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11/16/2021 | Press release | Archived content

A Guide to Asthma Inhalers

The basics

Asthma is a common lung condition that makes it hard to breathe. The symptoms of asthma are:

  • Breathlessness

  • Wheezing (noisy breathing)

  • Chest tightness

  • Cough

In the U.S., 25 million people are affected by asthma. That's roughly 1 in 13 adults and children.

Asthma can be mild or severe. Some people with asthma have symptoms every day. Others have symptoms that only kick in when they experience triggers.

Asthma symptoms can be triggered by:

  • Infections, such as pneumonia, sinusitis, or a viral cold

  • Allergies, especially to airborne substances like pollen or pet dander

  • Cold or humid weather

  • Exercise

Since asthma is a lung issue, it is often treated with medications that you breathe into your lungs. These medications are given using an inhaler.

This guide will explain the different inhalers used for asthma, what they do, and how to know which one(s) you need.

Ika84/E+ via Getty Images

Why trust us

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Dr. Kerry McGee is a pediatrician with many years of experience diagnosing and treating asthma in toddlers, children, and young adults. She earned her medical degree from the University of Virginia and completed her pediatric training at Doernbecher Children's Hospital in Portland, Oregon.

Dr. McGee knows that the different inhalers and medications used for asthma can be confusing for people and wishes all the potential combinations didn't have to be so daunting. But taking the time to understand how your medications work could be key to making the right choices in an emergency. The effort you put in to learn about your inhalers is time well-spent.

Do you have asthma?

Asthma is a breathing condition that can last throughout life. People with asthma have sensitive lungs that flare up in response to triggers in the environment.

Understanding and Treating Your Asthma: What to Ask Your Doctor

Written by Mandy Armitage, MD

During an asthma flare-up, the small air passages inside the lungs swell and squeeze shut. This swelling also produces fluid.

For many, asthma symptoms come and go, although some people have to deal with asthma all the time. Often, asthma is worse at night or first thing in the morning.

Both children and adults can have asthma. Some people grow out of it, while others develop it as they get older. Asthma tends to run in families and is common in people who have allergies or eczema.

If you think you might have asthma, you'll want to talk to your healthcare provider. In some cases, they'll be able to tell if you have asthma after talking to you and listening to your lungs. Specialist visits, X-rays, and lung-function tests can be helpful when your provider needs more information.

It's important to know that other conditions, like RSV (in children) or COPD (in adults), can cause symptoms very similar to asthma. Your healthcare provider can help tell the difference.

If you are diagnosed with asthma, it's possible you'll get a prescription for an inhaler that same day.

This guide is for people who use inhalers for asthma and want to know more about them.

What is an inhaler?

Inhalers are devices that allow medications to be breathed into your lungs through your mouth. They don't require electricity and are small enough to be carried in your pocket.

Inhalers make sense for treating asthma. They send medication directly into your airways, where it can fight asthma right where it happens.

There are several types of inhalers. They look different from each other and contain different technology. But what matters most is the medication inside.

The medication in some inhalers works quickly. These are useful for asthma attacks or flare-ups and are often called rescue, reliever, or quick-relief inhalers.

Other inhalers contain medication that works more slowly. These are taken every day, and their job is to keep asthma symptoms from starting. They are often called prevention, maintenance, or daily inhalers.

Bronchodilators

If you're having trouble breathing, it's important to find a fix, fast.

Bronchodilators contain medications that open the air passages in your lungs. The most common of them - the short-acting beta agonists, or SABAs - start working in just a few minutes.

Short-acting beta agonists (SABAs)

Examples of SABAs are:

How they work

Asthma causes the airways in your lungs to squeeze and swell. SABAs work to relax the squeeze, making it easier for air to pass through.

SABAs work because the walls of your smallest airways contain tiny muscles. Those muscle cells have molecules, called beta-2 receptors, on their surfaces that tell the muscle to relax when they detect a certain chemical signal. SABAs activate those receptors, causing the muscles to relax.

Taking a SABA inhaler will open your small airways quickly. But it won't fight the airway swelling that comes with asthma, and the effect won't last for very long.

