If you are having sudden breathing difficulty, reach for your short-acting bronchodilator (rescue inhaler) first, not your long-acting bronchodilator orsteroid inhaler.
Your healthcare provider or pharmacist can tell you which of your inhalers is your rescue inhaler, but some common ones include:
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While an important part of yourasthmaor chronic obstructive pulmonary disease (COPD) treatment plan, inhaled steroids, long-acting bronchodilators, and combination inhalers are considered maintenance medicines. In other words, they are used daily to prevent—not treat—acute symptom flare-ups and attacks.This article discusses why you need to use a rescue inhaler first in the case of acute breathing trouble and why maintenance bronchodilators and steroid inhalers don’t provide quick symptom relief. It also explains the role of these two medicines in your overall care.
Rescue InhalersShort-acting bronchodilators (albuterol)Open and relax airwaysUsed during an attackWork within minutesTaken as neededTypically an L-shaped inhalerControllersLong-acting bronchodilators, inhaled corticosteroids, or combination of bothUsed for preventing flare-ups/attacksTaken twice dailyTake hours to start workingUsually a disk-shaped inhaler, but may be L-shaped
Rescue InhalersShort-acting bronchodilators (albuterol)Open and relax airwaysUsed during an attackWork within minutesTaken as neededTypically an L-shaped inhaler
Short-acting bronchodilators (albuterol)
Open and relax airways
Used during an attack
Work within minutes
Taken as needed
Typically an L-shaped inhaler
ControllersLong-acting bronchodilators, inhaled corticosteroids, or combination of bothUsed for preventing flare-ups/attacksTaken twice dailyTake hours to start workingUsually a disk-shaped inhaler, but may be L-shaped
Long-acting bronchodilators, inhaled corticosteroids, or combination of both
Used for preventing flare-ups/attacks
Taken twice daily
Take hours to start working
Usually a disk-shaped inhaler, but may be L-shaped
Short-Acting Bronchodilators Work Quickly
Short-acting bronchodilators, known as short-acting beta-2 agonists (SABAs), provide quick relief ofasthma attacksandCOPD exacerbations. These are known as quick-relief or rescue inhalers.
SABAs, such as albuterol and levalbuterol, quickly work to open up (dilate) and relax constricted airways. If you are wheezing, feeling short of breath, or are having an asthma attack, use your short-acting bronchodilator inhaler. It should help you breathe easier in less than a minute.
SABAs bind to the beta-2 adrenergic receptor to relax the smooth muscle tissue of the lungs. This dilates the bronchi andbronchiolesof the airways to quickly improve airflow and relievebronchospasmsthat cause chest tightness and coughing during an asthma attack or COPD flare-up.
Used as a rescue or reliever inhaler, short-acting bronchodilators are taken as needed for acute symptom relief. They remain active in your system for four to eight hours.
SABAs are commonly delivered using a pressurized canister that delivers ametered dosevia an L-shaped inhaler and should be used with a spacer. Short-acting bronchodilators are also available as a dry powder inhaler, tablets, syrups, and for nebulizers (machines that turn liquids into a mist).
Use for Asthma
Short-acting bronchodilators are used to treat an acute asthma attack, including severe shortness of breath, chest tightness or pain, coughing, and wheezing.
In addition to a rescue inhaler, your healthcare provider will also prescribe an inhaled corticosteroid for long-term symptom management.
According to the 2019 Global Initiative for Asthma (GINA) recommendations, short-acting bronchodilators should only be used in conjunction with a corticosteroid controller medication to reduce the risk of severe asthma exacerbations.
Use for COPD
Short-acting bronchodilators are used to treat acute coughing spells anddyspnea(shortness of breath) associated with COPD.
What If I Don’t Have a Rescue Inhaler Handy?
If you are having difficulty breathing and do not have a short-acting bronchodilator with you, reaching for a long-acting medicine will not help. Try to remain calm and try these alternatives:
If your symptoms continue or worsen, call 911.
Short-Acting Beta Agonists (SABAs) for Asthma
Long-Acting Bronchodilators Keep Airways Open
Long-acting bronchodilators, known as long-acting beta-2 agonists (LABAs), are dry-powder maintenance inhalers used for longer-term control of breathing difficulties. Commonly taken twice a day (every 12 hours, symptoms or not), LABAs should not be used as a rescue inhaler.
Salmeterol and formoterol are the only inhaled LABAs available and are sometimes used incombination inhalersthat include corticosteroid medications. Brands of long-acting bronchodilators include:
Like short-acting bronchodilators, LABAs bind to the beta-2 adrenergic receptor and relax the smooth tissue of the lungs. But unlike SABAs, long-acting bronchodilators take longer to start working and provide symptom relief for up to 12 hours.
