Preventer inhalers treat the inflammation inside your airways, which is the underlying cause of asthma. They reduce the risk of asthma flare-ups (attacks). These inhalers also reduce the amount of mucus produced in the airways and long-term damage to the lungs.

There are two different types of preventer inhalers. Your healthcare practitioner will advise on which preventer is best for you.

1. Single ingredient preventer inhalers:

Single ingredient preventer inhalers only contain one preventer medication. Examples of these inhalers are Flixotide®, Pulmicort®, Beclazone® and Qvar®.

These inhalers need to be taken every day as a regular scheduled maintenance treatment to control asthma. If you only take your preventer inhaler occasionally, or stop taking it if you feel well, it can cause your asthma to get worse.

These inhalers do not provide immediate relief from asthma symptoms and cannot be used in asthma emergencies. For this reason, they need to be used alongside a separate fast-acting reliever inhaler like Ventolin®, Respigen®*, SalAir® or Bricanyl®.

2. Combination 2-in-1 preventer inhalers:

Combination 2-in-1 inhalers contain both a preventer and a long-acting reliever medication. In every dose from a combination inhaler, you get preventer medication which reduces the underlying inflammation AND a long-acting reliever medication which relaxes the tightened muscles around the airways, helping you to breathe easier. Examples of this type of inhaler include Seretide®, Breo Ellipta® Symbicort®, DuoResp Spiromax® and Vannair®.

The combination 2-in-1 preventer inhalers Seretide®, Breo Ellipta® and Vannair® must be used as a regular scheduled maintenance treatment alongside a separate fast-acting reliever inhaler (e.g., Ventolin®, Respigen®*, SalAir® or Bricanyl®) for immediate relief of asthma symptoms, or in an asthma emergency.

The combination 2-in-1 preventer inhalers Symbicort® and DuoResp Spiromax® can be used as either a reliever medication alone, or as a regular scheduled maintenance and reliever medication. These dry powder inhalers contain the preventer medicine budesonide and the fast-acting reliever medicine formoterol. There is no need to have a separate reliever inhaler.

*Note: The Respigen brand of salbutamol inhaler has been discontinued, due to the factory making Respigen inhalers being closed down (Pharmac notification, 11 October 2023). There may still be some stock in the supply chain, hence its inclusion in the information above.

Recommended preventer inhaler for people 12 years and older

The recommended preventer inhaler for people 12 years and older is the 2-in-1 combination inhaler containing the preventer medicine budesonide and the fast-acting reliever medicine formoterol (Symbicort® and DuoResp Spiromax®). The reliever medicine, formoterol, provides immediate relief of asthma symptoms and ongoing relief of symptoms for up to 12 hours.

For people with mild asthma, this inhaler can be used as a reliever alone without any maintenance treatment; in moderate to severe asthma, this inhaler can be used as both a regular scheduled maintenance and a reliever treatment. This means you use this inhaler once or twice daily (as you would a preventer inhaler) and as needed to treat asthma symptoms (as you would a reliever). This treatment is called ‘Single Maintenance And Reliever Therapy’ (SMART) by healthcare practitioners. You do not need a separate reliever inhaler when using this treatment.

What’s in a preventer inhaler?

All types of preventer inhalers in New Zealand contain an anti-inflammatory medicine called a corticosteroid. This is sometimes referred to as a ‘steroid’. Corticosteroids are not the same as steroids used by body builders. There is a huge amount of research which shows that inhaled corticosteroids are effective and safe when used long-term.

Side effects from inhaled corticosteroids

There can be side effects from preventer inhalers. These can include a husky voice, a sore throat or oral thrush. These side effects can be reduced by using a spacer (if you are using a puffer inhaler) and rinsing your mouth with water and spitting out after using your preventer inhaler.

For people on very high doses of corticosteroid, there can be other side effects. These include:

  • Thinning of the bones (osteoporosis)
  • Thinning of the skin leading to easy bruising
  • Reduced ability to respond to a severe medical illness

The risk of poorly treated asthma is greater than the risk of side effects from preventer medication. If you are concerned about the possible side effects, please discuss these with your healthcare practitioner.