Who they are good for

SABAs are used for immediate relief of asthma. Most people with asthma should have a SABA on hand for emergency use.

Ideally, a SABA should only be used occasionally. If you're taking steps to prevent asthma symptoms - including taking your daily medications as instructed - you shouldn't need to use your SABA inhaler very often.

Young children and people who have difficulty using inhalers can take a SABA in a nebulizer instead of an inhaler.

Typical timing

The usual SABA dose is 2 puffs. The first puff opens the airways enough to let the second puff penetrate deep into the lungs.

SABAs are used as needed, and their effect lasts for 4-6 hours or so. If you need to take them more frequently than that, you'll want to talk to your healthcare provider about other ways to control your asthma.

Precautions

If you need to take your SABA more than every 4 hours - either because your symptoms come back or because the inhaler isn't working - call your healthcare provider immediately. Needing this inhaler more than every 4 hours can be a sign that you need emergency medical care.

SABAs can cause shaking of the hands (tremors), noticeable heartbeats (palpitations), or feelings of excitement or stress.

Bottom line

SABAs are the most commonly prescribed inhaler for quick relief of asthma symptoms. They work fast, but they don't treat or prevent the underlying causes of asthma, and they only offer temporary relief.

Long-acting beta agonists (LABAs)

Similar to SABAs, long-acting beta-agonists open up airways by relaxing airway muscles. The difference? They last longer - but they can also take a bit longer to start working.

Examples of LABAs are:

How they work

Like SABAs, LABAs open the airways by relaxing the muscles around them.

Who they are good for

LABAs hold airways open, which can help prevent symptoms in people who have asthma. But they don't stop the airway swelling or drainage caused by an asthma trigger, and they aren't usually quick enough for emergency use. For this reason, LABAs are only taken together with other medications.

Typical timing

These medications can be given 1 or 2 times a day, depending on the inhaler.

Precautions

LABAs aren't great at preventing or treating asthma on their own, so they shouldn't be your only asthma medication.

LABAs may cause shaking of the hands (tremors), noticeable heartbeats (palpitations), or feelings of excitement or stress.

Bottom line

LABAs are long-acting medications that work for 12 to 24 hours to prevent or reduce asthma symptoms. They aren't used alone, but, when combined with other medications, they can be helpful.

Short-acting muscarinic antagonists (SAMAs)

In people who face moderate or severe asthma symptoms, SAMAs can add an extra boost to keep airways open.

Like SABAs, SAMAs are bronchodilators, but they work through anticholinergic (muscarinic) receptors in the lungs. They take longer to kick in than SABAs, and they carry added side effects.

Examples of SAMAs are:

Long-acting muscarinic antagonists (LAMAs)

Like their short-acting siblings, LAMAs are bronchodilators that can help people with severe asthma get a handle on their symptoms. They are most often used together with other medications.

Examples of LAMAs are:

Inhaled steroids

Asthma can cause your airways to squeeze and swell. Bronchodilators help loosen the squeeze, but steroids stop the swelling and inflammation from happening in the first place. Over time, steroids also treat asthma symptoms.

Inhaled steroids come in low, medium, or high dosage. The dose you take will depend on how severe your asthma is.

Examples of inhaled steroids are:

How they work

Steroids are anti-inflammatories. The medication is similar to a natural hormone made by the body called cortisol. Cortisol has many functions, and stopping inflammation is one of them.

Who they are good for

Steroids are helpful for people who get asthma symptoms often. If you use inhaled steroids regularly, they can block asthma symptoms before they happen. They can also be useful for treating asthma symptoms over time.

Typical timing

Steroids don't work instantly. Although they can help ease symptoms, they take several hours to start working.

To prevent asthma symptoms, inhaled steroids need to be taken before you encounter a trigger. That means taking them every day, even when you feel well. They are most often used twice a day: morning and night.

Precautions

Inhaled steroids have some side effects. If the medication settles inside your mouth, a fungal infection can develop. Using a spacer with your inhaler and rinsing your mouth after using it can help prevent this.