Use in Asthma
LABAs are sometimes used in the treatment of asthma as a maintenance medicine to help keep airways open and prevent acute attacks. They are typically prescribed only after treatment with inhaled corticosteroids and short-acting bronchodilators fail to control symptoms.
In asthma treatment, long-acting bronchodilators should only be used in combination with inhaled steroids due to an increased risk of serious asthma exacerbations that can result in hospitalization or even death.
The decision to use salmeterol or formoterol in the treatment of asthma should not be taken lightly due to an increased risk of fatal adverse effects. A 2014 Cochrane reviewof 102 studies on the safety and efficacy of LABAs involving 70,980 people with asthma could not definitively rule out a connection between LABAs and these safety concerns.
However, used in combination with inhaled steroids, LABAs help to improve lung function, decrease asthma symptoms, increase the number of symptom-free days, reduce the number of asthma attacks, decrease the use of rescue inhalers, and prevent exercise-induced asthma attacks.
For some people, the benefit of improved symptom control from LABAs may outweigh the risks. In that case, it is safer to take as a combination medication inhaler with salmeterol/formoterol plus a steroid, such as Symbicort, Advair, or Dulera.
Use in COPD
LABAs are used in the treatment of moderate to severe COPD for long-term symptom management. They are commonly prescribed when short-acting bronchodilators alone are unable to adequately control the disease.
Guidelines recommend that all people with COPD and shortness of breath or exercise intolerance (this includes most people with COPD) take a LABA along with another COPD medication called a long-acting muscarinic antagonist (LAMA).
LABAs are effective for medium- and long-term relief of COPD symptoms, including cough, wheezing, shortness of breath, and chest tightness, a 2013 Cochrane review reports. The analysis of 26 studies involving 14,939 people with moderate to severe COPD found LABA use in COPD resulted in fewer symptom flare-ups and improved quality of life.
Use of Long-Acting Bronchodilators
Steroid Inhalers Manage Inflammation
Steroid inhalers are not rescue inhalers and should not be used for quick relief of symptoms. It can take weeks of daily steroid inhaler use before you notice improvement. Thereafter, it may take several hours or even a day for a steroid to do its job.
Inhaled corticosteroids are delivered as a dry powder. Common steroid inhalers include:
Inhaled corticosteroids are the most effective long-term asthma control medicine. Taken daily to prevent chronic symptoms and asthma attacks, inhaled steroids reduce swelling and inflammation in the airways, helping to prevent asthma attacks.
Steroid inhalers are the first line of treatment for managing asthma. Since they may take a while to start working, your healthcare provider may also prescribe a SABA rescue inhaler in case of an asthma attack.
Once steroids begin to work, you should find yourself needing your rescue inhaler less often, if at all.
Inhaled corticosteroids are not typically prescribed on their own for the treatment of COPD. Steroids help to relieve airway inflammation and may be recommended if your COPD symptoms are not controlled with long- and short-acting bronchodilators.
Your healthcare provider may prescribe inhaled steroids for a trial of six weeks to three months to see if the addition of steroids helps to relieve COPD symptoms and improve breathing.
15 Inhalers for COPD
How Often Do You Use Your Rescue Inhaler?If you need to use your rescue inhaler more than twice a week, notify your healthcare provider. It may be a sign that your long-acting controller medication is not working properly.
How Often Do You Use Your Rescue Inhaler?
If you need to use your rescue inhaler more than twice a week, notify your healthcare provider. It may be a sign that your long-acting controller medication is not working properly.
Summary
If you have asthma or COPD and are having breathing difficulty, pick up your short-acting bronchodilator (rescue inhaler) first. Using your maintenance inhaler, whether a long-acting bronchodilator, steroid inhaler, or combination inhaler—will not treat your symptoms.
If you are unsure which of your inhalers is which, ask your healthcare provider or pharmacist.
