What Are The Different Types of Inhaler?
There are several types of inhalers used in the treatment of asthma. Asthma inhalers are split into a variety of types depending on what they treat and how to use them.
Types of Inhalers
Asthma inhalers are either used as a reliever or preventer. Most inhalers are also split into 2 main categories:
- metered dose inhalers (MDI)
- dry powder inhalers (DPI)
The type of inhaler you use will affect how you use them.
If you are diagnosed with asthma, you might feel overwhelmed by how much you need to remember when using your inhalers. Your asthma nurse will go through an asthma treatment plan which breaks down your treatment. Your asthma treatment plan will include information on your regular daily treatment and what to do when you feel your symptoms worsen. Your nurse or pharmacist will also explain how to use your inhalers.
The most important thing to remember is to stay consistent with your asthma treatment. Even if you feel better and can do your normal daily activities without getting breathless, it’s crucial to keep on top of your maintenance therapy. This will help ensure your lungs stay healthy.
You may also use the same inhalers if you have chronic obstructive pulmonary disease (COPD). COPD is a respiratory condition similar to asthma.
Reliever inhalers give you relief from the symptoms of asthma, including a tight chest and breathlessness. Reliever inhalers are also known as bronchodilators. Bronchodilators contain a medication called a short acting beta-agonist, like salbutamol. Beta-agonists relax the muscles in your airways to allow you to breathe easily.
Your doctor or asthma nurse will tell you how often to use your reliever. In general, you can take 1 or 2 puffs when you feel breathless or wheezy. If you’re feeling especially breathless, such as when having an asthma attack, you can take 1 puff up to 10 times, with 30 to 60 seconds in between, with a standard salbutamol inhaler.
Reliever inhalers are usually blue coloured, making them easy to locate if you are having an asthma attack. You can also use your reliever inhaler before you exercise if you know you’ll get breathless.
The most common reliever inhaler you’ll be prescribed is salbutamol, also known as Ventolin. Another reliever is called Bricanyl which contains terbutaline sulfate.
Some reliever inhalers contain long acting beta-agonists, such as Serevent. Long acting beta-agonists stay in your body for longer and can help with asthma symptoms for up to 12 hours. Short acting beta-agonists get to work within 15 minutes and their effects last for about 4 hours.
If you are prescribed a long acting beta-agonist, you need to use this regularly with your preventer inhaler.
Your doctor will prescribe a reliever inhaler for you as part of your asthma treatment plan. You can also request a salbutamol inhaler from Asda Online Doctor without needing to make an appointment. Simply fill out our short consultation questionnaire. This will be reviewed by one of our doctors. We can then send your inhaler to your home address or you can choose to collect it from an Asda Pharmacy.
Preventer inhalers are used for long term treatment of asthma. Preventer inhalers are part of maintenance therapy, meaning they help to maintain the health of your lungs.
The inhalers contain inhaled corticosteroids such as fluticasone, beclomethasone or budesonide. Preventer inhalers are often used twice a day, in the morning and evening before bed.
It’s important to continue to use your preventer inhalers regularly to keep your lungs in good condition and make it easier for you to carry out daily activities. It will also reduce the chances of having an asthma attack and how often you need to use your reliever inhaler.
Whenever you use a preventer inhaler that contains corticosteroids, make sure you rinse your mouth thoroughly with water and spit out the residue after use. This is to prevent oral thrush, as corticosteroids in your mouth can cause oral thrush, which can give you a white tongue or white inner cheeks. Oral thrush is treatable, but it’s best to avoid it in the first place.
The most common preventer inhaler prescribed is Clenil Modulite which contains beclomethasone. Other preventer inhalers include Qvar and Pulmicort Turbohaler.
Combination inhalers contain both a reliever and a preventer. Most combination inhalers contain a long acting beta-agonist as a reliever, such as formoterol or salmeterol. They can be found in combination inhalers like Fostair, Seretide and Symbicort. Your doctor may prescribe a combination inhaler if your symptoms are not well controlled with a standard reliever and preventer.
Trimbow is a triple combination or triple therapy inhaler as it contains 3 active ingredients. Trimbow contains beclometasone, formoterol and glycopyrronium. Glycopyrronium is an additional type of medication used in asthma therapy called an antimuscarinic agent. Antimuscarinics relax the smooth muscle in your chest. Triple therapy with Trimbow is used when your asthma is hard to control with other inhalers.
You should use your combination inhaler regularly as you would with a preventer inhaler. This is usually once or twice a day. Make sure you keep on top of your asthma treatment to reduce any worsening of symptoms and to keep your lungs healthy so you can breathe easily.
Both your reliever and preventer can come in a range of different inhaler devices. Your doctor, nurse or pharmacist will show you how to use each device. Different devices will work in a slightly different way, which is why it’s important to know how to use them properly. Not using your inhalers properly means you might not get the benefit you need.
You can also watch Asthma + Lung UK’s videos on how to use your inhaler. They have useful videos on every type of inhaler including using spacer devices.
Standard MDI inhaler
A standard metered dose inhaler (MDI), also known as a pressurised MDI (pMDI), is the standard type of inhaler you’ll be prescribed.
Using an MDI inhaler is straightforward:
- before use, remove the cap and shake the inhaler
- breathe out
- put your mouth around the mouthpiece and make sure your lips are sealed around it
- press down on the canister and breathe in slow and deep at the same time
- take your mouth away from the mouthpiece and hold your breath for 10 seconds
- breathe out slowly
The key to using an MDI inhaler is to take a slow and steady deep breath in. If you inhale too quickly, the medication will hit the back of your throat instead of going into your lungs.