Steroids are also linked to growth suppression in children and to a slightly weaker immune response in everyone who takes them. Often, these side effects are small compared to the potential benefits of inhaled steroids for asthma. Talk to your healthcare provider if you have concerns about side effects.

Bottom line

Inhaled steroids play an important role in preventing and treating asthma. There are a number of different types, combinations, and ways to use them. Make sure you understand the dose and schedule that your healthcare provider wants you to use.

Combination inhalers

Combination inhalers contain two or more medications mixed together in the same inhaler.

The most common combination inhalers include a LABA and an inhaled steroid.

Examples of combination inhalers are:

How they work

The combination of a steroid and a LABA in one inhaler helps to reduce inflammation in the lungs and relax the muscles in the airways. This combination can be very effective for preventing or controlling asthma.

Who they are good for

Combination inhalers work for anyone with asthma symptoms. They are especially recommended for people who:

  • Get asthma symptoms every day

  • Wake up with asthma symptoms at night

  • Take a daily medication to prevent asthma

Typical timing

These are taken 1 or 2 times a day, depending on the inhaler and symptoms.

Bottom line

Combination inhalers make it easier to take two medications that help symptoms of asthma and prevent symptoms long term. They can be used in cases of mild, moderate, or severe asthma.

SMART

For years, most people with asthma needed to juggle multiple inhalers. Preventing asthma and treating asthma symptoms required two different medications.

But recent guidelines suggest that a certain combination steroid/LABA inhaler - specifically one that uses formoterol as the LABA - could solve this problem for some people.

The plan, which is called single maintenance and reliever therapy - or SMART - means using the same inhaler for both prevention and treatment. It has some serious benefits:

  • It reduces confusion. The same inhaler can be used for both daily asthma prevention and for in-the-moment treatment.

  • It works better. The strong prevention offered by this medication combination results in fewer symptoms in the first place. And when symptoms do break through, it works fast enough to treat symptoms in the moment. The added dose of steroid helps turn things around quickly.

Although SMART sounds like a win-win for people with asthma, steroid/formoterol inhalers (Symbicort and Dulera) are still very expensive, and, so far, they aren't fully covered by insurance.

Typical asthma treatments

There are other, more typical asthma treatments. These are based on guidelines published by the Global Initiative for Asthma (GINA) and the National Heart, Lung, and Blood Institute.

Which treatment you need depends on many factors, including how often you get asthma symptoms.

If you get asthma symptoms less than twice a month (intermittent asthma), you might need:

  • An albuterol (SABA) inhaler, taken as needed

OR

  • A steroid/formoterol (Symbicort or Dulera) combination inhaler in a low dose, taken as needed

If you get asthma symptoms more than twice a month (persistent asthma), you might need:

  • An inhaled steroid such as budesonide (Pulmicort) or beclomethasone (Qvar), taken daily, AND

  • An albuterol (SABA) inhaler, taken as needed

OR

  • An inhaled steroid such as budesonide (Pulmicort) or beclomethasone (Qvar), AND

  • An albuterol (SABA) inhaler, taken together as needed

OR

If you get asthma symptoms most days, or if asthma wakes you up at night every week, you might need:

  • A higher-dose inhaled steroid such as budesonide (Pulmicort) or beclomethasone (Qvar), taken daily, AND

  • An albuterol (SABA) inhaler, taken as needed

OR

OR

  • A higher-dose steroid/formoterol (LABA) (Symbicort or Dulera) combination inhaler, taken daily, AND

  • An albuterol (SABA) inhaler, taken as needed

For people who have moderate or severe asthma, other inhalers or oral medications are sometimes needed. These aren't usually used alone but can be added as additional medications when inhaled steroids and bronchodilators aren't enough.

Other medications used for asthma include:

Using your inhalers

Learning how to use your inhaler correctly is important. There are several different types of inhaler devices, and they work in different ways.

Your healthcare provider, asthma nurse, or pharmacist can help teach you how to use your inhaler. There are also great videos online on how to use different inhalers and spacer devices.