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Lung Association.Understand your asthma medication.Billington CK, Penn RB, Hall IP.β Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64Smith S, Edwards CT.Long-acting inhaled bronchodilators for cystic fibrosis.Cochrane Database Syst Rev. 2017 Dec 19;12(12):CD012102. doi:10.1002/14651858.CD012102.pub2Reddel HK, FitzGerald JM, Bateman ED, et al.GINA 2019: a fundamental change in asthma management: Treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents.Eur Respir J. 2019;53(6):1901046. doi:10.1183/13993003.01046-2019Saguil A, Garcia D.Safety of long-acting beta agonists in adults with asthma.Am Fam Physician. 2014;90(7):453-454.American Academy of Allergy, Asthma, & Immunology.AAAAI allergy & asthma medication guide: long-acting beta-agonists (LABAS).Xia Y, Kelton CM, Xue L, Guo JJ, Bian B, Wigle PR.Safety of long-acting beta agonists and inhaled corticosteroids in children and adolescents with asthma.Ther Adv Drug Saf. 2013;4(6):254-263. doi:10.1177/2042098613504124Cates CJ, Wieland LS, Oleszczuk M, Kew KM.Safety of regular formoterol or salmeterol in adults with asthma: an overview of Cochrane reviews.Cochrane Database Syst Rev. 2014;2014(2):CD010314. doi:10.1002/14651858.CD010314.pub2Nici L, Mammen MJ, Charbek E, et al.Pharmacologic management of chronic obstructive pulmonary disease. An official American Thoracic Society clinical practice guideline[published correction appears in Am J Respir Crit Care Med. 2020 Sep 15;202(6):910].Am J Respir Crit Care Med. 2020;201(9):e56-e69. doi:10.1164/rccm.202003-0625STKew KM, Mavergames C, Walters JA.Long-acting beta2-agonists for chronic obstructive pulmonary disease.Cochrane Database Syst Rev. 2013;(10):CD010177. doi:10.1002/14651858.CD010177.pub2American Academy of Allergy, Asthma & Immunology.AAAAI allergy & asthma medication guide: Inhaled asthma medications.American Academy of Allergy, Asthma, & Immunology.AAAAI allergy & asthma medication guide: inhaled corticosteroids.Asthma and Allergy Foundation of America.Asthma treatment.NIH: National Heart, Lung, and Blood Institute.COPD.American Lung Association.Assessing asthma control.
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Lung Association.Understand your asthma medication.Billington CK, Penn RB, Hall IP.β Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64Smith S, Edwards CT.Long-acting inhaled bronchodilators for cystic fibrosis.Cochrane Database Syst Rev. 2017 Dec 19;12(12):CD012102. doi:10.1002/14651858.CD012102.pub2Reddel HK, FitzGerald JM, Bateman ED, et al.GINA 2019: a fundamental change in asthma management: Treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents.Eur Respir J. 2019;53(6):1901046. doi:10.1183/13993003.01046-2019Saguil A, Garcia D.Safety of long-acting beta agonists in adults with asthma.Am Fam Physician. 2014;90(7):453-454.American Academy of Allergy, Asthma, & Immunology.AAAAI allergy & asthma medication guide: long-acting beta-agonists (LABAS).Xia Y, Kelton CM, Xue L, Guo JJ, Bian B, Wigle PR.Safety of long-acting beta agonists and inhaled corticosteroids in children and adolescents with asthma.Ther Adv Drug Saf. 2013;4(6):254-263. doi:10.1177/2042098613504124Cates CJ, Wieland LS, Oleszczuk M, Kew KM.Safety of regular formoterol or salmeterol in adults with asthma: an overview of Cochrane reviews.Cochrane Database Syst Rev. 2014;2014(2):CD010314. doi:10.1002/14651858.CD010314.pub2Nici L, Mammen MJ, Charbek E, et al.Pharmacologic management of chronic obstructive pulmonary disease. An official American Thoracic Society clinical practice guideline[published correction appears in Am J Respir Crit Care Med. 2020 Sep 15;202(6):910].Am J Respir Crit Care Med. 2020;201(9):e56-e69. doi:10.1164/rccm.202003-0625STKew KM, Mavergames C, Walters JA.Long-acting beta2-agonists for chronic obstructive pulmonary disease.Cochrane Database Syst Rev. 2013;(10):CD010177. doi:10.1002/14651858.CD010177.pub2American Academy of Allergy, Asthma & Immunology.AAAAI allergy & asthma medication guide: Inhaled asthma medications.American Academy of Allergy, Asthma, & Immunology.AAAAI allergy & asthma medication guide: inhaled corticosteroids.Asthma and Allergy Foundation of America.Asthma treatment.NIH: National Heart, Lung, and Blood Institute.COPD.American Lung Association.Assessing asthma control.