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Asthma inhalers: Which one's right for you?

7:46 PM, Posted by healthsensei, 3 Comments

Inhalers allow people with asthma to lead active lives without fear of an attack. Here's a rundown of inhaler types, with tips on proper use.

By Mayo Clinic staff

Inhalers have transformed asthma treatment. They enable children and adults with asthma to deliver medicine directly to their lungs nearly anytime and anywhere. A variety of inhalers are available to help relieve or control asthma symptoms.

Types of inhalers

Inhalers are hand-held portable devices that deliver medication directly to the lungs. A variety of inhalers exist, but they basically fall into two categories:

Metered dose inhalers
These inhalers use a chemical propellant to force a measured dose of medication out of the inhaler. They consist of a pressurized canister containing medication, a mouthpiece and a metering valve that dispenses the correct dose of medication. The medication is released either by squeezing the canister or by inhaling. You may find it easier to use a hand-actuated inhaler with a spacer — a short tube that attaches to the inhaler. Using a hand-actuated inhaler to release the medication into the chamber gives you time to inhale more slowly. It decreases the amount of medicine that's deposited on the back of your throat and increases the amount that ultimately reaches your lungs.

Some metered dose inhalers have counters so that you know how many doses remain. If there is no counter, you have to track of the number of doses you've used so that you know when the inhaler is out of medication.

The chemical propellant in metered dose inhalers has traditionally been a chlorofluorocarbon (CFC). But after an international agreement to ban CFCs because they damage the ozone layer, other propellants such as hydrofluoroalkane (HFA) are now used instead. The dose of medication released by an HFA inhaler may feel softer and warmer than the dose released by a CFC inhaler. If you're used to a CFC inhaler, it may not seem like a complete dose — even though the medication is reaching your lungs.

Dry powder inhalers
These inhalers don't use a chemical propellant to push the medication out of the inhaler. Instead, the medication is released by breathing in more quickly than you would with a traditional metered dose inhaler.

Some people find dry powder inhalers easier to use than the conventional pressurized metered dose inhalers because hand-lung coordination isn't required. Some models require operating a cocking device that requires dexterity. Available types include a dry powder tube inhaler, a powder disk inhaler and a single-dose dry powder disk inhaler. Spacers shouldn't be used with dry powder inhalers.

Comparing inhaler types
Choosing the right kind of inhaler for you depends on several factors, such as your hand-breath coordination, your dexterity, whether you can take a deep, fast breath, and what types of medication you need. The chart below can help you understand the pros and cons of each type. Work with your doctor to find the best inhaler for your needs.

Inhaler features

Metered dose inhalerMetered dose inhaler with a spacerDry powder inhaler
Portable and convenientLess portable and convenient, more complex and more expensive than a metered dose inhaler without a spacerPortable and convenient
Doesn't require a deep, fast breathDoesn't require a deep, fast breathRequires a deep, fast breath
Accidental exhalation before activation won't disrupt medicationAccidental exhalation before activation won't disrupt medicationAccidental exhalation before activation will blow away medication
Hand-actuated models without a spacer require hand-breath coordinationHand-breath coordination is not criticalHand-breath coordination is not necessary
Can result in large amounts of medication on the back of your throat and tongueLess medication settles on the back of your throat and tongueCan result in large amounts of medication on the back of your throat and tongue
Minimal or no maintenance requiredSpacer requires periodic cleaning with soap and waterMinimal or no maintenance required
Some models require you to keep track of how many doses remainSome models require you to keep track of how many doses remainIt is clear when the device is out of medication
Requires shaking and primingRequires shaking and priming, correct use of spacerSingle-dose models require loading capsules for each use
Humidity does not affect medicationHumidity does not affect medicationHigh humidity can cause powdered medication to clump

Medications delivered through inhalers

Inhalers are used to deliver a variety of asthma medications — some that assist with long-term control and others that provide quick relief of symptoms. Some medications may only be available in certain inhaler types. Inhaled asthma medications include:

  • Short-acting bronchodilators. These medications, including albuterol (Proventil, Ventolin) and pirbuterol (Maxair), provide immediate relief of asthma symptoms.
  • Long-acting bronchodilators. These medications relieve asthma symptoms for longer periods of time. They include salmeterol (Serevent) and formoterol (Foradil).
  • Corticosteroids. Used long term to prevent asthma attacks, these medications include beclomethasone dipropionate (Qvar), fluticasone (Flovent), budesonide (Pulmicort), triamcinolone acetonide (Azmacort) and flunisolide (Aerobid).
  • Cromolyn or nedocromil. These nonsteroidal medications are used long term to prevent inflammation.
  • Corticosteroid plus long-acting bronchodilator. This medication combines a corticosteroid and a long-acting bronchodilator (Advair, Symbicort).