Inhaler technology

You could encounter several different types of inhalers, including:

  • Metered-dose inhalers (MDIs)

  • Dry powder inhalers (DPIs)

  • Soft mist inhalers (SMIs)

Although these inhalers look and work differently, the most important difference between them is the medication inside.

MDIs

MDIs contain medication in a liquid form. The liquid medication is propelled out of the inhaler as an aerosol, like a spray can. When using an MDI, you need to inhale deeply just as you push a button on the inhaler. The timing of this can be tricky for some people.

A spacer chamber is sometimes used with an MDI. A spacer is a mouthpiece that connects to your inhaler with a plastic tube. It helps the medication reach your lungs instead of sticking around inside of your mouth. Spacers only work with MDIs - and they make MDIs much easier to use. For help on how to use a spacer with an MDI, check out this video.

DPIs

DPIs contain a sealed dose of dry powder in a capsule or disk. The inhaler mechanism pierces the capsule so you can suck the powder into your lungs. DPIs are easier for some people to use: A deep in-breath is all it takes to make them work. If you can't inhale deeply, these inhalers may not be right for you. You can see a video of how to use a diskus inhaler (one type of DPI) here.

SMIs

Unlike other types of inhalers, soft mist inhalers release a cloud of medication that you can pull into your lungs just by breathing normally. This makes them easy to use and very effective at getting medication where it's needed. This type of inhaler is relatively new, so it isn't widely available yet. Watch this video on how to use a soft mist inhaler.

Nebulizers

A nebulizer is a machine that turns a liquid medication into a mist that you can breathe through a mask. Although nebulizers are easier to use for some people, it can take a long time for a nebulizer to deliver a single dose of medication. Plus, nebulizers are relatively large and often require electricity to work, so they are much less practical for everyday use.

Nebulizers are often used in the hospital when someone is very breathless. They are also helpful for babies and children who are too young or uncooperative to use inhalers.

Paying for inhalers

Inhalers can be expensive, so how can you save money if you need one? Here are some of your options:

  • Try a GoodRx coupon. A discount can help you save up to 80% on your out-of-pocket cost.

  • Switch to a more affordable alternative. Different prescription plans cover different brands of medication. Plus, there are generic options available for some inhalers. Sometimes making a switch to a different brand or generic can offer huge savings. Speak to your doctor to see if there are any less-costly alternatives available for you.

  • Try a manufacturer copay card or patient assistance program. Many inhalers, especially expensive brand-only ones, will have options to save through the drug manufacturer. To see the programs available for your inhalers, simply search for your drug on the GoodRx website or mobile app. Then scroll down to "Ways to save" on your prescription, which are suggestions on how to lower your costs beyond just the GoodRx coupons.

  • If your inhaler isn't covered by your insurance, submit an appeal. Just because a drug isn't covered by your plan doesn't mean that you will have to cover the full cost of your medication. Speak with your doctor, or call your insurance company to start an appeal process. Persistence can pay off.

Keep in mind

Asthma symptoms can be triggered by a person's environment, allergies, or infections. There are a few ways you can help prevent or improve asthma symptoms in addition to taking medication.

Stop smoking

Quitting smoking is the single best thing you can do for your asthma or your child's asthma.

  • Quitting smoking reduces the number of flare-ups.

  • Quitting smoking helps asthma medications work better.

  • Quitting smoking lowers the risk of chest infections.

There are lots of resources to help you quit smoking.

Reduce indoor allergens

Allergens are harmless substances in our environment that can trigger asthma symptoms. There are outdoor allergens, such as grass and tree pollen. There are also indoor allergens, such as:

Not everyone is sensitive to the same allergens. Take steps to find out what allergens you may be sensitive to. Then, reduce harmful allergens in your environment by:

  • Keeping pets away from your sleeping and/or living spaces

  • Fixing leaks, and keeping the humidity in your house below 50%

  • Covering your mattress and pillow with dust-mite protectors

  • Removing carpet, rugs, and draperies

  • Washing your bedding regularly

  • Dusting and vacuuming your home often

Treat your allergy symptoms

If you have allergies that cause a runny nose and sinusitis (rhinosinusitis), treating those symptoms with antihistamines or decongestants can improve asthma symptoms.

