If you or your loved ones have asthma, understanding how asthma medication works is essential. It will allow you to better manage your asthma and to live a full and active life.
Asthma medication is usually delivered by an inhaler, also called a “puffer”. Having a good inhaler technique and using your inhaler as directed is really important in getting your asthma under control. Here are answers to some commonly asked questions about asthma inhalers.
What is an inhaler?
An inhaler, sometimes called a “puffer”, is a small plastic device that holds asthma medicine. It delivers the medication directly into your lungs. There are two main types of asthma inhalers:
A metered dose (or aerosol) inhaler contains medicine in a gas form. This type of inhaler needs to be shaken immediately before use to ensure the medicine is mixed with the gas propellent before you use it. When you push down on the inhaler, it releases the medicine from the cannister contained inside the plastic case. Metered dose inhalers are best used with spacers, as using a spacer can increase the amount of medicine delivered to the lungs by up to 50%. If your metered dose inhaler contains a preventer medicine (corticosteroid), then you should rinse your mouth and spit out after each dose.
A dry powder inhaler contains medicine in a powder form. It doesn’t need to be shaken before use. The medication is breathed in directly from the mouthpiece. Types of dry powder inhalers include the Accuhaler, Breezhaler, Ellipta, Spiromax and Turbuhaler. If you are using a dry powder inhaler that contains a corticosteroid medicine then you should rinse your mouth and spit out after each dose.
What is a spacer?
A spacer is a clear plastic tube. The inhaler fits at one end of the spacer, and the other end has a mouthpiece. A mask can be fitted onto the mouthpiece, if needed for younger children. All metered dose inhalers should be used with a spacer. Spacers ensure that as much medicine as possible goes down into the lungs.
Using a spacer means that medicine is less likely to get stuck at the back of your mouth or breathed out again. If you are not sure how to use an inhaler or spacer, ask your doctor, nurse or pharmacist to demonstrate the correct technique so that you get the most benefit from your medicine.
What are the different medicines inside my inhalers?
There are three main types of asthma medications that do different things inside your lungs: preventers, relievers and combination inhalers. Many New Zealanders use both preventer and reliever inhalers to manage their asthma. The recommended treatment for asthma in people over the age of 12 years is a combination inhaler containing budesonide/ formoterol. This medicine is available in New Zealand as a dry powder inhaler with the brand name Symbicort Turbuhaler or DuoResp Spiromax.
Preventer medications, also known as maintenance medications, treat the underlying inflammation in the lungs that causes asthma. These inhalers are meant for daily use; they reduce the amount of mucus produced in the airways and reduce the long-term damage to the lungs. Preventer inhalers are usually orange, brown or yellow in colour, and include the brand names Flixotide®, Pulmicort®, Beclazone ® and Qvar®.
Reliever medications, also known as bronchodilators, relax the muscles of the airways which tighten when asthma starts to worsen. These inhalers provide immediate relief from the symptoms of asthma, but do not address underlying inflammation. They are used ‘as needed’ to relieve symptoms. If you are using your reliever inhaler more than twice a week, this indicates that your asthma is not wellcontrolled. Reliever inhalers are usually blue or white. Some of these medications currently available in New Zealand are Ventolin®, Respigen®, SalAir® and Bricanyl®.
For anyone over the age of 12 years, reliever inhalers, on their own, are not a recommended treatment for asthma. Overuse or over-reliance on reliever inhalers can cause your asthma to get worse.
Combination inhalers contain both preventer and reliever medications. There are a few different combination inhalers available, but the budesonide/formoterol combination inhaler (Symbicort or DuoResp Spiromax ) is now the recommended asthma treatment for people aged 12 years and over.
The budesonide/formoterol inhaler is currently available in New Zealand as a dry powder inhaler, under the brand name Symbicort or DuoResp Spiromax. This medicine works by opening up the airways quickly and delivering a dose of anti-inflammatory at the same time to address the underlying cause of asthma. It has been shown to be extremely effective in asthma management and reduces asthma attacks.
For mild asthma, the budesonide/formoterol inhaler can be used as a reliever only. As you get a regular dose of preventer with each dose, a separate preventer inhaler is not needed. This is known as AIR therapy.
For moderate to severe asthma, the budesonide/formoterol inhaler is used both daily as a preventer and as a reliever when needed. This is called SMART therapy.
What other kinds of asthma medication are available?
For severe episodes of asthma, you may be prescribed short term corticosteroid tablets. This medication works slowly over several hours to reverse the swelling of airways.
Another medication that comes in tablet form is the antiinflammatory asthma treatment, Montelukast. Montelukast is taken regularly and cannot be used in an acute attack of asthma.
A newer form of treatment available in New Zealand for those with severe asthma are the biologics, medicines which target specific types of inflammation in asthma. These are administered by injection and can only be prescribed by specialists to people who meet certain funding criteria.