Table of ContentsView AllTable of ContentsPurposesMedication TypesDelivery SystemsHow to Choose
Table of ContentsView All
View All
Table of Contents
Purposes
Medication Types
Delivery Systems
How to Choose
Asthma inhalers are hand-held devices that allow you to inhale a dose of medication to treat asthma symptoms. There are many types ofasthma inhalers. They differ in whether they’re used for quick relief or long-term control, what type of drug they contain, and how the medications are delivered to the lungs.
By understanding the differences and comparing your options, you can make more informed choices when working with yourpulmonologist.
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Quick Relief vs. Long-Term Control
One of the primary differences between asthma inhalers is whether they are meant for quick relief of anasthma attack(referred to as a rescue inhaler) or are used on a daily basis to help better prevent attacks from occurring.
Quick Relief
Rescue inhalersare short-termbronchodilators, meaning that they open (dilate) the airways of the lungs (calledbronchiandbronchioles).
There are two classes of drugs used in rescue inhalers:
The drugs start working in 15 to 20 minutes and provide relief for around four to six hours.
Long-Term Control
People with chronic asthma symptoms often need a once- or twice-daily inhaler to reduce the frequency and severity of asthma attacks. The use of these long-acting drugs (also referred to as controller inhalers) can reduce the need for rescue inhalers.
There are three types of controller inhalers commonly used for this:
LABAs and LAMAs are only used in combination with an inhaled steroid for the treatment of asthma. LABAs have a black-boxed warning for severe worsening asthma when used as monotherapy for the treatment of asthma.
As with rescue inhalers, there are combination inhalers that combine LABAs with LAMAs, LABAs with ICS, and LABAs with LAMAs and ICS. Using these drugs in combination can often improve long-term control.
Types of Inhaled Asthma Medications
Within each class of inhaled asthma medication are different drugs with different brand names. Within each brand are different formulations with different delivery systems.
In addition to individual inhalers, combination inhalers are increasingly being prescribed—not only for their convenience but also to afford better relief or long-term control.
Method of Administration
Asthma inhalers also differ based on how the drugs are delivered into your lungs. The choice of delivery system requires discussion with your pulmonologist to determine which one works best for you as an individual.
For some people, inhaling deeply or forcefully can be a challenge. For others, hand and breath coordination may be an issue. Choosing the right inhaler can ensure better control of your asthma symptoms.
Metered Dose Inhalers
Meter dose inhalers (MDIs) consist of a pressurized canister that fits into a boot-shaped plastic mouthpiece. With each compression of the mouthpiece, a dose of the drug is sprayed into your mouth as you inhale.
The pressurized canisters contain a specific number of doses. Some devices have automatic counters that tell you how many doses are left, while newer ones are connected to an app on your phone telling you how many remain.
To ensure enough medications get into your lungs, an add-on device called a spacer can be connected to the mouthpiece. The spacer tube goes deeper inside your mouth, directing the spray directly into your throat. This reduces the amount of drug deposited on your cheeks, gums, and roof of your mouth.
Dry Powder Inhalers
Dry powder inhalers (DPIs) don’t use an aerosolized propellant to push the medicine into your mouth. Instead, you forcefully inhale a dose of powdered medication from the device (some of which are shaped like disks or tubes while others are similar in shape to MDIs).
DPIs contain up to 200 powdered doses per device. To receive the correct amount, you would either click or twist the device, loading a specific amount of the drug in the medication chamber. You then simply wrap your lips around the mouthpiece and inhale forcefully. With each click or twist, an automated counter tells you how many doses are left.
Examples of DPIs include those with the names Digihaler, Handihaler, Ellipta, Diskus, Pressair, Neohaler, Twisthaler, RespiClick, Redihaler, or Flexhaler. Wixela Inhub is also a DPI.
Soft Mist Inhalers
Soft mist inhalers (SMIs) are propellant-free devices that are slightly larger than MDIs. The devices release a low-velocity mist that can be slowly inhaled over a longer period. Because the medication is delivered less forcefully, less is left in the mouth.
Some SMIs come equipped with face masks to use on younger children who may not have the lung capacity or coordination to manage DPIs or MDIs.
Examples of SMIs include those with the name Respimat, like Seebri Respimat and Spiriva Respimat.
When choosing between asthma inhalers, your healthcare provider will make recommendations based on best practices. The one area in which your input and personal preference are important is in the selection of the delivery system, each of which has pros and cons.