Avoid irritants

Similar to allergens, irritants can be found both indoors and outdoors and can also make asthma symptoms worse. Irritants include substances like:

  • Tobacco smoke (your own or someone else's)

  • Smoke from forest fires

  • Hair sprays

  • Perfumes

  • Chemicals

  • Air pollution

  • Workplace irritants

Stay up to date with vaccinations

For people with asthma, a chest infection can be a big deal. Staying up to date with vaccines that protect against the seasonal flu and community-acquired pneumonia is an important part of staying healthy. People with asthma should get the following vaccines:

  • Influenza vaccine, to protect against seasonal flu. You'll need this every year.

  • Pneumococcal vaccine, to protect against community-acquired pneumonia. The exact timing will depend on your age. Your provider will be able to guide you.

  • COVID vaccine, to protect you against COVID-19.

Oral steroids

Occasionally, your asthma may flare up so much that your usual inhalers just aren't enough. In those cases, oral steroid pills can help.

Some people with asthma keep a rescue supply of steroid pills at home to take when this happens. Others get a prescription when they think they are having a flare-up.

Steroid pills work in a similar way as inhaled steroids: They reduce inflammation in your lungs. Short doses of steroids don't have serious side effects. But if you take steroids pills often, they can affect your long-term health.

Antibiotics

Infection - either in the lungs or sinuses - is a common cause of an asthma flare-up. If that infection is due to bacteria, your doctor may prescribe you antibiotics.

Treat heartburn

GERD (gastroesophageal reflux disease) is a condition where acid from the stomach goes up into the esophagus and throat and causes heartburn. It can also make asthma symptoms worse, particularly coughing. Treating acid reflux with antacid medications in people who have asthma and GERD can also improve asthma symptoms.

Aim for a healthy body weight

People with obesity tend to have more severe asthma and more frequent symptoms.

People who have overweight and obesity are also more likely to have obstructive sleep apnea (OSA). This is a condition that causes a person to stop breathing for short periods during sleep. People with OSA get very tired during the day. If they also have asthma, their asthma symptoms get worse, too.

Studies show that when people with obesity lose weight, their asthma symptoms improve. Treating OSA also improves asthma symptoms.

References

American Academy of Allergy, Asthma & Immunology. (2020). Pollen definition.

American Lung Association. (2020). Cockroaches.

View All References (14)
expand_more

American Lung Association. (2020). Dust mites.

American Lung Association. (2020). Learn about sleep apnea.

American Lung Association. (2020). Mold and dampness.

American Lung Association (2020). Pet dander.

Centers for Disease Control and Prevention. (2016). Lung disease including asthma and adult vaccination.

Centers for Disease Control and Prevention. (2017). Work-related asthma.

Centers for Disease Control and Prevention. (2019). Pneumococcal vaccination.

Centers for Disease Control and Prevention. (2020). Most recent national asthma data.

Davies, S. E., Bishopp, A., Wharton, S., et al. (2018). Does continuous positive airway pressure (CPAP) treatment of obstructive sleep apnoea (OSA) improve asthma-related clinical outcomes in patients with co-existing conditions? - A systematic review. Respiratory Medicine.

Global Initiative for Asthma. (2020). Global strategy for asthma management and prevention.

National Heart, Lung, and Blood Institute. (2012). Guidelines for the diagnosis and management of asthma.

Peters, U., Dixon, A. E., & Forno, E. (2018). Obesity and asthma. The Journal of Allergy and Clinical Immunology.

Polosa, R., & Thomson, N. C. (2013). Smoking and asthma: Dangerous liaisons. European Respiratory Journal.

Reddel, H. K., Taylor, D. R, Bateman, E. D., et al. (2009). An official American Thoracic Society/European Respiratory Society Official Statement: Asthma control and exacerbations. The American Journal of Respiratory and Critical Care Medicine.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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