to use a spacer.

Dry powder inhalers (DPIs)

A dry powder inhaler (DPI) delivers your asthma medication as a fine powder rather than a spray. They are breath-activated, which means you will need to breathe in quickly and deeply to get the medication to enter your lungs. Taking a fast and deep breath releases a pre-measured dose of the powdered ingredients.

Soft mist inhalers (SMIs)

Soft mist inhalers turn liquid medications into a mist that can be inhaled. They are thought to allow more medication to reach the lungs, as less is deposited in the back of the throat. Soft mist inhalers require you to breathe slowly and steadily when using them.

Asthma inhalers work by sending medication, either steroids, bronchodilators, or a combination of both, to your airways in your lungs to lower inflammation or relax the smooth muscles to make breathing easier. Most people will use a combination inhaler for AIR or MART therapy, but some may use a separate preventer inhaler for asthma and a blue asthma inhaler for when they have symptoms.

How does a blue asthma inhaler work?

A reliever or blue asthma inhaler contains a short-acting bronchodilator, such as salbutamol, to relax the muscles in the airways and make breathing easier. They are used when asthma symptoms occur, such as during an asthma attack.

The most recent asthma guidelines recommend the use of combination inhalers, which contain both a steroid and a long-acting bronchodilator. No one should be prescribed only a blue inhaler. If you only have a blue inhaler, make an appointment with a doctor to review your asthma treatment plan.

How does an asthma steroid inhaler work?

Preventer inhalers contain a low dose of a corticosteroid to reduce airway swelling and inflammation, which are the underlying causes of asthma. Over time, the use of these medications can make your airways less sensitive to asthma triggers. They are used every day, even if you have no symptoms, to help build up protection and prevent an asthma attack.

How does a combination asthma inhaler work?

Combination inhalers contain both a steroid preventer medication to reduce airway inflammation and a long-acting bronchodilator to relax the smooth muscles in the lungs and open your airways.

There are different types of combination inhaler available, and depending on which type you have, you may need a separate blue inhaler. For example, combination inhalers, like Seretide, can be used daily to prevent asthma symptoms, but they also contain a long-acting bronchodilator (salmeterol) which may not work fast enough to relieve an asthma attack. So, you will have a separate reliever inhaler for when you get asthma symptoms that contain salbutamol which is a fast acting bronchodilator.

Another type of combination inhaler is one that contains the long-acting bronchodilator, formoterol. These can in one of the following 2 ways, depending on your asthma symptoms:

1. AIR therapy – Where you use a combination inhaler when you have asthma symptoms, just like how a blue inhaler was used.
2. MART – Rather than having 2 separate inhalers, you only have 1, which is taken daily to prevent symptoms and reduce inflammation, and as when it is needed if you get asthma symptoms.

No matter which type of inhaler or combination of inhalers you use, it is important that you use them correctly to make sure the medication works properly. Most people will be given a pMDI, DPI, or a soft mist inhaler, and each one works differently.

Here’s how to use the different asthma inhaler types:

Pressurised metered dose inhaler

To use a pMDI, you should:

1. Hold the inhaler upright and remove the mouthpiece cover.
2. Check for any signs of a blockage or debris in the mouthpiece.
3. Give the inhaler a shake.
4. Slowly breathe out, away from the inhaler, until your lungs feel empty.
5. Place your lips around the mouthpiece and slowly begin to breathe in through your mouth.
6. Press the canister down to release the medication while still breathing in slowly.
7. Remove the inhaler from your mouth and hold your breath for 10 seconds, or as long as you find comfortable.
8. Slowly breathe out.
9. When you have finished, replace the cap on your inhaler.
10. If the inhaler contains a steroid, rinse your mouth with water to prevent mouth infections.

Dry powder inhalers

To use a dry powder inhaler, you should:

1. Open the cover of your inhaler and hold it as shown by your doctor or the instruction manual.
2. Load a dose of the medication as shown in your instruction manual.
3. Stand up or sit up straight.
4. Slowly breathe out, away from the inhaler, until your lungs feel empty.
5. Place your lips around the mouthpiece and slowly begin to breathe in through your mouth.
6. Take a deep and fast breath through your mouth.
7. Hold your breath for 10 seconds or as long as you feel comfortable.
8. Remove the inhaler from your mouth and breathe out slowly.
9. When you have finished, replace the cap on your inhaler.
10. If the inhaler contains a steroid, rinse your mouth with water to prevent mouth infections.

Soft mist inhalers

To use a soft mist inhaler, you should:

1. Check the dose indicator to make sure the cartridge is not empty.
2. Hold the inhaler upright with the cap still closed.
3. Turn the bottom of the inhaler in the direction of the arrows until it clicks.
4. Push the catch on the side to open the cap.
5. Hold the inhaler horizontally and check that there is nothing blocking the mouthpiece.
6. Sit or stand up straight, then slightly tilt your chin up.
7. Breathe out slowly through your mouth, away from the inhaler, until your lungs feel empty.
8. Make a tight seal using your lips around the mouthpiece.
9. Start to breathe in slowly through your mouth and at the same time press the button on the inhaler to release the medication.
10. Continue breathing in until your lungs feel full.
11. Remove the inhaler from your mouth and hold your breath for 10 seconds.
12. Then, slowly breathe out away from the inhaler.
13. When you have finished, close the inhaler’s cap.