Summary
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 Academy of Allergy, Asthma, and Immunology.Inhaled asthma medications.Univeristy of North Carolina School of Medicine.Rescue vs. controller inhalers.Da Silva D, Jacinto T.Inhaled β-agonists in asthma management: an evolving story.Breathe (Sheff). 2016;12(4):375-7. doi:10.1183/20734735.017116Albertson TE, Sutter ME, Chan AL.The acute management of asthma.Clin Rev Allergy Immunol. 2015 Feb;48(1):114-25. doi:10.1007/s12016-014-8448-5Tang W, Sun L, Fizgerald JM.A paradigm shift in the treatment of mild asthma?JThorac Dis.2018;10(10):5655-8. doi:10.21037/jtd.2018.09.127American Academy of Allergy, Asthma, and Immunology.Long-acting beta-agonists (LABAs).Casale TB, Foggs MB, Balkissoon RC.Optimizing asthma management: role of long-acting muscarinic antagonists.J Allergy Clin Immunol. 2022 Sep;150(3):557-568. doi: 10.1016/j.jaci.2022.06.015Jackson DJ, Bacharier LB.Inhaled corticosteroids for the prevention of asthma exacerbations.Ann Allergy Asthma Immunol. 2021 Aug 13;127(5):524–529. doi:10.1016/j.anai.2021.08.014Smith JD, Arteta M, Baptist AP, et al.Table 9. Combination ICS + LABA inhalers with equivalent dosing. In:Asthma.Ann Arbor (MI): Michigan Medicine University of Michigan; 2021 Jul.U.S. Food and Drug Administration.Drug treatments for asthma and chronic obstructive pulmonary disease that do not use chlorofluorocarbons.American Academy of Family Physicians.How to use a metered dose inhaler.Icahn School of Medicine at Mount Sinai.What you need to know about metered dose inhalers and the HFA propellant.Nationwide Children’s Hospital.How to use a dry powder inhaler.Komalia V, Wong CYJ, Sibum I, et al.Advances in soft mist inhalers.Expert Opin Drug Deliv. 2023 Jul-Dec;20(8):1055-1070. doi:10.1080/17425247.2023.2231850Usmani OS.Choosing the right inhaler for your asthma or COPD patient.Ther Clin Risk Manag.2019 Mar 14;15:461–472. doi:10.2147/TCRM.S160365
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 Academy of Allergy, Asthma, and Immunology.Inhaled asthma medications.Univeristy of North Carolina School of Medicine.Rescue vs. controller inhalers.Da Silva D, Jacinto T.Inhaled β-agonists in asthma management: an evolving story.Breathe (Sheff). 2016;12(4):375-7. doi:10.1183/20734735.017116Albertson TE, Sutter ME, Chan AL.The acute management of asthma.Clin Rev Allergy Immunol. 2015 Feb;48(1):114-25. doi:10.1007/s12016-014-8448-5Tang W, Sun L, Fizgerald JM.A paradigm shift in the treatment of mild asthma?JThorac Dis.2018;10(10):5655-8. doi:10.21037/jtd.2018.09.127American Academy of Allergy, Asthma, and Immunology.Long-acting beta-agonists (LABAs).Casale TB, Foggs MB, Balkissoon RC.Optimizing asthma management: role of long-acting muscarinic antagonists.J Allergy Clin Immunol. 2022 Sep;150(3):557-568. doi: 10.1016/j.jaci.2022.06.015Jackson DJ, Bacharier LB.Inhaled corticosteroids for the prevention of asthma exacerbations.Ann Allergy Asthma Immunol. 2021 Aug 13;127(5):524–529. doi:10.1016/j.anai.2021.08.014Smith JD, Arteta M, Baptist AP, et al.Table 9. Combination ICS + LABA inhalers with equivalent dosing. In:Asthma.Ann Arbor (MI): Michigan Medicine University of Michigan; 2021 Jul.U.S. Food and Drug Administration.Drug treatments for asthma and chronic obstructive pulmonary disease that do not use chlorofluorocarbons.American Academy of Family Physicians.How to use a metered dose inhaler.Icahn School of Medicine at Mount Sinai.What you need to know about metered dose inhalers and the HFA propellant.Nationwide Children’s Hospital.How to use a dry powder inhaler.Komalia V, Wong CYJ, Sibum I, et al.Advances in soft mist inhalers.Expert Opin Drug Deliv. 2023 Jul-Dec;20(8):1055-1070. doi:10.1080/17425247.2023.2231850Usmani OS.Choosing the right inhaler for your asthma or COPD patient.Ther Clin Risk Manag.2019 Mar 14;15:461–472. doi:10.2147/TCRM.S160365