You’ll need to be able to coordinate your breath while activating the inhaler.
Some MDI inhalers are breath actuated. This means they activate when you breathe in deeply. You do not need to press down on the canister or button if you have a breath actuated inhaler.
To take another puff, wait between 30 to 60 seconds for the inhaler to recharge.
Breath activated inhalers
Breath activated inhalers work when you breathe in. They require a quick, deep breath to activate the inhaler.
Dry powder inhalers (DPIs) use breath activation to deliver the medication to your lungs. This is a suitable choice of inhaler if you have enough strength in your lungs to activate the inhaler.
If you have reduced lung function or are under 18 years old, a standard metered dose inhaler (MDI) might be more appropriate for you.
Types of DPIs include Seretide Accuhaler and Symbicort.
To use a DPI or breath activated inhaler, make sure you read the instructions in the leaflet that comes with the medication to find out how to load the dose. Some DPI inhalers only need you to click the device to load the next dose of medication before you inhale it. Other inhalers may require you to load separate capsules into the holding chamber.
You do not need to shake the DPI inhaler as you would with an MDI, but you should:
- load the dose of medication in the inhaler
- breathe out gently
- seal your lips tightly around the mouthpiece
- inhale one puff quickly and deeply
- remove the inhaler from your mouth and hold your breath for 10 seconds
- breathe out slowly
When using breath activated inhalers or DPIs you must inhale quickly and deeply. The force of you breathing in will activate the inhaler.
Follow your device’s instructions to find out how to load your next dose if you need to take another puff. Many DPIs will have a dose counter to show you how many doses are left in the device.
Spacer devices make it easier for you to get the full dose of an inhaler into your lungs. These devices are useful if you find coordination difficult with a standard metered dose inhaler (MDI) or if your breath is not strong enough to activate a dry powder inhaler (DPI). Spacer devices are especially helpful if your child is struggling to use their inhaler or for people who have joint pain or limited mobility in their fingers.
Not all inhaler types will be suitable for a spacer. If this is the case, your doctor or nurse may switch your inhaler to a different device to make it suitable for a spacer.
You can get a spacer device prescribed to you by your doctor, or you can buy a device from your local pharmacy.
Spacers are usually found under the brand names Volumatic or AeroChamber Plus.
Make sure you are sitting upright or standing up when using your spacer and inhaler. To use a spacer device:
- remove the cap from the inhaler and shake the inhaler
- secure the inhaler to the end of the spacer
- seal your lips tightly around the mouthpiece of the spacer, or close the gap between the face mask and your skin by pressing it tightly against your face so it’s tightly sealed around your nose and mouth
- tilt your head upwards to make it easier for the medicine to get into your lungs
- breathe in and out slowly without removing the spacer from your mouth
- press down on the button or canister of your inhaler to release a puff
- continue to breathe in and out through the spacer 5 times
- remove the spacer from your mouth
- hold your breath for up to 10 seconds
If you need to take another dose, you can shake the inhaler while it is attached to the spacer. Wait at least 30 to 60 seconds to take another puff.
Spacer devices also reduce your chance of getting oral thrush, as it limits how much medicine is in contact with the inside of your mouth.
If you use your spacer regularly, you should clean it with water around once a week and replace it every year.
You may be prescribed a nebuliser if you have severe asthma, lung disease or difficulty breathing. Nebulisers are devices that deliver high doses of asthma medication to your lungs. In severe asthma, you may need a higher dose of a medication than a standard inhaler can deliver. Each dose can take around 5 to 10 minutes to inhale.
Nebulisers use nebules inside the device. Nebules are liquid solutions of medication that nebulisers convert into a fine mist of aerosol droplets that are easy for you to inhale. You can get nebules on prescription from your doctor. You may also be prescribed saline nebules to dilute the medication.
Nebuliser devices are often introduced to you by a hospital respiratory clinic. You’ll be in contact with a specialist team that will assist you in getting the nebuliser up and running at home. They’ll also make sure you know how to use your nebuliser and how to take care of it.
Which inhaler is right for you?
Deciding which inhaler is right for you can be simple. If you have mild asthma, you can use a dry powder inhaler (DPI) without needing to coordinate activating the inhaler and breathing in. If you think you might struggle to breathe in deeply enough, you can opt for a standard metered dose inhaler (MDI).
Some MDIs have both a breath actuated feature and a canister you can press down. This means you do not need to make a choice and can tailor how you use your inhaler depending on how breathless you feel.
When it comes to using inhalers, the most important steps are:
- performing the proper inhaler technique
- using your inhalers regularly
- using a spacer if you need to
- having a review once a year with a healthcare professional
By following these steps, you’ll have a high chance of achieving the best control over your asthma and be able to maintain a healthy and active life.
Dr Kathryn Basford
Dr Kathryn Basford is a qualified GP who works as a GP in London, as well as with ZAVA. She graduated from the University of Manchester and completed her GP training through Whipps Cross Hospital in London.Meet our doctors
Article created: 26 Apr 2022
Last reviewed: 26 Apr 2022
Asthma: Beta-2 agonists (NICE) [May 2021] [accessed March 2022]
Inhaler technique MDI [June 2018] [accessed March 2022]
How to use a dry powder inhaler [Oct 2021] [accessed March 2022]
(Reviews are for ZAVA UK)