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Lung Association.Understand your asthma medication.Billington CK, Penn RB, Hall IP.β Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64Smith S, Edwards CT.Long-acting inhaled bronchodilators for cystic fibrosis.Cochrane Database Syst Rev. 2017 Dec 19;12(12):CD012102. doi:10.1002/14651858.CD012102.pub2Reddel HK, FitzGerald JM, Bateman ED, et al.GINA 2019: a fundamental change in asthma management: Treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents.Eur Respir J. 2019;53(6):1901046. doi:10.1183/13993003.01046-2019Saguil A, Garcia D.Safety of long-acting beta agonists in adults with asthma.Am Fam Physician. 2014;90(7):453-454.American Academy of Allergy, Asthma, & Immunology.AAAAI allergy & asthma medication guide: long-acting beta-agonists (LABAS).Xia Y, Kelton CM, Xue L, Guo JJ, Bian B, Wigle PR.Safety of long-acting beta agonists and inhaled corticosteroids in children and adolescents with asthma.Ther Adv Drug Saf. 2013;4(6):254-263. doi:10.1177/2042098613504124Cates CJ, Wieland LS, Oleszczuk M, Kew KM.Safety of regular formoterol or salmeterol in adults with asthma: an overview of Cochrane reviews.Cochrane Database Syst Rev. 2014;2014(2):CD010314. doi:10.1002/14651858.CD010314.pub2Nici L, Mammen MJ, Charbek E, et al.Pharmacologic management of chronic obstructive pulmonary disease. An official American Thoracic Society clinical practice guideline[published correction appears in Am J Respir Crit Care Med. 2020 Sep 15;202(6):910].Am J Respir Crit Care Med. 2020;201(9):e56-e69. doi:10.1164/rccm.202003-0625STKew KM, Mavergames C, Walters JA.Long-acting beta2-agonists for chronic obstructive pulmonary disease.Cochrane Database Syst Rev. 2013;(10):CD010177. doi:10.1002/14651858.CD010177.pub2American Academy of Allergy, Asthma & Immunology.AAAAI allergy & asthma medication guide: Inhaled asthma medications.American Academy of Allergy, Asthma, & Immunology.AAAAI allergy & asthma medication guide: inhaled corticosteroids.Asthma and Allergy Foundation of America.Asthma treatment.NIH: National Heart, Lung, and Blood Institute.COPD.American Lung Association.Assessing asthma control.
American Lung Association.Understand your asthma medication.
Billington CK, Penn RB, Hall IP.β Agonists.Handb Exp Pharmacol. 2017;237:23-40. doi:10.1007/164_2016_64
Smith S, Edwards CT.Long-acting inhaled bronchodilators for cystic fibrosis.Cochrane Database Syst Rev. 2017 Dec 19;12(12):CD012102. doi:10.1002/14651858.CD012102.pub2
Reddel HK, FitzGerald JM, Bateman ED, et al.GINA 2019: a fundamental change in asthma management: Treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents.Eur Respir J. 2019;53(6):1901046. doi:10.1183/13993003.01046-2019
Saguil A, Garcia D.Safety of long-acting beta agonists in adults with asthma.Am Fam Physician. 2014;90(7):453-454.
American Academy of Allergy, Asthma, & Immunology.AAAAI allergy & asthma medication guide: long-acting beta-agonists (LABAS).
Xia Y, Kelton CM, Xue L, Guo JJ, Bian B, Wigle PR.Safety of long-acting beta agonists and inhaled corticosteroids in children and adolescents with asthma.Ther Adv Drug Saf. 2013;4(6):254-263. doi:10.1177/2042098613504124
Cates CJ, Wieland LS, Oleszczuk M, Kew KM.Safety of regular formoterol or salmeterol in adults with asthma: an overview of Cochrane reviews.Cochrane Database Syst Rev. 2014;2014(2):CD010314. doi:10.1002/14651858.CD010314.pub2
Nici L, Mammen MJ, Charbek E, et al.Pharmacologic management of chronic obstructive pulmonary disease. An official American Thoracic Society clinical practice guideline[published correction appears in Am J Respir Crit Care Med. 2020 Sep 15;202(6):910].Am J Respir Crit Care Med. 2020;201(9):e56-e69. doi:10.1164/rccm.202003-0625ST
Kew KM, Mavergames C, Walters JA.Long-acting beta2-agonists for chronic obstructive pulmonary disease.Cochrane Database Syst Rev. 2013;(10):CD010177. doi:10.1002/14651858.CD010177.pub2
American Academy of Allergy, Asthma & Immunology.AAAAI allergy & asthma medication guide: Inhaled asthma medications.
American Academy of Allergy, Asthma, & Immunology.AAAAI allergy & asthma medication guide: inhaled corticosteroids.
Asthma and Allergy Foundation of America.Asthma treatment.
NIH: National Heart, Lung, and Blood Institute.COPD.
American Lung Association.Assessing asthma control.
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