All medications can cause side effects, including asthma inhalers, although not everyone will get them. You can get more information about asthma inhaler side effects in the patient information leaflet that comes with your medication.

Common preventer inhaler for asthma side effects are:

• sore mouth or throat
• hoarse voice
• thrush in the mouth

A common preventer inhaler brand is Clenil Modulite, and you can check its patient information leaflet for more information about potential side effects.

Common blue asthma inhaler side effects include:

• feeling shaky
• headaches
• mouth and throat irritation

Ventolin is a common brand of reliever inhaler. The patient information leaflet contains more information about the potential side effects of salbutamol.

Common combination inhaler side effects are:

• heart palpitations
• trembling
• shaking
• thrush in the mouth
• mild sore throat
• cough
• hoarse voice
• headache

The Symbicort Turbohaler is an example of a combination inhaler, and its side effects are clearly stated in the patient information leaflet that is provided with it.

Asthma inhalers are prescription-only medications, and you should only use them if they have been prescribed to you. They may not be suitable if you have certain medical conditions or are taking any other prescribed, over-the-counter, or herbal medications.

Tell your doctor before taking an asthma inhaler if you are taking:

• beta blockers
• medications for a fast or irregular heartbeat or heart failure
• diuretics, also known as water tablets
• steroids
• any other bronchodilators
• antidepressants
• medications to treat HIV
• Parkinson’s disease medications
• medications to manage thyroid problems

You should also tell your doctor you have:

• diabetes
• a lung infection
• high blood pressure
• a heart issue
• thyroid or adrenal gland problems
• low blood potassium levels
• severe liver problems

You should attend your asthma check-ups with your doctor or asthma nurse so they can review your treatment plan each year or if you feel like your asthma symptoms are getting worse.

Asthma inhalers are prescription-only medications, which means you need a doctor’s permission to get them. You can request asthma inhalers online from trusted services such as Asda Online Doctor or the NHS.

Can you buy asthma inhalers online?

Yes, you can request an asthma inhaler from Asda Online Doctor if you already have an asthma diagnosis and a prescription.

To order your asthma inhaler from us, you need to:

1. Complete a short 5-minute health questionnaire for one of our doctors to review.
2. Order and pay for your preferred treatment.
3. One of our doctors will review your questionnaire answers to make sure the medication is safe and suitable for you.
4. If approved, your asthma inhaler will be delivered to your address in discreet packaging, or you can choose to collect it from your nearest Asda Pharmacy.
5. If your order is not approved, our doctors will contact you about what to do next.

Ordering a repeat prescription for your inhaler for asthma is quick and easy and does not require you to have a face-to-face appointment with your doctor. However, we recommend that you attend your asthma check-ups, so that your GP can make sure you are getting the right treatment.

Can you get an asthma inhaler over the counter?

No, asthma inhalers require a prescription from a doctor, which means you cannot buy them over the counter.

Can you get an asthma inhaler on the NHS?

Yes, asthma inhalers are available on the NHS. If you think you have asthma, you should make an appointment with your GP to get a diagnosis and appropriate treatment.

Please note: Our doctors cannot diagnose asthma or provide a new prescription for asthma inhalers. So, you will already need a prescription to buy asthma inhaler from us.

Proper maintenance and storage of your asthma inhaler is just as important as using it correctly. If inhalers are not looked after, they may not deliver the right dose or even stop working completely. Here are some of the ways you can look after your inhaler:

Keeping track of your doses

If your inhaler has a dose counter, use it to track how many doses you have left. Most inhalers also have a red zone that indicates around 20 doses remaining; when you reach this level, you should order a new inhaler.

Keep a backup inhaler with you so you are never without a working one.

How to store your asthma inhaler

Storing your inhaler in the right conditions will help to keep it working properly. The patient information leaflet provided with your inhaler will tell you how to look after it, but in general, you can follow these tips:

• keep your inhaler at room temperature and away from extreme heat or cold
• store them somewhere dry and out of direct sunlight because dampness or humidity can affect the medication, so avoid storing your inhaler in the bathroom
• always replace the mouthpiece cover after use to stop any debris from getting inside and blocking it or contaminating the medication
• store inhalers out of the reach of children and pets so they are not accidentally knocked over or used

When to replace your inhaler

An asthma inhaler should be replaced when:

• the dose counter says 0
• it has passed its expiry date
• the device has been damaged, or it has been exposed to moisture
• it has not been used for a while

Cleaning an asthma inhaler

Asthma inhalers need to be kept clean, and different asthma inhaler types will have different cleaning routines. It is essential to read the patient information leaflet that is supplied with your medication for specific instructions.