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 Academy of Allergy, Asthma, and Immunology.Inhaled asthma medications.Univeristy of North Carolina School of Medicine.Rescue vs. controller inhalers.Da Silva D, Jacinto T.Inhaled β-agonists in asthma management: an evolving story.Breathe (Sheff). 2016;12(4):375-7. doi:10.1183/20734735.017116Albertson TE, Sutter ME, Chan AL.The acute management of asthma.Clin Rev Allergy Immunol. 2015 Feb;48(1):114-25. doi:10.1007/s12016-014-8448-5Tang W, Sun L, Fizgerald JM.A paradigm shift in the treatment of mild asthma?JThorac Dis.2018;10(10):5655-8. doi:10.21037/jtd.2018.09.127American Academy of Allergy, Asthma, and Immunology.Long-acting beta-agonists (LABAs).Casale TB, Foggs MB, Balkissoon RC.Optimizing asthma management: role of long-acting muscarinic antagonists.J Allergy Clin Immunol. 2022 Sep;150(3):557-568. doi: 10.1016/j.jaci.2022.06.015Jackson DJ, Bacharier LB.Inhaled corticosteroids for the prevention of asthma exacerbations.Ann Allergy Asthma Immunol. 2021 Aug 13;127(5):524–529. doi:10.1016/j.anai.2021.08.014Smith JD, Arteta M, Baptist AP, et al.Table 9. Combination ICS + LABA inhalers with equivalent dosing. In:Asthma.Ann Arbor (MI): Michigan Medicine University of Michigan; 2021 Jul.U.S. Food and Drug Administration.Drug treatments for asthma and chronic obstructive pulmonary disease that do not use chlorofluorocarbons.American Academy of Family Physicians.How to use a metered dose inhaler.Icahn School of Medicine at Mount Sinai.What you need to know about metered dose inhalers and the HFA propellant.Nationwide Children’s Hospital.How to use a dry powder inhaler.Komalia V, Wong CYJ, Sibum I, et al.Advances in soft mist inhalers.Expert Opin Drug Deliv. 2023 Jul-Dec;20(8):1055-1070. doi:10.1080/17425247.2023.2231850Usmani OS.Choosing the right inhaler for your asthma or COPD patient.Ther Clin Risk Manag.2019 Mar 14;15:461–472. doi:10.2147/TCRM.S160365
American Academy of Allergy, Asthma, and Immunology.Inhaled asthma medications.
Univeristy of North Carolina School of Medicine.Rescue vs. controller inhalers.
Da Silva D, Jacinto T.Inhaled β-agonists in asthma management: an evolving story.Breathe (Sheff). 2016;12(4):375-7. doi:10.1183/20734735.017116
Albertson TE, Sutter ME, Chan AL.The acute management of asthma.Clin Rev Allergy Immunol. 2015 Feb;48(1):114-25. doi:10.1007/s12016-014-8448-5
Tang W, Sun L, Fizgerald JM.A paradigm shift in the treatment of mild asthma?JThorac Dis.2018;10(10):5655-8. doi:10.21037/jtd.2018.09.127
American Academy of Allergy, Asthma, and Immunology.Long-acting beta-agonists (LABAs).
Casale TB, Foggs MB, Balkissoon RC.Optimizing asthma management: role of long-acting muscarinic antagonists.J Allergy Clin Immunol. 2022 Sep;150(3):557-568. doi: 10.1016/j.jaci.2022.06.015
Jackson DJ, Bacharier LB.Inhaled corticosteroids for the prevention of asthma exacerbations.Ann Allergy Asthma Immunol. 2021 Aug 13;127(5):524–529. doi:10.1016/j.anai.2021.08.014
Smith JD, Arteta M, Baptist AP, et al.Table 9. Combination ICS + LABA inhalers with equivalent dosing. In:Asthma.Ann Arbor (MI): Michigan Medicine University of Michigan; 2021 Jul.
U.S. Food and Drug Administration.Drug treatments for asthma and chronic obstructive pulmonary disease that do not use chlorofluorocarbons.
American Academy of Family Physicians.How to use a metered dose inhaler.
Icahn School of Medicine at Mount Sinai.What you need to know about metered dose inhalers and the HFA propellant.
Nationwide Children’s Hospital.How to use a dry powder inhaler.
Komalia V, Wong CYJ, Sibum I, et al.Advances in soft mist inhalers.Expert Opin Drug Deliv. 2023 Jul-Dec;20(8):1055-1070. doi:10.1080/17425247.2023.2231850
Usmani OS.Choosing the right inhaler for your asthma or COPD patient.Ther Clin Risk Manag.2019 Mar 14;15:461–472. doi:10.2147/TCRM.S160365
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