Sometimes, it can seem overwhelming at just how many different inhalers there are. It is quite common to be on one type of inhaler, but your friend or family member is on another. ‘Puffer’ inhalers (also called metered-dose inhalers or MDIs) are the most common inhaler and these are generally used with a spacer. However, there are also other types of inhaler devices depending on which inhaler medication you have been prescribed. We sat down with Joanna Turner, Research and Education Manager for ARFNZ, to put together a helpful guide, which breaks down what types of inhalers are available in New Zealand, and what they are used for.
Inhaled corticosteroids are anti-inflammatory maintenance medicine (preventer) for asthma. They prevent asthma symptoms by reducing inflammation in the airways. In addition, they reduce the amount of mucus produced by the bronchial tubes and help to reduce long-term damage. ICS medicines are the core treatment for asthma control and maintenance and need to be taken every day, even when feeling well. Preventer ICS inhalers are usually orange, brown or yellow. Current ICS medications available in New Zealand are: • Budesonide (Pulmicort® Turbuhaler) • Fluticasone (Flixotide® MDI and Accuhaler, Floair® MDI) • Beclomethasone dipropionate (Beclazone® MDI, Qvar® MDI)
This medication provides quick relief of shortness of breath and wheezing. SABAs work by relaxing the muscles around the narrowed airways, and are delivered via a metered-dose inhaler or a turbuhaler. Unlike long-acting beta2-agonists (LABAs) which are used on a daily basis, SABAs are only used “as needed” to provide fast relief of asthma symptoms or for use in an asthma emergency, with the effects wearing off after 4-6 hours. Overuse, or over-reliance on this type of inhaler is a sign that your asthma is not well controlled, and we would recommend that you discuss this with your doctor or healthcare provider.
These inhalers are usually blue or green. Current SABA medications available in New Zealand are: • Salbutamol (Ventolin® MDI, Respigen® MDI, SalAir® MDI) • Terbutaline (Bricanyl® turbuhaler)
Like SABAs, SAMAs provide relief of symptoms but take a little longer to have an effect (up to 30 minutes). This medication is typically used for COPD. Current SAMA medication available in New Zealand is: • Ipratropium (Atrovent® MDI)
This medication is a combination of both a short-acting beta2 agonist and a short-acting muscarinic antagonist, which helps to relieve the symptoms of asthma.
Current SABA/SAMA medication available in New Zealand is: • Salbutamol + Ipratropium (Duolin HFA® MDI)
This medication is prescribed to control the symptoms of COPD, or for asthma symptoms where preventer treatment alone is not effective. LABAs should never be used alone for the management of asthma. LABAs last longer than SABAs, with effects that last for up to 12 hours. LABA medication relaxes the muscles around the narrowed airways to help keep them open. When used regularly, you should begin to experience fewer symptoms. LABAs should not be used in an emergency; therefore it is important to always have a short-acting reliever inhaler (i.e. a SABA inhaler) on hand.
Current LABA medications available in New Zealand are: • Salmeterol (Serevent® MDI and Accuhaler®, Meterol® MDI) • Indacaterol (Onbrez Breezhaler®) • Formoterol fumarate (Oxis® Turbuhaler) • Formoterol fumarate dihydrate (Foradil® powder for inhalation caps, used with Aerolizer® device)
LAMAs are similar to LABAs and are prescribed for the management of COPD. However, there are people with severe asthma, who are under specialist care, who may also be prescribed a LAMA. Like LABAs, LAMAs must not be used in an emergency situation Current LAMA medications available in New Zealand are: • Tiotropium (Spiriva Respimat®) • Umeclidinium (Incruse Ellipta®) • Glycopyrronium (Seebri Breezhaler®)
This medication is a combination of both a long-acting beta2 agonist and a long-acting muscarinic antagonist, to help control COPD symptoms. Current LABA/LAMA medications available in New Zealand are: • Gycopyrronium + Indacterol (Ultibro Breezhaler®) • Umeclidinium + Vilanterol (Anoro Ellipta®) • Oldaterol + Tiotropium bromide (Spiolto Respimat®)
This medication contains both a preventer medicine and a long-acting reliever medicine. Depending on the combination inhaler that you are prescribed, you will also need to have a fast-acting reliever inhaler for use in an asthma flare-up, or asthma emergency, with the exception of Symbicort® Turbuhaler. Symbicort® is a unique inhaler that contains a quick onset, long-acting reliever, and can be used for the immediate or emergency relief of asthma symptoms.
Current ICS/LABA medications available in New Zealand are: • Fluticasone + Salmeterol (Seretide® MDI and Accuhaler®, RexAir® MDI) • Budesonide + Formoterol (Symbicort® Turbuhaler, Vannair® MDI) • Fluticasone furoate + Vilanterol (Breo Ellipta®)
A spacer is a clear plastic cylinder, designed to make metered-dose inhalers (MDIs) easier to use. The spacer helps deliver the medicine directly into the lungs, instead of the mouth and throat. Spacers are designed to deliver up to twice the amount of medication to the lungs. Order your free spacer from our website at arfnz.org.nz.
It is important to regularly check in with your health care professional about the medications you are taking at least once a year, to make sure that these are still working effectively. Please note, some of the medications listed above are not fully funded in New Zealand and part charges may apply. The medications listed as available are current as of 1 June 2020.
In this series, we will be highlighting a range of respiratory-related devices and explaining best practice on how to use these. In this issue, we demonstrate how to use a spacer, and why it is important to use one.