Inhalers may come with slightly different instructions. Follow those instructions carefully and ask your doctor for a demonstration.

The importance of using inhalers properly

It's important that you use your inhaler correctly so that the medication reaches your lungs. Carefully follow the instructions. And ask a doctor, nurse or pharmacist for a demonstration. Use the inhaler in front of this person and ask for feedback. Then practice at home in front of a mirror.

If you're unable to use an inhaler, a nebulizer may be an option. Nebulizers are designed for those who can't use an inhaler, such as infants, young children and those who are seriously ill. The device works by converting medication into a mist and delivering it through a mask that you wear over your nose and mouth.

Using an inhaler is just one part of your asthma treatment plan, which may also include checking your lung function with a peak flow meter, eliminating asthma triggers and exercising. But knowing what types of inhalers are available and how to use them can help you better manage your asthma and get the most from your treatment.


Aug. 17, 2007


Vince @ April 2, 2009 at 1:49 AM

Ozone-friendly inhalers could face early demise

Benefits vague, problems clear in inhaler ban

Asthma Patients Outraged at Indifference to Problems with New Inhalers:

Olympian Jackie Joyner-Kersee: FDA "Insensitive" to Asthma Patients' Problems:

The number of patient complaints is skyrocketing:

Read the thousands of complaints at this petition:

Patients at are reporting HFA inhalers as "useless" with a rating of 1.2 on
a scale of 1 to 5 with 5 being the best and 1 being the worst:

You can only wonder if the FDA is trying to kill asthmatics:

Also worth mentioning from the FDA website is the fact that a manufacturer of one of the HFA inhalers admits in it's own new drug application to the FDA that it's HFA based albuterol is less safe and effective than it's CFC based albuterol:

These quotes taken directly from the new drug application for Ventolin HFA.

"In the multiple dose adolescent and adult studies, albuterol HFA showed a numerically smaller improvement in FEV1 than was seen with albuterol CFC"

"There was other evidence that the HFA formulation delivers a lower/less effective dose on a per acutation basis than the CFC product. In the single dose, dose ranging study in adults, and in the single dose methacholine challenge study in adults one and two acutations of albuterol CFC were statistically indistinguishable in terms of effect, whereas significant differences were seen between one and two acutations of albuterol HFA. Finally, the combined adolescent/adult studies showed that the HFA formulation had a longer median time to onset of effect(4.2-9.6 minutes versus 3.6-4.2 minutes), had a shorter duration of effect(1.55-3.30 hours versus 2.29 - 3.69 hours), and was associated with more albuterol 'back up' use than the CFC formulation."

"We note that in the two 12 week clinical trials in adolescents and adults, Ventolin HFA Inhalation Aerosol consistently showed a smaller effect size than Ventolin CFC Inhalation Aerosol"

"Because it is expected that many physicians will prescribe Ventolin HFA Inhalation Aerosol for patients who have previously used the CFC formulation, it would be appropriate to include some description of the relative effectiveness of these two formulations in the product label."

"Unfavorable changes in physical examinations were observed in the ears, nose, and throat category as follows: 8% placebo HFA; 13% albuterol HFA; and 5% albuterol CFC."

The following false advocates have hung asthmatics out to dry as they are
not responding to any of the pleas for help:
American Lung Association
Asthma and Allergy Foundation of America
Allergy and Asthma Network Mothers of Asthmatics
American Academy of Allergy, Asthma and Immunology

Contact them for yourself and see how happy they will be to "help" you!

healthsensei @ April 12, 2009 at 2:07 PM

thanks so much for your information and time. i'm sorry to hear those associations are not listening. more for me to look up.

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